International Journal of Fertility & Sterility最新文献

Background: Endometrial carcinoma (EC) is a significant gynecologic malignancy. Investigating competing endogenous RNA (ceRNA) networks, including long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and messenger RNAs (mRNAs), offers insights into EC's molecular intricacies and may improve therapeutic and diagnostic strategies. This study focuses on the ceRNA axis, particularly the interactions of lncRNA-miRNA-mRNA-Gene, using TCGA-UCEC database analysis and experimental validation.

Materials and methods: In this case-control study, differentially expressed lncRNAs (DElncRNAs), microRNAs (DEMIs), and genes (DEGs) were identified, highlighting ADIRF-AS1 as a potential target. Validated interactions between ADIRF-AS1, miR-191-5p, and EGR1 were established, with significant ADIRF-AS1/EGR1 correlation. Protein-protein interaction (PPI) analysis identified 21 proteins linked to EGR1, with gene ontology (GO) analysis revealing roles in myeloid cell differentiation. Expression levels of genes, lncRNA, and microRNAs were evaluated by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Western blot analysis was applied for protein evaluation.

Results: RT-qPCR results showed that the RNA expression levels of ADIRF-AS1 and EGR1 genes in endometrial cancer and hyperplasia samples were significantly lower (P<0.001) than control samples. Also, the expression level of miR-191-5p in endometrial cancer tissues was significantly higher than patients with hyperplasia (P<0.001) and normal samples (P<0.001). Western blot results also showed that the protein level of EGR1 in endometrial cancer samples was significantly lower than control samples (P<0.001).

Conclusion: Here, we observed an interaction between lncRNA ADIRF-AS1and hsa-miR-191-5p, and also, ADIRFAS1 downstream effects on EGR1 in EC, that seems may be a suggesting therapeutic and diagnostic targets. Further research could explore its clinical relevance in endometrial carcinoma.

Endometriosis is a chronic gynecological condition defined by the ectopic presence of endometrial-like tissue outside the uterine cavity, often resulting in debilitating symptoms and significant impacts on quality of life. While the exact etiology of endometriosis remains elusive, emerging evidence suggests that diet and nutrition may play a crucial role in its pathogenesis and management. This comprehensive review explores the complex interplay between various food substances and endometriosis, summarizing the latest research findings on both risk-enhancing and protective nutritional factors. Notably, consumption of alcohol, red and processed meats, foods high in saturated and trans fats, and excessive caffeine has been correlated with increased systemic inflammation and hormonal dysregulation-key mechanisms implicated in endometriosis pathogenesis. In contrast, nutrients such as antioxidants, B-complex vitamins, vitamin D, calcium, polyunsaturated fatty acids (PUFAs, particularly omega-3 and omega-6), and dietary fiber have shown promise in exerting anti-inflammatory and protective effects against endometriosis. The review emphasizes the importance of promoting a balanced and nutritious diet rich in anti-inflammatory and antioxidant-rich food while limiting the intake of pro-inflammatory substances for individuals with endometriosis. In addition to dietary interventions, lifestyle modifications, including regular physical activity, stress management, and optimizing sleep hygiene, are highlighted as integral components of comprehensive treatment plans for endometriosis patients. Further research is required to clarify the precise mechanisms underlying the relationship between diet and endometriosis and to establish evidence-based dietary recommendations personalized for patients with endometriosis.

Background: This study aimed to evaluate the effects of vitamin D and probiotic supplements on anti-Mullerian hormone (AMH), glycemic control, inflammatory markers, and in vitro fertilization (IVF) success in women with polycystic ovary syndrome (PCOS).

Materials and methods: A randomized, double-blind, placebo-controlled trial was conducted with 120 women aged 30-45 years, diagnosed with PCOS and undergoing IVF. Participants were divided into four groups (30 each): daily 4,000 IU vitamin D, probiotic (1.8×10⁹ CFU/capsule), a combination of both, or placebo for 8 weeks.

Results: After 8 weeks, the combination group showed significant reductions in insulin levels (-0.33 ± 0.37 vs. -0.14 ± 0.29, -0.11 ± 0.04, -0.02 ± 0.36 μIU/mL, P=0.020), insulin resistance (-0.07 ± 0.09 vs. -0.03 ± 0.07, -0.03 ± 0.09, -0.07 ± 0.09, P=0.024), and increased insulin sensitivity (+0.001 ± 0.001 vs. +0.0006 ± 0.001, +0.0005 ± 0.002, +0.00004 ± 0.001, P=0.034) compared to other groups. The combination also led to a significant reduction in high-sensitivity C-reactive protein (hs-CRP) levels (-0.18 ± 0.22 vs. -0.07 ± 0.17, -0.08 ± 0.15, +0.04 ± 0.18, P=0.001). No significant changes were observed in plasma total nitrite, fasting glucose, and AMH levels. There was a notable decrease in TNF-α gene activity (P=0.007) in peripheral blood mononuclear cells (PBMCs) in the combination group.

Conclusion: The combined supplementation of vitamin D and probiotics over 8 weeks improved insulin function, hs-CRP levels, and TNF-α gene expression in women with PCOS undergoing IVF. However, it did not significantly impact plasma total nitrite, fasting glucose, or AMH levels (registration number: IRCT20130211012438N34).

Background: The World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) aims to facilitate international research on endometriosis by developing a standardized questionnaire. This study focuses on translating and validating the Persian version of the endometriosis patient questionnaire (EPQ), ensuring cultural compatibility and reliability for future studies in the region.

Materials and methods: In this cross-sectional study, a total of 37 women aged between 18 and 45 years who were assessed for endometriosis through diagnostic sonography or laparoscopy, or were suffering from symptoms such as dysmenorrhea, dyspareunia, pelvic pain not associated with menstruation lasting more than six months, were evaluated. The evaluation took place from May 2021 to December 2023. The research methodology was structured into two phases: translation and cross-cultural adaptation, followed by cross-cultural validation. The Persian version of the WERF EPHect was translated and adapted in accordance with established guidelines. Content validity was evaluated by six experts in the relevant fields, while face validity was assessed qualitatively by seven participants. To determine the reliability of the final version of the Persian questionnaire, 30 patients diagnosed with endometriosis completed it on two separate occasions that were two weeks apart, with the repeatability of each question analyzed using Kappa statistics.

Results: The translated questionnaire was administered to 30 patients diagnosed with endometriosis, with an average completion time of 55 minutes. Final modifications to the questionnaire were made to align with the Iranian culture, incorporating feedback from specialists and study participants. Overall, the findings suggest that the Persian version demonstrates both validity and reliability in medical and cultural aspects.

Conclusion: The recent study demonstrated that the Persian version of the WERF-EPHect questionnaire is both valid and reliable, with cultural relevance. Additional validation studies conducted in various languages will help eliminate language and cultural disparities, facilitating collaborative, large-scale, prospective international research on endometriosis.

Background: Worldwide, infertility is the third most serious illness of the 21^st century, after cancer and cardiovascular diseases. This study aims to evaluate the prevalence and epidemiology of female infertility in the city of Zahedan, Southeast Iran.

Materials and methods: This cross-sectional population-based study was conducted from 2020 to 2022 on all female Iranian residents of Zahedan. The women, aged 15-45 years, had been married for at least one year and reported no contraceptive use for at least 12 months from the onset of their marriage until the time of the study. We used a multi-stage sampling method to conduct face-to-face interviews with the 440 eligible women. Data were analysed using the chi-square test, t test, and logistic regression model. P<0.05 were considered statistically significant.

Results: The mean age of the women was 30.45 ± 9.44 years and 71.1% were urban residents. There were 14.5% of women who were infertile (4.8%: primary; 9.8%: secondary). The most prevalent infertility occurred in women who were 26 to 30 years of age. Age group and infertility did not show a significant correlation (P=0.05). The results indicated that 12.8 and 18.9% of urban and rural residents were infertile, respectively. Rural residents reported primary infertility more than urban residents (10.2 vs. 2.6%, P=0.005). On average, the time from decision to become pregnant to pregnancy lasted 7.97 ± 9.15 months for fertile women and 42.81 ± 42.36 months for infertile women (P<0.001). Female factor (70.3%) and male factor (14.1%) were the most common reasons for infertility.

Conclusion: This study, performed for the first time in Zahedan, Sistan and Baluchistan province showed a high prevalence of infertility. Given the growing concern about the aging population in Iran, the findings of this study could be informative and beneficial for regional health policymakers and providers. More studies on infertility and its causes in might help policymakers to make appropriate interventions to increase the fertility rate.

Background: This study aims to evaluate the crucial relationship between the follicular distribution pattern (FDP) in polycystic ovaries and its impact on reproductive outcomes. Recognizing these correlations is essential for optimizing assisted reproductive treatments and improving fertility outcomes in polycystic ovary syndrome (PCOS) patients.

Materials and methods: This prospective cohort study included women diagnosed with PCOS who were referred for IVF/ICSI treatment at the Arash Women's Hospital. Patient screening was conducted between March 2022 and September 2023. Ultrasound imaging was performed on cycle days 2-3 of either natural menstrual cycles or those induced by progestin to assess follicular distribution and ovarian characteristics. Ovarian ultrasound images were classified based on the Rotterdam criteria. The association between the FDP and the menstrual status, luteinizing hormone (LH) and Anti-Müllerian hormone (AMH) levels, as well as total number of retrieved and metaphase II oocytes and the rate of ovarian hyperstimulation syndrome (OHSS) at risk were evaluated.

Results: Of the 157 PCOS patients evaluated during the study period, 73 patients were classified in the peripheral cystic pattern (PCP) ovaries group and 84 patients in the general cystic pattern (GCP) ovaries group. There was no statistically significant difference in age and body mass index between groups. The mean serum levels of LH, AMH, total testosterone, and 17-OHP in the PCP group were significantly higher than the GCP group (P=0.022, P=0.023, P<00.001, and P=0.028, respectively). The number of retrieved oocytes and the OHSS at risk rate in the PCP group were notably greater than the GCP group.

Conclusion: Myomectomy may lead to a significant decrease in AMH levels in women with uterine leiomyoma undergoing both open and laparoscopic myomectomies, and the size and type of myoma significantly affects the changes in the hormone.

Background: There is a lack of reliable data or evidence-based protocol for the management of deep infiltrating endometriosis (DIE) lesions in reproductive age women. This study examines ovarian reserves in women who underwent endometriosis surgeries in an attempt to assist clinicians with decision-making for surgery and fertility preservation.

Materials and methods: This single-centre cross-sectional study included 508 women who underwent laparoscopic endometriosis surgery from June 2018 to December 2022. The women were divided into three groups: endometrioma (OMA; n=156), OMA+DIE (n=235), and DIE (n=117). Their anti-Müllerian hormone (AMH) levels were compared to 50 healthy controls before surgery and at four and eight months post-surgery.

Results: The DIE group had lower baseline AMH levels compared to the other groups (P<0.0001) following surgery, AMH levels decreased notably across all groups (P<0.001). Reductions in AMH levels after surgery were as follows: OMA group (49.84%), OMA+DIE group (62.20%), and the DIE group (43.46%). The most substantial decline was observed in the OMA+DIE group. There was no significant difference in AMH levels between four and eight months post-surgery.

Conclusion: Although the OMA+DIE group experienced the greatest drop in ovarian reserve after surgery, DIE is as effective as OMA in reducing ovarian reserve pre- and post-surgery. Hence, overlooked DIE lesions during an ultrasound examination can greatly impact ovarian reserve in these women.

Uterine arteriovenous malformation (AVM) is an uncommon yet potentially life-threatening condition characterized by significant vaginal hemorrhage. Diagnosis can be established through various imaging modalities, including doppler ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or pelvic angiography. The choice of treatment is influenced by several factors, including the patient's age, clinical symptoms, reproductive aspirations, and the size and anatomical location of the malformation. For symptomatic AVM in patients of reproductive age who wish to preserve fertility, uterine artery embolization (UAE) is considered the preferred therapeutic approach. This article is about the management of resistant vaginal bleeding after unsuccessful uterine artery embolization. This report presents a case of uterine AVM in a 32-year-old female who experienced abnormal vaginal bleeding following an induced abortion. The diagnosis of uterine AVM was confirmed via doppler ultrasonography. Although bilateral UAE was performed, the patient continued to experience significant vaginal bleeding. Following the unsuccessful embolization procedure, the patient was effectively managed through bilateral hypogastric artery ligation. Abnormal vaginal bleeding may be indicative of uterine AVM, particularly in individuals with a history of cesarean delivery, induced abortion, or dilation and curettage (D/C) procedures. While transcatheter UAE is generally an effective treatment, it may not succeed in all cases.

Background: Defects in endometrial receptivity are significant factors in infertility and recurrent implantation failure (RIF) during in vitro fertilization (IVF). This study aimed to evaluate the expression levels of steroid hormone receptors and circulating biomarkers in women with RIF compared to fertile controls.

Materials and methods: This case-control study was conducted in Tehran from June 2021 to December 2023, involving 50 fertile women as controls and 50 women with unexplained RIF referred to the RIF Medical Center at Arash Hospital. Blood samples and endometrial biopsies were collected at the day of the LH surge was LH 0. The expression levels of estrogen receptors (ESR-α and ESR-β) and progesterone receptor B (PGR-B) in endometrial tissue were assessed using real-time polymerase chain reaction (RT-PCR). Serum levels of estrogen were measured by enzyme-linked immunosorbent assay (ELISA).

Results: Women with RIF exhibited significantly higher ESR-α expression and lower ESR-β and PGR-B expression compared to fertile women (P<0.001). A positive correlation was found between ESR-α gene expression and hs-CRP levels, while ESR-β and PGR-B were associated with AMH concentrations. RIF patients showed lower serum levels of AMH and Vit-D3, but elevated hs-CRP. Fertile women demonstrated a positive association between PGR-B expression and Vit-D3 levels. The ROC curve analysis revealed high discrimination power for the expression of ESR-α (AUC 1.00), ESR-β (0.988), and PGR-B (0.898).

Conclusion: The study links endometrial PGR-B expression and vitamin D3 levels to decidualization and inflammation regulation. It suggests that infertility in women with RIF may stem from elevated ESR-α, increased inflammation, and reduced ESR-β and PGR-B expression. Further research is needed on PGR-B, VDR gene expression, and fertility biomarkers. ROC analysis indicates that endometrial steroid receptor expression, AMH, and vitamin D3 levels could aid in diagnosing RIF.

Background: Oocyte in vitro maturation (IVM) is a valuable technology applied to acquire fully developed oocytes for several clinical purposes. Despite substantial research on optimizing culture media, the success rate of IVM remains low. Platelet-rich plasma (PRP) contains several growth factors that has been found to improve ovarian function in women with a variety of reproductive issues, including poor ovarian response (POR) and primary ovarian insufficiency (POI). The current study aimed to determine whether adding autologous PRP to the culture medium could promote IVM outcomes in retrieved human oocytes.

Materials and methods: In this experimental research, a total of 200 immature oocytes at the germinal vesicle (GV) stage with normal morphology were collected from 76 women who participated in the intracytoplasmic sperm injection (ICSI) procedure. Immature oocytes were randomly distributed into the following two groups: i. The control group, which was cultured in IVM medium for 48 hours and ii. The treatment group, which was incubated in IVM medium supplemented with autologous PRP (5%) for 48 hours at 37°C.

Results: Our results showed that the percentage of GV oocytes that progressed into the metaphase II (MII) phase was significantly (P<0.05) increased in the PRP group (34%), as compared to the control group (19%). Moreover, schmorl staining revealed that the number of mature oocytes with refractile bodies (RBs, >5 μm) diminished in the PRP group compared with the control group. However, the differences failed to reach statistical significance.

Conclusion: Taken together, our finding demonstrated that adding autologous PRP to the conventional IVM medium increased the meiotic potential of human immature oocytes, probably due to the present of growth factors. This study indicates that PRP may be a beneficial supplement for improving IVM medium.