International Journal of Fertility & Sterility
Year:2019 | Volume:13 | Issue:3|Papers Count:14

Several causes for primary ovarian insufficiency (POI) have been described, including iatrogenic and environmental factor, viral infections, chronic disease as well as genetic alterations. The aim of this review was to collect all the genetic mutations associated with non-syndromic POI. All studies, including gene screening, genome-wide study and assessing genetic mutations associated with POI, were included and analyzed in this systematic review. Syndromic POI and chromosomal abnormalities were not evaluated. Single gene perturbations, including genes on the X chromosome (such as BMP15, PGRMC1 and FMR1) and genes on autosomal chromosomes (such as GDF9, FIGLA, NOBOX, ESR1, FSHR and NANOS3) have a positive correlation with non-syndromic POI. Future strategies include linkage analysis of families with multiple affected members, array comparative genomic hybridization (CGH) for analysis of copy number variations, next generation sequencing technology and genome-wide data analysis. This review showed variability of the genetic factors associated with POI. These findings may help future genetic screening studies on large cohort of women.

Rubella infection within the first trimester of pregnancy may lead to adverse pregnancy outcomes. The present study was conducted to evaluate the immunity against rubella among the pregnant Iranian women. The steps of meta-analyses were conducted based on the MOOSE protocol and results were reported according to the PRISMA guideline. To review the associated English and Persian literature, a comprehensive search was conducted among the international databases such as Scopus, PubMed/Medline, Science Direct, Embase, Cochrane library, Web of Science and Google Scholar search engine as well as Iranian databases, until April 1, 2018 using the following medical subject headings (MeSH) keywords: ‘ Pregnant’ , ‘ Gestational’ , ‘ Prenatal care’ , ‘ Complications of pregnancy’ , ‘ Pregnancy’ , ‘ Rubella infection’ , ‘ Prevalence, ‘ Epidemiology’ , ‘ Immunity’ , ‘ Immunization’ , ‘ Antibody’ , ‘ Immunogenicity’ and ‘ Iran’ . Cochran’ s Q test and I2 index were used to investigate heterogeneity in the studies. Random effects model was used to estimate the rate of rubella immunity. The obtained data were analyzed using Comprehensive Meta-Analysis Ver. 2. Fifteen studies constituting 7, 601 pregnant Iranian women met the inclusion criteria. The overall pooled rubella immunity rate was 90. 1% [95% confidence interval (CI): 86. 1-93. 1]. Rubella immunity rates were respectively 88. 6% (95% CI: 80. 6-93. 6) and 91. 5% (95% CI: 88. 1-93. 9) before and after national vaccine program. Rubella immunity rates were 91. 4% (95% CI: 87. 8-94. 0) and 87. 2% (95% CI: 74. 3-94. 1) based on the enzyme-linked immunosorbent assay (ELISA) and haemagglutination-inhibition (HAI) methods, respectively. There was no significant association between rubella immunity and vaccination program (P=0. 398), diagnostic methods (P=0. 355), geographic regions (P=0. 286), quality of the studies (P=0. 751), occupation (P=0. 639), residence (P=0. 801), and year of the studies (P=0. 164), but it was significantly associated with age (P<0. 001). Despite high rubella immunity among the pregnant Iranian women, anti-rubella antibody screening is recommended for all women of childbearing age.

Background: This study assessed the effects of a lactobacillus-based medication on pain intensity scores in women with endometriosis. Materials and Methods: The present randomized pilot placebo-controlled trial was done on eligible women who were surgically and pathologically diagnosed with endometriosis. Thirty-seven participants who had not received hormonal treatment in the last three months, were enrolled and randomized into LactoFem® and placebo groups. Lactobacillus capsules or placebo were administrated orally once a day for 8 weeks. Patients were assessed for pain severity using Visual Analogue Scale (VAS) scores for dysmenorrhea, dyspareunia and chronic pelvic pain at baseline and after 8 and 12 weeks post-intervention. Results: Mean age of participants and mean body mass index (BMI) for the LactoFem® and control groups were comparable. All patients had stage 3 and 4 of the disease based on revised American fertility society (AFS) classification of endometriosis. Mean initial pain scores for dysmenorrhea, dyspareunia and chronic pelvic pain were 6. 53 ± 2. 88, 4. 82 ± 3. 76 and 4. 19 ± 3. 53, respectively in the LactoFem® group and 5. 60 ± 2. 06, 3. 67 ± 2. 64 and 2. 88 ± 2. 80, respectively for the control group; the two groups had comparable scores in this regard. There was more decrease in pain scores for both dysmenorrhea and the overall pain after 8 weeks of treatment in LactoFem® group compared to the control group. The scores for dysmenorrhea were 6. 53 ± 2. 88 and 5. 60 ± 2. 06 in the LactoFem® and control groups, respectively, before intervention but, after 8-week treatment, these values were 3. 07 ± 2. 49 and 4. 47 ± 2. 13 (P=0. 018), respectively. The changes in overall pain score in the LactoFem® and control group during this period were 7. 33 ± 7. 00 and 4. 11 ± 1. 68, respectively (P=0. 017). Conclusion: This study showed some beneficial effects of lactobacillus administration on endometriosis-related pain (Registration number: IRCT20150819023684N5).

Background: Toxoplasma gondii is one of the major causes of abortion in pregnant women. Most cases of abortion occur in the acute phase of infection and early pregnancy. The purpose of this study was to investigate the association between spontaneous abortion and seropositive status of toxoplasmosis in women with first-time spontaneous abortion. Materials and Methods: This research is a case-control study on 240 serum samples from women experiencing spontaneous abortion for the first time as the case group, and 240 serum samples from women who had a normal delivery with no history of abortion as the control group. The level of anti-Toxoplasma gondii IgM and IgG antibodies were assessed in serum samples using ELISA. To separate the acute and chronic infections, all IgM-positive samples in both groups and IgG-positive samples of the case group were examined using IgG avidity. Results: The Toxoplasma IgM antibody was detected in 3. 3% (8/240) of the case group and 0. 4% (1/240) of the control group, which was a statistically significant difference between the two groups [P=0. 019, odds ratio (OR)=10. 266]. Of all samples 47. 5% and 46. 3% of the case and control groups were positive for Toxoplasma IgG antibody, respectively. Seven out of 8 (87. 5%) IgM-positive serum samples from the case group had low IgG avidity, indicating acute infections, whereas all IgG-positive sera and 1 IgM-positive serum, which was related to the control group, showed a high IgG avidity, indicating chronic infections. Conclusion: Maternal acute toxoplasmosis during pregnancy is raised as one of the factors that increase the chance of spontaneous abortion. The necessary health training, especially on the parasite transmission ways to women before marriage, as well as the serological test in women before and during pregnancy is recommended. Polymerase chain reaction (PCR) and IgG avidity assays should be performed in the medical diagnostic laboratories for accurate distinguishing of the initial infection of toxoplasmosis in the pregnant women.

Background: The aim of this study was to evaluate the impact of body mass index (BMI) and lipid profile on reproductive outcomes of women undergoing intracytoplasmic sperm injection (ICSI) cycles. Materials and Methods: This retrospective observational study was conducted in the Center of Human Reproductive Physiopathology of University of Catania between April 2017 and March 2018 and enrolled 114 couples undergoing ICSI. Levels of total cholesterol, low-density lipoprotein-cholesterol (LDL-c), high-density lipoprotein-cholesterol (HDL-c) and triglycerides were determinate and, according to the BMI, samples were divided into the following groups: group A (BMI: 18. 5-24. 9 kg/m2); group B (BMI: 25-29. 9 kg/m2); and group C (BMI >30 kg/m2). BMI and lipid profile associations with the number of oocytes and embryos retrieved, the oocytes and embryo quality, the fertilization rate as well as the percentage of miscarriages and pregnancies, were assessed. The statistical analysis was performed using Shapiro-Wilk test, analysis of variance (ANOVA) and Kruskal-Wallis method. Results: Fertilization and pregnancy rates were lower in women with BMI>30 than in women with BMI: 25-29. 9 and BMI: 18. 5-24. 9, despite the not altered levels of lipoprotein. Conclusion: Our results demonstrated that an excess of adipose tissue in women undergoing ICSI was not directly related with altered biochemical lipid values. However, overweight and obese patients showed poor fertilization and pregnancy rate despite the not altered values of lipoprotein.

Background: L-carnitine (Lc) as a type of flavonoid antioxidants and bone marrow stromal cells (BMSCs) as a type of mesenchymal stem cells may recover damaged ovaries. It seems that Lc has favorable effects on differentiation, increasing lifespan and decreasing apoptosis in BMSCs. The aim of this study was to investigate effects of co-administration of BMSC+Lc on damaged ovaries after creating a chemotherapy model with cyclophosphamide in rats. Materials and Methods: In this experimental study, cyclophosphamide was intraperitoneally (IP) injected to forty female wistar rats for 14 days, in terms of chemotherapy-induced ovarian destruction. The rats were then randomly divided into four groups: control, Lc, BMSCs and co-administration of BMSC+Lc. Injection of BMSCs into bilateral ovaries and intraperitoneal injection of Lc were performed individually and together. Four weeks later, levels of serum estradiol (E2) and follicle-stimulating hormone (FSH) using enzyme-linked immunosorbent assay (ELISA) kit, number of ovarian follicles at different stages using hematoxylin and eosin (H&E) staining and expression of ovarian Bcl-2 and Bax proteins using western blot were assessed. Results: Co-administration of BMSC+Lc increased E2 and decreased FSH levels compared to the control group (P<0. 001). The number of follicles was higher in the co-administrated group compared to the control group (P<0. 001). Co-administration of BMSC+Lc increased Bcl-2 protein level, decreased Bax protein level and increased Bcl-2/Bax ratio (P<0. 001). Conclusion: The effect of co-administration of BMSC+Lc is probably more effective than the effect of their separate administration on the recovery of damaged ovaries by chemotherapy.

Background: Infertile females experience some types of distress such as social stress, depression, and sexual dysfunction that may be exacerbated by polycystic ovary syndrome (PCOS). The current study aimed at comparing psychological profile of infertile females with PCOS with that of women without PCOS with respect to four domains: infertility stress, depression, sexual dysfunction, and alexithymia. Materials and Methods: The current case-control study was conducted on 240 infertile females (120 with PCOS and 120 without PCOS) in Fatemeh Azahra Infertility and Reproductive Health Research Center (Babol, Iran) from 2016 to 2017. The following questionnaires were used to collect data: the fertility problem inventory (FPI), the female sexual function index (FSFI), the Beck depression inventory-II (BDI-II), and the Toronto alexithymia scale (TAS-20). Results: Females with PCOS had higher FPI total scores than the ones without PCOS (120. 68 ± 29. 42 vs. 112. 83 ± 30. 94). Of the subscales of infertility stress, the mean scores of social stress and rejection of a future life without a child were higher in females with PCOS than the ones without PCOS (P<0. 05). Also, the mean total scores of alexithymia symptoms (TAS-20) in females with PCOS were significantly higher than those of the ones without PCOS (59. 83 ± 11. 36 vs. 55. 69 ± 11. 52). There was no significant difference between the two groups regarding the mean scores of depression symptoms and sexual function. Conclusion: Infertile females with PCOS experienced higher levels of infertility stress and inability to distinguish and describe their feelings compared with the ones without PCOS. It is suggested that infertility care providers should provide more psychosocial support for infertile females with PCOS.

Background: Abortion is a sensitive issue surrounded by social, cultural and religious stigmata. Therefore, estimation of its prevalence involves methodological challenges. The aim of this manuscript is to estimate the abortion prevalence, stratified by type, using a direct and two indirect methods. Materials and Methods: This cross-sectional study was done in 2016, we recruited 1020 women aging 18-49 years. Three methods were applied to estimate the abortion prevalence: direct question, network scale-up (NSU), and single sample count (SSC). In the direct method, to guarantee anonymity, data were collected by means of a self-administered questionnaire. In other methods, data were collected through gender-matched street-based interviews. Results: The annual rate of abortion estimated by direct and NSU methods were respectively 29 (10 intentional, 4 therapeutic and 15 spontaneous) and 23 (9 intentional, 3 therapeutic, and 11 spontaneous) per 1000 women aging 18-49 years. The annual rate of intentional abortion estimated based on SSC method was higher (15 per 1000 women) than other methods. Conclusion: The present estimates are higher than previously reported ones. The results of three methods more or less supported each other confirming the internal validity of our estimates.

Background: Despite the fact that many infertile couples have to decide about whether or not to choose donor conception, there is no predictive scale for evaluating the process of decision-making on donor conception and its determinants in such couples. The present study was conducted to develop a decision-making questionnaire for selecting donor conception and assess its psychometric properties in Iranian infertile couples. Materials and Methods: This cross-sectional validation study was conducted based on the method developed by DeVellis (2012) in four steps at Milad Infertility Clinic, Mashhad, Iran. The dimensions of the concept of decisionmaking were determined in the first step based on the qualitative results obtained from 38 semi-structured in-depth interviews. Items that were appropriate for the questionnaire were developed in the second step using the qualitative data and a review of the literature. In the third step, the research team reviewed and eliminated some of the items. The fourth step evaluated the face, content and construct validity of the questionnaire through exploratory factor analysis on a sample of 220 infertile couples using convenience sampling and investigated its initial and final reliability. Results: Based on the results of the qualitative study, a pool of 170 items was developed, 101 of which were eliminated after revision due to ambiguity, repetition or their poor face and content validity and initial reliability. The questionnaire was evaluated for its construct validity with 69 items. After the exploratory factor analysis, the decisionmaking donor conception questionnaire (DMDCQ) having 51 items and seven factors, was finalized. All the factors had Cronbach’ s alpha values of 0. 75-0. 87 and intra-class correlation coefficients (ICC) greater than 0. 7. Conclusion: This study led to development of a valid and reliable scale for examining infertile couples’ decisionmaking about whether or not to use donor conception as well as the determinants of this decision.

Background: Oxidative stress as a potential cause of poor oocyte quality can influence a female’ s reproductive system. This study aimed to investigate the effects of melatonin on chemical pregnancy rates of a significant number of polycystic ovary syndrome (PCOS) patients undergoing intrauterine insemination (IUI). Materials and Methods: In this double-blinded randomized clinical trial (RCT) study, the samples included 198 PCOS patients fulfilling the inclusion criteria and undergoing the IUI treatment. On the third day of menstruation, a 3-mg melatonin tablet or its placebo was given to the patients according to the randomized study protocol; this prescription was continued until the day of human chorionic gonadotropin (hCG) administration. The current study attempted primarily to scrutinize the effect of melatonin administration on the rate of chemical pregnancy and mature follicles during the IUI treatment cycle, and secondarily to determine the endometrial thickness (ET) on the day of IUI. Results: The mean age of the participants in the study was 28. 9 ± 5. 5 years. The chemical pregnancy rate in the group receiving melatonin was about 32%, when it was 18% in the control group (P=0. 012). Furthermore, it was concluded that the addition of melatonin to the treatment cycle of PCOS individuals could significantly improve the ET after the treatment (P<0. 001). Conclusion: The results of this study demonstrated that the treatment of PCOS patients undergoing IUI with melatonin significantly improves the rate of chemical pregnancy.

Background: The prevalence of endometriosis in the general population is estimated at 7-10%. There are various risk factors for this disease, including early menarche age, prolonged menstruation or no history of pregnancy. It seems that sexual activity leading to orgasm during menstruation increases the retrograde menstruation, sending endometrial tissue to an abnormal sites and thus increasing the risk of endometriosis. The present study is aimed to determine the association between sexual activity during menstruation and endometriosis. Materials and Methods: This case-control study, conducted in the year 2017, recruited 555 women who were visited at Alzahra Hospital in Tabriz, Northwest of Iran. The case group comprised 185 women of reproductive age with confirmed endometriosis. The control group comprised 370 women of reproductive age without endometriosis visiting the hospital for other issues. Data was collected using a researcher-made questionnaire based on previous studies. Bivariate analysis was performed by the chi-squared test and multivariate analysis was done using conditional logistic regression to control confounding variables. Results: The sexual activity of the two groups during menstruation was significantly different. The occurrence of endometriosis in women who stated they had vaginal intercourse or non-coital sexual activities, leading to orgasm during menstruation, was significantly higher compared to those who stated they did not. Conclusion: According to our findings, there is an association between sexual activities leading to orgasm during menstruation and endometriosis.

Background: In this work, we have determined the levels of interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α ), which function as cytokines in endometrial receptivity, through the endometrial secretion within the eligible individuals and thus studied their relationships with the success or failure of pregnancy in in vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) cycles. Materials and Methods: In this prospective study, 76 women were selected for their first IVF/ICSI and met the study inclusion criteria. All of the patients have undergone the endometrial secretion aspiration prior to performing the oocyte collection. The levels of IL-1and TNF-α were analyzed by the means of enzyme-linked immunosorbent assay method, using special standard kits. The patients were requested to undergo the serum human chorionic gonadotropin measurements and ultrasound evaluation for the purpose of detecting successful implantations and pregnancies. Results: Among the 76 subjects of the study, 33 (43. 4%) patients had a positive beta-human chorionic gonadotropin (β-hCG) and 44 (56. 6%) resulted in a negative β-hCG. It should be also noted that through the patients with positive β-hCG, 23 (30. 3%) of them displayed fetal heart rate in their transvaginal sonography (TVS). Compared to the group with failed pregnancies and their cytokine levels, we perceived a higher concentration of IL-1 in the group containing successful chemical pregnancies (P=0. 00). However, there was no significant difference in terms of clinical pregnancy in the IL-1 levels between the two groups (P=0. 06). In addition, there was not any notable difference in the levels of TNF-α between the two groups, neither in terms of chemical nor clinical pregnancy (P=0. 8 and P=0. 6, respectively). Conclusion: The current study suggests that higher concentrations of IL-1 in endometrial secretions could be associated with improved endometrial receptivity and IVF outcome. With regards to TNF-α , no statistically significant difference was observed between the groups of with and without successful pregnancies.

Background: Two-six percentage of vasectomized men will ultimately seek vasectomy reversal, which late stricture and obstruction after operation are relatively common. To find a method for improving vasovasostomy outcomes, we used intra-operative local mitomycin-C (MMC) preventing possible fibrosis and stricture. Materials and Methods: In this randomized clinical trial, 44 patients were assigned to two groups randomly during a one-year study and the data of 40 patients were analyzed. The patients were followed up for 6 months after surgery. The case group (n=19) was treated by vasovasostomy with intra-operative local MMC. The control group (n=21) underwent standard vasovasostomy. Results: Mean sperm count in MMC group was significantly higher than the controls. The sperm count of more than 20 million/ml was respectively 53% and 14% in MMC and control groups. In a subgroup where the interval between vasectomy and reversal was 5-10 years, post-reversal azoospermia was absent in MMC group, but 50% of the controls were still azoospermic. In addition, 80% of MMC group had more than 20 million/ml sperms, but all of the controls had less than 20 million/ml sperms. No significant complication was seen. Conclusion: Intra-operative local MMC in vasovasostomy can be regarded as a safe and efficient technique which has several advantages including lower cost. Increase of sperm count is the main effect of local MMC application that is more prominent when the interval between vasectomy and reversal is 5-10 years.

Actins play essential roles in cellular morphogenesis. In mice, the T-actin1 and 2 genes, which encode actin-like proteins, are specifically expressed in haploid germ cells. Both T-ACTIN1/ACTLB and T-ACTIN2/ACTL7A have also been cloned and studied. The orthologous genes in humans are present on chromosome 9q31. 3 as intronless genes. Defects of germ cell-specific genes can introduce infertility without somatic function impairment. We determined TACTIN1 and 2, specifically expressed in the testis using reverse-transcription polymerase chain reaction (RT-PCR). To examine whether genetic polymorphisms of the T-ACTIN1 and 2 genes are associated with male infertility, we screened for T-ACTIN1 and 2 polymorphisms by direct sequencing of DNA from 282 sterile and 89 fertile Japanese men. We identified five and six single nucleotide polymorphisms (SNPs) in the T-ACTIN1 and 2 regions of the sterile and fertile subjects respectively. Among these genetic polymorphisms was a novel SNP that was not in the National Center for Biotechnology Information SNP database. Although we could not determine whether these SNPs cause infertility, the prevalence of these genetic polymorphisms may be useful for analyzing polymorphisms in future largescale genetic analyses.