International Journal of Fertility & Sterility最新文献

Background: In recent times, various algorithms have been developed to assist in the selection of embryos for transfer based on artificial intelligence (AI). Nevertheless, the majority of AI models employed in this context were characterized by a lack of transparency. To address these concerns, we aim to design an interpretable tool to automate human embryo evaluation by combining artificial neural networks (ANNs) and genetic algorithms (GA).

Materials and methods: This retrospective cohort study included 223 human blastocyst time-lapse (TL) images taken at 110 hours post-injection. All the images were evaluated by five embryologists from different clinics in terms of blastocyst expansion (BE), quality of the inner cell mass (ICM), and trophectoderm (TE). The embryo database was used to develop an AI system (70% training, 15% validation, and 15% test) for automate blastocyst assessment. The entire set of images underwent a standardization process, followed by processing and segmentation using Matlab software. The resulting quantified variables were utilized in AI techniques (ANN and GA). Finally, the accuracy and performance of the automation tool was assessed with the area under the receiver operating characteristic (ROC) curve (AUC). Then, the level of agreement among embryologists and between embryologists and the AI system was compared with Kappa Index.

Results: The overall agreement among embryologists was low (Kappa: 0.4 for BE; and 0.3 for TE and ICM). The AI tool achieved higher consistency (Kappa 0.7 for BE and ICM; and 0.4 for TE). The AI exhibited high accuracy in classifying BE (test 81.5%), ICM (test 78.8%), and TE (test 78.3%) and better performance for BE (AUC 0.888-0.956) than for ICM (AUC 0.605-0.854) and TE (AUC 0.726-0.769) assessment.

Conclusion: Our AI tool highlighted the superior consistency of AI compared to human operators in grading blastocyst morphology. This research represents an important step towards fully automating objective embryo evaluation.

Background: The objective of this study was to investigate the correlation between the expression levels of sperm microRNA-149b and 34c and sperm quality in men diagnosed with oligoasthenoteratozoospermia.

Materials and methods: In the experimental study, we recruited 30 infertile men with oligoasthenoteratozoospermia and 30 control samples. In this study, miR-149b and miR 34c expression using reverse transcription polymerase chain reaction (RT-PCR) were evaluated. Semen samples were collected and subjected to initial analysis, including semen parameters, following the protocol provided by the World Health Organization (WHO). The levels of total antioxidant capacity (TAC) and malondialdehyde (MDA) were measured using an ELISA kit.

Results: The expression levels of miR-149b and miR-34c were significantly downregulated in men with oligoasthenoteratozoospermia compared to age-matched normozoospermic men, as determined by RT-qPCR (P=0.001, and P=0.003 respectively). Correlation analysis revealed a positive correlation between the expression levels of mmiR-149b and miR-34c and various sperm parameters, including sperm count, motility, morphology, viability, sperm mitochondrial membrane potential, sperm capacity, and TAC. Additionally, an inverse correlation was observed between the expression levels of miR-149b, miR-34c, DNA fragmentation, and MDA levels.

Conclusion: The findings of this study indicate that the decreased expression of miR-149b and miR-34c is associated with oligoasthenoteratozoospermia, potentially affecting fundamental semen parameters. These results provide a basis for future research aimed at exploring potential therapeutic interventions for male infertility.

Background: Sperm DNA fragmentation is an important factor that affects male fertility. This study intends to evaluate the impact of sperm DNA damage [single-strand breaks (SSB) and double-strand breaks (DSB)] on fertilisation and embryonic euploidy after intracytoplasmic sperm injection (ICSI). Of the different sperm selection techniques, the novel microfluidic sperm sorting (MSS) ZyMōt™ ICSI device reduces both SSB and DSB in semen samples. The second objective is to study the impact of this MSS device on fertilisation and embryonic euploidy.

Materials and methods: This retrospective study included data from 167 ICSI treatments. The alkaline and neutral Comet assays were used to analyse SSB and DSB, respectively. Analysis of fertilisation and embryo euploidy rates was performed in four groups of patients with normal/altered SSB or DSB values. Density gradient centrifugation (DGC) and the ZyMōt™ ICSI MSS device were used for semen preparation.

Results: Fertilisation rates in 167 ICSI cycles were higher when using sperm from patients with normal SSB values (70.84%) and patients with abnormal SSB whose samples were processed using the MSS device (69.71%) compared to patients with abnormal SSB values using DGC (58.49%). Preimplantation genetic testing for aneuploidies (PGTA) revealed a higher embryo euploidy rate in patients with normal DSB values (60.00%) and patients with abnormal DSB whose samples were processed using the MSS device (44.59%) compared to patients with abnormal DSB values using DGC (36.84%). When female age was considered, there were fewer euploid embryos in women ≥35 years of age compared to younger women, independently of SSB and DSB. The number of euploid embryos increased when the MSS device was used.

Conclusion: High SSB and DSB values in semen samples decreased fertilisation rates and embryonic euploidy, respectively. The ZyMōt™ ICSI device for semen preparation increased both rates, especially in couples that included women <35 years old.

Background: Endometriosis is an idiopathic gynecological condition affecting women with pelvic pain and infertility in reproductive ages. Due to preventive and therapeutic effects of soy isoflavones (SI) and broccoli extract (BE) on tumor angiogenesis, inflammation and oxidative stress and since endometriosis is accompanied by chronic inflammation, in this study, we aim to evaluate the potential role of these compounds on the pathological scores of endometriosis and also consider the expression level of the gene markers of autophagy, apoptosis, and oxidative stress in an endometriosis rat model.

Materials and methods: In the present experimental study, 45 mature female Sprague- Dawley rats weighing 220 ± 20 g at the age of eight weeks with surgically induced endometriosis was divided into five groups and treated for six weeks with normal saline (control group), BE, SI, BE+SI by oral gavage, and also Diphereline intramuscularly. The histopathological scores of the endometrial implants (0, 1, 2, 3: no, poorly, moderately and well-preserved epithelial layers, respectively) and the mRNA expression level of Bcl-2, Bax, Caspase-3, Beclin-1, Lc3, and Sod within peritoneal tissue were compared among the groups.

Results: Pathologic scores of the implants in the Diphereline (1.2 ± 0.27) and BE+SI (1.2 ± 0.41) groups were declined significantly in comparison with the control group (2.08 ± 0.44) (P≤0.001). In the endometriotic structures, the mRNA expression levels of our target genes were improved significantly (P≤0.01) in comparison with the control group.

Conclusion: The findings of the current study demonstrated that the simultaneous consumption of a certain amount of broccoli extract and SI can be considered as a promising therapeutic strategy for treatment of endometriosis.

While international guidelines on oncofertility practice have been published in developed countries, there is limited information available on oncofertility practice in developing countries, which often face limitations in their cancer health support networks. As survival rates improve in the field of cancer and other diseases, there is a growing need for stronger oncofertility services in developing countries. Given that 50% of cancer patients are under the age of 65, many of these patients are of reproductive age and preserving their fertility health prior to starting treatment is valuable. However, due to resource limitations and the heavy burden of treatment costs imposed on these patients and their families, fertility preservation (FP) may not be a top priority for them. As a result, many healthcare providers and their patients focus on eliminating cancer and its related treatments while overlooking the importance of fertility as a factor that can significantly impact their future quality of life. In this review, we have tried to increase the knowledge of healthcare providers involved in the oncofertility network by reviewing current cancer treatments, FP options in female cancer patients, and their challenges in developing countries.

Background: Threatened abortion (TA) is associated with adverse pregnancy outcomes. Despite the attention paid to the adverse outcomes of obstetrics, only a few studies have been conducted on the psychological status of women with threatened abortion. This study aimed to compare the symptoms of depression and anxiety in women with TA and those without threatened abortion.

Materials and methods: In a case-control study, 136 women with TA (the case group) and 136 women without TA (the control group), were matched with the case group in terms of gestational age, education level, age, and number of pregnancies, were examined from Obstetric clinics of Babol University of Medical Sciences. Demographic information and pregnancy history were obtained from all participants. Additionally, the women filled out the BSI-18 questionnaire. Statistical analysis was performed using SPSS version 22 software.

Results: The results showed that in women with threatened abortion, the likelihood of experiencing depression symptoms was 1.9 times higher [odds ratio (OR)=1.91, 95% confidence interval (CI)=1.13-3.23, P=0.015], anxiety symptoms were 1.8 times higher (OR=1.83, 95% CI=1.08-3.10, P=0.024), and somatization was 2.6 times higher (OR=2.65, 95% CI=1.61-4.37, P<0.001) compared to pregnant women without threatened abortion. Additionally, in women with threatened abortion, the risk of psychological distress was 3.3 times higher (OR=3.30, 95% CI=1.96- 5.56, P<0.001) than in women without threatened abortion.

Conclusion: This study suggests that gynecologists, midwives, and healthcare providers, in addition to providing medical care for women threatened with abortion, should identify women at risk of experiencing symptoms of depression and anxiety. Providing appropriate psychological support should be prioritized in the management of women with threatened abortion.

Background: This study aimed to determine the alteration of endometrial expression levels of HOXA9/HOXA10/ HOXA11/HOXD10 genes and HOX transcript antisense intergenic RNA (HOTAIR) in mid-luteal phase endometrium in patients with hydrosalpinx before and after salpingectomy.

Materials and methods: In this prospective study, 14 infertile women with unilateral hydrosalpinx who were scheduled for laparoscopic salpingectomy were evaluated. The presence of hydrosalpinx was confirmed by hysterosalpingography or transvaginal 2D-ultrasonography. All patients had normal hormonal profiles, body mass index, and regular menstrual cycles identified by mid-luteal serum progesterone. Fourteen healthy fertile age-matched women with a successful pregnancy history were considered the control group. Mid-luteal-phase endometrial biopsies were performed at the time of surgery and during the mid-luteal phase of the fourth treatment cycle by Pipelle. After tissue collection, RNA extraction and cDNA synthesis were performed. Real-time polymerase chain reaction (PCR) technique was used for quantitative gene expression of HOXA9/HOXA10/ HOXA11/ HOXD10 and lnc HOTAIR.

Results: The endometrial expression of HOXA9 (P<0.001), HOXA10 (P=0.001), HOXA11 (P=0.003), and HOXD10 (P=0.004) were significantly lower in the patients with hydrosalpinx compared to the controls. After salpingectomy, we observed a significant increase in the endometrial HOXA9 (P=0.006) and HOXA10 (P=0.023) mRNA expression levels compared to before salpingectomy samples. Similarly, a significant upregulation in endometrial HOXA11 (P= 0.013) and HOXA10 mRNA expression levels (P=0.012) were detected in postoperative samples compared to preoperative tissue. Moreover, the lnc HOTAIR was significantly higher in the endometrium-induced hydrosalpinx fluid than in controls (P=0.020), which had a 2.89-fold decrease following salpingectomy (P=0.010).

Conclusion: Elevated endometrial lncRNA HOTAIR may disrupt the expression of endometrial receptivity HOX genes in women with hydrosalpinx. However, our results failed to show a significant inverse correlation between HOTAIR and HOX genes due to limited sample size. Further studies with larger sample sizes are required to investigate HOTAIR inverse co-expression with HOX genes in these subjects.

There is a significant increase in the use of complementary and alternative medicine (CAM) by infertile patients. This study aimed to assess the prevalence of CAM use by infertile patients. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The required data were obtained by searching English databases (PubMed and Web of Science) as well as Google Scholar as an additional source of records. We included cross-sectional studies published in English journals up to March 2023 that examined the prevalence of CAM use among infertile patients in different countries. The retrieved articles were independently assessed by two reviewers. Discrepancies were resolved by discussion with the intent to reach a consensus. We reviewed 1192 documents. From these, 29 studies were included in this systematic review and meta-analysis. The results of meta-analysis conducted on 32, 804 infertile patients showed a prevalence rate of CAM use between 26.3% [95% confidence interval (CI): 21.7%-31.3%] and 96.1% (95% CI: 95.7%-96.5%) in various countries. The pooled prevalence rate calculated by the random effects model showed that, overall, 54% (95% CI: 46%-61%) of both infertile women and men used CAM, whereas 55% (95% CI: 47%-67%) of infertile women and 29% (95% CI: 17%-41%) of infertile men reported treatment with CAM. More than half of the infertile patients used CAM. Therefore, healthcare practitioners need to be aware of this practice to better provide care for infertile patients. Further studies should examine the reasons for CAM use by infertile patients.

Background: While the effects of polycystic ovary syndrome (PCOS) and infertility on women's health have often been discussed, not many studies have assessed the other complications of infertility. One of these complications is female sexual dysfunction (FSD), a range of psychosexual disorders. The aim of this study is to investigate the prevalence of FSD in PCOS and its comparison with other causes of infertility.

Materials and methods: In this cross-sectional study, two questionnaires were filled out by two groups (60 people each) of infertile patients, due to PCOS and other causes, referred to Arash Women's Hospital from December 2018 to 2019. The data was analyzed in SPSS software to evaluate the frequency of FSD in the whole study population and each group separately as well as its relationship with age, history of pregnancy, the literacy level of the patient or spouse, body mass index (BMI), infertility duration, hirsutism, and acne.

Results: The frequency of FSD in the study group had a significant inverse relationship with the women's level of education (P=0.044), although no such correlation was found with age, pregnancy history, spouse's literacy level, BMI, duration of infertility, acne, and hirsutism. In the comparison group, there was a significant relationship between the duration of infertility and FSD (P=0.002). The prevalence of FSD in the study and comparison groups was 43.1 and 52%, respectively. The prevalence of FSD sub-domains in all categories, except for pain, was higher in the study group. PCOS, compared to other groups, presented at a relatively younger age.

Conclusion: In the PCOS group, patients with lower education levels were more likely to suffer from FSD. This suggests the effect of education and awareness on the sexual performance of these people. No significant difference in FSD experience was found between PCOS and other groups.

Background: Endometriosis, is a prevalent condition among women of childbearing age, characterized by the presence of ectopic endometrial glands. It is associated with pelvic pain and infertility. Unfortunately, the diagnosis of endometriosis is often delayed in many patients. While laparoscopic investigation is required for a definitive diagnosis, physical examination combined with ultrasonography can provide reasonably accurate detection. Machine learning (ML) techniques have shown promise tools in medical imaging and diagnostics. However, there is a lack of sufficient ML studies focusing on Iranian endometriosis female patients. In this study, we aimed to compare the diagnostic accuracy of different ML algorithms for endometriosis detection.

Materials and methods: In this retrospective study, our objective was to assess the diagnostic accuracy of different ML algorithms in classifying suspicious cases of endometriosis using ultrasonographic signs. Our data set consisted of 505 patients, among which 149 were confirmed cases of endometriosis. We divided the data set into training and test sets to train and evaluate the performance of the ML models. To ensure robust evaluation, we employed stratified 5-fold cross-validation and calculated the area under the receiver operating characteristic curve (AUC) as a measure of model performance.

Results: In the test set, a total of 37 out of 127 patients (29.1%) were diagnosed with endometriosis, while in the training set, 112 out of 378 patients (29.6%) were confirmed to have the condition. Sensitivities ranged from 59.5 to 75.7%, and specificities ranged from 71.7 to 83.3%. Notably, the SVM, Random Forest, Extra-Trees, and Gradient Boosting models exhibited the highest performance, with AUCs of 0.76.

Conclusion: Our study supports the use of ML models for the screening and diagnosis of endometriosis. The superior performance of the SVM, Random Forest, Extra-Trees, and Gradient Boosting models, as indicated by their high AUCs, suggests their potential as valuable tools in improving the accuracy of endometriosis detection.