International Journal of Fertility & Sterility
Year:2019 | Volume:13 | Issue:1|Papers Count:15

Urocortin (UCN) is a neuropeptide that belongs to the corticotrophin-releasing hormone family and is expressed byeutopic and ectopic human endometria. The past years, this expression has been thoroughly investigated in the fieldof endometriosis. The objective of this systematic review is to accumulate current evidence related to the expressionof UCN in tissue and blood samples of patients suffering from endometriosis. Literature search was designed accordingto the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and primarilyconducted using the Medline (1966-2018), Scopus (2004-2018), EMBASE (1947-2018) and Clinicaltrials. gov (2008-2018) databases, along with the reference lists of electronically retrieved full-text papers. Overall, eight studies wereretrieved. Current evidence suggests that the expression of UCN is increased in patients with ovarian endometriomasand that its levels may correlate with the severity of the disease. The diagnostic efficacy of UCN1 plasma levels wasevaluated in three studies. Two of them suggested that the sensitivity and specificity of the method may reach, andeven exceed, 80%. However, the wide variation in outcome reporting and outcome reporting measures in endometriosisamong the included studies precludes meta-analysis of available data. Therefore, although UCN seems to be apromising biomarker for the identification and follow-up of patients that suffer from endometriosis, more studies areneeded to reach firm conclusions with respect to its predictive accuracy.

Background: Tumor necrosis factor-alpha (TNF-α ) is an important cytokine in acute inflammatory response to infectivefactors. Based on investigation in different populations, it is thought that this response increases in patients with endometriosisdue to the presence of cytokines such as TNF-α . This study aimed to examine the association of four TNF-α polymorphisms, namely-238G/A,-308G/A,-857C/T and-863C/A, with susceptibility to endometriosis in an Iranian population. Materials and Methods: We recruited 150 women with endometriosis and 150 women without endometriosis in thiscase-control study and collected 4 ml of blood from all subjects. After DNA extraction, the polymorphisms were genotypedby polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The allele frequency of TNF-α-863C/A in the case and control groups showed a significant difference [oddsratios (OR)=0. 64, 95% confidence interval (CI)=0. 41-0. 99, P=0. 047] but the result is not significant when Adjustingfor multiple testing (P=0. 188). No significant difference in the allele frequencies of-238G/A (OR=1. 07, 95%CI=0. 51-2. 25, P=0. 862),-308G/A (OR=0. 79, 95% CI=0. 43-1. 45, P=0. 438) and-857C/T (OR=1. 03, 95% CI=0. 66-1. 61, P=0. 887) was observed. We adjusted all four polymorphism genotypes by age and body mass index (BMI), however, no significant difference was detected. There was an association between the case and control and BMI whenadjusting by age (OR=1. 082, 95% CI=1. 009-1. 162, P=0. 028). Conclusion: For the first time the association of the four polymorphisms in the promoter region of the TNF-α gene withendometriosis has been conducted in women of Iranian origin. The present research reveals the-863 A allele may playa role in incidence of endometriosis among Iranian women. Development of endometriosis among those people with-863 A allele seems low. According to the results, the current study indicates that there might be a correlation betweenBMI and progression of endometriosis.

Background: The prognostic value of peripheral natural killer (pNK) cells, as a screening test in women with recurrentpregnancy loss (RPL) and unexplained infertility, is still a matter for discussion. The purpose of this study was tocompare the percentage of circulating CD56+NK cells, CD69 and perforin markers between women with unexplainedinfertility and RPL with the healthy control group. Materials and Methods: In this case-control study, the percentage of CD56+NK cells and activation markers (CD69and perforin levels) in the peripheral blood were measured in 25 women with unexplained infertility, 24 women withidiopathic RPL and 26 women from the healthy control group, using specific monoclonal antibodies by flow cytometry. Results: The percentage of CD56+NK cells was significantly higher in patients with infertility in comparison withthe healthy control group (P=0. 007). There were not significant differences either in the total number of CD56+ cellsbetween the RPL group and the control group (P=0. 2) or between the RPL group and the infertile group (P=0. 36). The percentage of CD69+ lymphocytes in RPL group was significantly higher than in the infertility group (P=0. 004). There was a statistically significant difference in Perforin levels between RLP and control (P=0. 001) as well as RPLand infertile (P=0. 002) groups. Conclusion: An increased percentage of CD56+NK cells in patients with unexplained infertility, an elevated expressionof CD69 on NK cells in patients with RPL and infertility and a high level of perforin on CD56+ cells in the RPL groupmight be considered as immunological risk factors in these women.

Background: Despite numerous studies indicating an imperative role for reproduction, however, the role of VitaminD supplementation on outcomes of assisted reproductive techniques remains controversial. This clinical trial was performedto evaluate the effect of Vitamin D supplementation 6 weeks prior to intracytoplasmic sperm injection (ICSI)on fertility indices. Materials and Methods: The present study was a double-blind clinical trial conducted on infertile women was randomlyallocated into two groups: Vitamin D supplementation (42 participants) and placebo (43 participants). SerumVitamin D was measured before and six to eight weeks after treatment, on the day of ovum pick up. Results wereanalyzed using SPSS16 and fertility indices were compared between the two groups. Results: No significant difference was observed between the intervention and control groups regarding the meannumber of oocytes retrieved, percentage mature oocyte, fertilization rate and the rate of good quality embryos (allP>0. 05). But, percentages of the individual with suitable endometrium (7-14 mm thickness) were significantly higherin the Vitamin D compared to control group (P=0. 011). The rate of chemical (47. 6 vs. 25. 5%, P=0. 013) and clinicalpregnancy rate (38. 1 vs. 20. 9%, P=0. 019) were also significantly higher in the Vitamin D compared to control group. Conclusion: The present study reveals that consuming Vitamin D for 6 weeks prior to ICSI improves quality of endometrium, rate of chemical and clinical pregnancy (Registration Number: IRCT2015111124999N1).

Background: We designed the present study to evaluate the simultaneous effect of obesity in couples on in vitrofertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. Materials and Methods: In this cross-sectional study, performed at Royan Institute between January 2013 and January2014, we evaluated the recorded data of all patients during this time period. The study population was limited tocouples who underwent ICSI or IVF/ICSI cycles with autologous oocytes and fresh embryo transfers. We recorded theheights and weights of both genders and divided them into groups according to body mass index (BMI). Multilevellogistic regression analysis was used to determine the odds ratio for live births following ICSI or IVF/ICSI. Results: In total, 990 couples underwent IVF/ICSI cycles during the study period. Among the ovulatory women, asignificant difference existed between the BMI groups. There was a 60% decrease [95% confidence interval (CI): 0. 11-0. 83] in the odds of a live birth among overweight subjects and 84% (95% CI: 0. 02-0. 99) decrease among obesesubjects. Among the anovulatory women, the association between the BMI and live births presented no clear tendencies. We did not observe any significant relationship between male BMI and live birth rate. The results demonstratedno significant association between the couples’ BMI and live birth rate. Conclusion: Based on the present findings, increased female BMI independently and negatively influenced birth ratesafter ICSI. However, increased male BMI had no impact on live births after ICSI, either alone or combined with increasedfemale BMI.

Background: The aim of the present study was to determine the maternal pre-pregnancy body mass index (BMI), first-trimester fasting blood sugar (FBS), and the combination of (BMI+FBS) cut-points for at-risk pregnant womenconceived by assisted reproductive technology (ART) to better predict the risk of developing gestational diabetes mellitus(GDM) in infertile women. Materials and Methods: In this nested case-control study, 270 singleton pregnant women consisted of 135 (GDM)and 135 (non-GDM) who conceived using ART were assessed. The diagnosis of GDM was confirmed by a one-stepglucose tolerance test (O-GTT) using 75 g oral glucose. BMI was classified base on World Health Organization(WHO) criteria. The relationship between BMI, FBS, and BMI+FBS with the risk of GDM development was determinedby logistic regression and adjusted for confounding factors. Receiver operating characteristic (ROC) curveanalysis was performed to assess the value of BMI, FBS, and BMI+FBS for the prediction of GDM. Results: The GDM group had significantly higher age, BMI, family history of diabetes, and history of polycystic ovary syndromein comparison with the non-GDM group (P<0. 05). Overweight and obese women had 3. 27, and 5. 14 folds increasein the odds of developing GDM, respectively. There was a 17% increase in the risk of developing GDM with each 1 mg/dlincrease in fasting glucose level. The cut points for FBS 84. 5 mg/dl (72. 9% sensitivity, 74. 4% specificity), BMI 25. 4 kg/m2(68. 9% sensitivity, 62. 8% specificity), and BMI+FBS 111. 2 (70. 7% sensitivity, 80. 6% specificity) was determined. Conclusion: The early screening and high-quality prenatal care should be recommended upon the co-occurrence ofhigh FBS (≥ 84. 5 mg/dl) in the first-trimester of the pregnancy and the BMI (≥ 25. 4 kg/m2) in pre-pregnancy period inwomen undergone ART. The combination of BMI and FBS is considered a better prediction value.

Background: In vitro maturation (IVM) is an artificial reproductive technology in which immature oocytes are harvestedfrom the ovaries and subsequently will be matured in vitro. IVM does not require ovarian hyperstimulation(OH) and thus the risk of ovarian hyperstimulation syndrome (OHSS) is avoided. In this study, we assessed the livebirth rate per initiated IVM cycle in women eligible for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and at risk for OHSS. Furthermore, we followed women who were not pregnant after IVM and committed to aconventional IVF/ICSI procedure. Materials and Methods: In this multicenter prospective cohort study, we started 76 IVM cycles using recombinantfollicle stimulating hormone (rFSH) priming in 68 patients. There were 66 oocyte retrievals, in which a total of 628oocytes were collected. We incubated the immature oocytes for 24-48 hours and fertilized those that reached metaphaseII by ICSI. Results: Three hundred eighty six (61% oocytes) achieved metaphase II. The fertilization rate was 55%. We performed59 embryo transfers (1. 9 embryos per transfer) in 56 women, including 3 frozen embryo transfers. There werefour ongoing pregnancies (5. 3% per initiated cycle) leading to the birth of a healthy child at term. None of the patientsdeveloped OHSS. The ongoing pregnancy rate of the first conventional IVF/ICSI cycle after an unsuccessful IVMcycle was 44%, which was unexpectedly high. Conclusion: We concluded that IVM led to live births but with low effectiveness in our study. Earlier reported IVMsuccess rates are higher which can be caused by a more extended experience in these centers with the intricate laboratoryprocess. However, a possible selection bias in these studies cannot be ruled out. Furthermore, IVM might have abeneficial effect on further IVF/ICSI treatments due to its “ ovarian drilling” effect.

Background: The purpose of this study was to compare the effects of Glycyrrhiza glabra (Licorice), a cyclooxygenase-2 inhibitor (Celecoxib) and a gonadotropin-releasing hormone analog (Diphereline® ), with a control group onendometrial implants in rats. Materials and Methods: In this experimental study, endometriosis was induced in rats by auto transplantation andafter confirmation, the rats were divided into 4 groups that were treated for 6 weeks with normal saline (0. 5 ml/day, orally), licorice extract (3000 mg/kg/day, orally), celecoxib (50 mg/kg, twice a day, orally) or diphereline (3 mg/kg, intramuscularly). At the end of treatments, the mean area, volume, histopathology and hemosiderin-laden macrophage(HLM) counts of the endometrial implants were evaluated and compared among the four groups. Results: The mean area, volume and HLM counts of the implants in the licorice group were significantly lower thanthose of the control group (P<0. 001). The histopathologic grades of endometrial implants were significantly decreasedby licorice compared to the control group (P<0. 001). There was no significant change in the mentioned parameters inrats treated with celecoxib compared to the control group. Diphereline was the most potent agent for suppressing thegrowth of endometrial implants in terms of all of the above-mentioned parameters. Conclusion: Licorice decreased the growth and histopathologic grades of auto-transplanted endometrial implants. However, while celcoxib had no significant effect, diphereline showed the highest potency for decreasing the endometrialgrowth. Licorice may have the potential to be used as an alternative medication for the treatment of endometriosis.

Background: Chlorpyrifos (CPF), an organophosphate pesticide, is widely used in farms in order to preserve cropsand fruits. Previous studies have shown that CPF exposure might cause chronic toxicity in male genital system. Thepresent study investigated the protective effect of N-Acetyl Cysteine (NAC), a potent antioxidant against testiculartoxicity of CPF in male mice. Materials and Methods: In this experimental study, 42 adult male mice were divided into seven groups, CPF low (0. 5mg/kg. b. w) and high (5 mg/kg. b. w) doses groups, NAC group (35 mg/kg. b. w), NAC+CPF 0/5 mg/kg. b. w, NAC+CPF5 mg/kg. b. w, dimethyl sulfoxide (DMSO, 0. 75% solution mg/kg. b. w) and control group. All treatment were doneintraperitoneally. Treatment was conducted for four consecutive weeks (five days each week). However NAC wasinjected to NAC+CPF groups five days before initiation of the treatment procedure. One week after the last injection, mice were sacrificed using anesthetic gas to evaluate alterations in testicular histology and sperm parameters. Results: Seminiferous tubules area and diameter were significantly diminished in the group treated with 5 mg/kg CPF(P<0. 05). CPF also statistically reduced sperm parameters (count and motility) and damaged sperm morphology) atboth doses (P<0. 05). However, NAC significantly improved spermatogonia, spermatocytes, spermatid cell counts aswell as sperm parameters in mice treated with both CPF concentrations (P<0. 05). Conclusion: According to our results, NAC may significantly ameliorate CPF-induced damages to spermatogonia, spermatocytes, spermatids cell counts and sperm parameters.

Background: Busulfan (BU) has a destructive effect on the male reproductive system. The goal of this study was toassess the effects of olive leaf extract (OLE) as a source of antioxidants and phenolic compounds, on BU-induceddamages in rat testes. Materials and Methods: In this experimental study, 40 male Wistar rats were randomly divided into 5 groups. Thecontrol group (CTL) received a single intraperitoneal (i. p. ) injection of dimethyl sulfoxide (DMSO), followed byoral administration of distilled water for 5 weeks. In BU group, BU (10 mg/kg) was administrated i. p. once. In cotreatmentgroups, first, received BU (10 mg/kg, a single i. p. injection) then, OLE was administrated orally at differentdoses of 250 mg/kg (BU+OLE 250), 500 mg/kg (BU+OLE 500) and 750 mg/kg (BU+OLE 750), for 5 weeks. Next, blood and sperm samples were collected. The left testis was removed to investigate testicular parameters and apoptosisby using H&E and TUNEL staining, respectively. All data were analyzed by SPSS software and a P<0. 05 wasconsidered significant. Results: There was a significant decline in sperm viability (P=0. 017), number of primary spermatocyte (PS) (P=0. 001)and Leydig cells (P=0. 023) in the BU group versus the CTL group. OLE at three doses could repair these defects versusBU group. Increases in apoptotic spermatogonia cells (SG) due to BU were significantly reduced by OLE 250and 500 mg/kg (P<0. 01). A reduction in germinal epithelium height and an increase in apoptotic SG were observed inBU+OLE 750 group vs. other groups (P<0. 01) and alkaline phosphatase (ALP) was at the highest level, also Aspartateaminotransferase (AST) increased markedly vs. CTL (P=0. 024). Conclusion: Oral administration of OLE at the doses of 250 and 500 mg/kg could be helpful in ameliorating BUinducedtoxicity in rat testes, while OLE 750 mg/kg not only did not cause positive effects, but also could exacerbatethe harmful effects.

Background: Infertility, one of life’ s great stressors, may adversely affect marital satisfaction. No studies have investigatedthe relationship between perceived stress and marital satisfaction at the dyadic level. The current studyassessed the actor and partner effects of perceived stress on marital satisfaction in husband-wife dyads using an innovativedyadic analysis approach, the Actor-Partner Interdependence Model (APIM). Materials and Methods: In this cross-sectional study, we recruited a total of 141 infertile couples. Marital satisfactionand stress were assessed using the ENRICH Marital Satisfaction Scale (EMS Scale) and Perceived Stress Scale-4Item (PSS-4), respectively. Dyadic data have been analysed by the APIM approach, with distinguishable dyads. In thisapproach, actor effect is the impact of a person᾽ s perceived stress on his/her own marital satisfaction. Partner effect isthe impact of a person's perceived stress on the partner᾽ s marital satisfaction. Results: Both men and women’ s perceived stress exhibited an actor effect on their marital satisfaction (β =-0. 312, P<0. 001, β =-0. 405, P<0. 001, respectively). Women’ s perceived stress had a negative relationship to the marital satisfactionof their partner (β =-0. 174, P=0. 040). Although the partner effect of men’ s perceived stress on woman’ s maritalsatisfaction was not significant (β =-0. 138, P=0. 096), women whose husbands had higher levels of stress were morelikely to have poorer marital satisfaction. Both actor and partner effects of perceived stress on marital satisfaction weresimilar among men and their wives. Conclusion: The findings of this study have highlighted that marital satisfaction in patients with infertility was influencedby not only their own perceived stress, but also their spouses’ perceived stresses. Therefore, psychologicalinterventions that target a reduction in perceived stress and enhancement of marital satisfaction in the context of infertilityshould treat the couple as a unit.

Background: Endometriosis is considered the most common cause of pelvic adhesions in women. Endometriosisassociatedadhesions could result in the formation of fibrous bands, which contain endometriotic glands, stroma andscarring. The aim of this study was to identify the impact of endometriosis-related adhesions on quality of life amonginfertile women. Materials and Methods: This descriptive study was conducted at Endoscopic Unit, in Zagazig University Hospitals, Egypt. Oral consent for participation in this study was taken from 109 women who were candidates for laparoscopy asinfertile cases and were diagnosed with endometriosis. They were classified into two groups namely, group I (n=41)who had endometriosis with adhesions and group II (n=68) who had endometriosis without adhesions. A structuredinterviewing form, adhesion scoring method of the American Fertility Society, and Global Quality of Life Scale wereused to collect required information. Results: The prevalence of adhesions resulted from endometriosis was 37. 6%. Demographic characteristics of thewomen with endometriosis-related adhesions were not significantly different from those of women without endometriosis-related adhesions. The most common location for endometriotic adhesions was adnexal adhesion (51. 2%) followedby adhesion of anterior abdominal wall (24. 4%). Quality of life was significantly impacted by endometriosisrelatedadhesions (P=0. 002). Conclusion: A high percentage of studied patients had a moderate degree of adhesions. Adhesions caused by endometriosishad an impact on quality of life of the studied women.

Single nucleotide polymorphisms (SNPs) in a number of genes involved in sperm maturation are considered as one ofthe main factors for male infertility. The aim of the present case-control study was to examine the association of SNPsin protamine1 (PRM1) and protamine2 (PRM2) genes with idiopathic teratozoospermia. In this case-control study, some SNPs in PRM1 (c. 49 C>T, c. 102 G>T and c. 230A>C) and PRM2 (rs545828790, rs115686767, rs201933708, rs2070923 and rs1646022) were investigated in 30 idiopathic infertile men with teratozoospermia (case group) incomparison with 35 fertile men (controls). Genotyping of SNPs was undertaken using polymerase chain reaction(PCR)-direct sequencing. For PRM1, c. 230A>C, as a synonymous polymorphism, was detected in both teratozoospermicmen (heterozygous n=26, homozygous minor n=1) allele frequency C(48) A(52) and controls (heterozygousn=15, homozygous minor n=4). All cases and controls were genotyped for rs545828790 in PRM2, a missense polymorphism, as well as rs115686767 and rs201933708, both of which synonymous variants. The findings showed anintronic variant in PRM2 (rs2070923) was also present in both groups. Also, rs1646022, a missense polymorphism, occurred in teratozoospermic men (heterozygous n=10, homozygous minor n=5) and controls (heterozygous n=13, homozygous minor n=2). However, there were no significant differences in SNPs of PRM1 and PRM2 between thetwo groups, however, for c. 230A>C, the frequency of the CA genotype was significantly higher in infertile men withteratozoospermia (P=0. 001). We demonstrate that PRM2 G398C and A473C polymorphisms were associated with theteratozoospermia and its genetic variation was in relation to semen quality, sperm apoptosis, and morphology in theIranian population. This study is a preliminary study and presenting data as part of a future comprehensive study toclinically establish whether these gene polymorphisms are biomarkers for susceptibility to teratozoospermia.

Mü llerian anomalies are very common, and a frequent cause of infertility. The most used classification system untilnow, proposed by the American Society for Reproductive Medicine in 1988, categorizes comprehensively uterineanomalies but fails to classify defects of the cervix or vagina. This is based on a developmental theory that postulatesthat mü llerian duct fusion is unidirectional, beginning caudally and extending cranially, which does not account forisolated cervical or vaginal defects. More recently, the European Society of Human Reproduction and Embryologyhas developed a consensus, which allows for independent cervical anomalies. We present a case of a 39-year-oldwoman with secondary infertility, found to have a cervical duplication in an anteroposterior disposition, which putsinto question the principles of embryology formerly known, but supports the theory that development happens in asegmentary fashion.

Psychiatric disorders are prevalent throughout theworld and based on the latest survey on the prevalenceof mental disorders among Iranians, these disorders werefound in 23. 6% of the population and were more prevalentin women than men. Pregnancy, childbirth anda year after delivery is considered “ the perinatal period” which is a critical period for mothers, babies and the entirefamily. The prevalence of psychiatric disorders inthe perinatal period is 15-29% with depressive andanxiety disorders being the most common conditions...