International Journal of Fertility & Sterility最新文献

Small extracellular vesicles (sEVs) have been recognized as a promising therapeutic modality due to their low immunogenicity, and the ability to penetrate biological barriers. They contain significant amounts of lipids, proteins, and microRNAs, effectively participating in intra- and inter-cellular communications. sEVs derived from mesenchymal stem cells (MSCs) are being explored as a potential therapeutic option due to their immunomodulatory, anti-inflammatory, antioxidant, and regenerative properties, offering advantages over stem cell transplantationbased treatments. Chemotherapy induces side effects on various organs, particularly those with high proliferative capacity, such as testicular tissue. Exposure to some groups of chemotherapeutic agents, such as cyclophosphamide, cisplatin, and doxorubicin can cause DNA damage and induce apoptosis in spermatogonia and primary spermatocytes. Chemotherapy has been shown to induce cellular stress in testicles, leading to testicular dysfunction and the activation of apoptotic pathways in response to external and internal stress. The current research aims to review the potential therapeutic advantages of sEVs derived from MSCs in addressing sperm abnormalities and male infertility resulting from chemotherapy. Several lines of evidence indicate that treatment with sEVs can reduce testicular tissue damage caused by chemotherapy by decreasing oxidative stress and inflammatory responses. sEVs boost the growth and motility of spermatogenic cells and protect them from apoptosis by activating internal pathways. Therefore, as a non-invasive approach, they have shown promising results in regenerating damaged spermatozoa and restoring spermatogenesis.

Despite the apparent resilience of the male reproductive system, various viruses have been found to impact male fertility by causing testicular inflammation, hormonal imbalances, and sperm abnormalities. The integrity of the genome is vital for cell function, and its instability, influenced by various factors including viral infections, may contribute to age-related conditions such as cancer and neurodegenerative disorders. This scoping review aims to investigate the relationship between viral infections and sperm genetic stability, exploring their interactions and potential impact on male reproductive health and fertility. In order to conduct this scoping review, PubMed, MEDLINE (OVID), ScienceDirect, Google Scholar, and Cochrane databases were explored to find the relevant articles using a search strategy developed in collaboration with a medical librarian. Two independent reviewers screened titles and abstracts of the relevant papers, followed by full-text screening. Studies focusing on infertile males with viral infections, compared to fertile males, examining DNA damage and sperm abnormalities were included. Thirty-four studies were included in the current review. This review will provide valuable information to healthcare professionals in addressing virusinduced sperm genetic instability and its implications for reproductive health. Furthermore, it highlights the socioeconomic and public health aspects of preventing and managing viral infections.

Background: Lack of matured oocytes after ovarian stimulation for in vitro fertilization (IVF) is one problem affecting the number of good-quality embryos. In vitro maturation (IVM) rescue is one way that can be done to rescue the immature oocytes retrieved after ovarian stimulation. It has been proven that cumulus cells (CCs) play an essential role in the growth and development of oocytes. However, their role in immature oocytes undergoing IVM rescue still needs to be improved. To assess the role of CCs in immature oocytes after controlled ovarian stimulation (COS) that underwent IVM rescue followed by intra cytoplasmic sperm injection (ICSI).

Materials and methods: A retrospective study consists of 200 immature oocytes with normal morphology obtained from IVF patients who had undergone ovarian stimulation. They were randomly divided into a control group (complete denudation, n=100) and a study group (non-denudation, n=100). Both groups then underwent IVM rescue for 24 hours. Oocytes that mature through IVM rescue were followed by ICSI. Our primary outcome is the number of good-quality embryos. Other intermediate outcomes such as oocyte maturation rate, fertilization rate, embryo cleave and rate, and embryo quality were also analyzed.

Results: The two groups had no significant difference in oocyte maturation rate 71 vs. 73% (P=0.875). However, significant differences were found in the fertilization rate 38.1 vs. 61.6% and embryo cleave rates 37.1 vs. 62.2% (P=0.006 and 0.005, respectively). In addition, immature oocytes that underwent IVM rescue with attached CCs produced more good embryos compared to IVM rescue of denuded oocytes 20 vs. 35.7% (P=0.003).

Conclusion: Current research indicates that IVM rescue of immature oocytes with attached CCs may produce more good-quality embryos.

Background: In vitro fertilization (IVF) with egg donation often stands as the sole treatment option for women with premature ovarian insufficiency (POI) or poor ovarian response (POR); for this reason, alternative techniques are being developed, among which stand surgical techniques for ovarian activation. The aim of the present study was to evaluate the effectiveness of surgical techniques for ovarian activation in patients affected by POI or POR.

Materials and methods: In this systematic review study, a comprehensive search of the literature was carried out on the principal databases. Only original studies reporting the treatment of POI or POR using surgical techniques for ovarian activation in human subjects were deemed eligible for inclusion in this qualitative analysis.

Results: Overall, 187 patients with POI and 65 patients with POR were treated with experimental surgical techniques. Among the POI patients, 10 pregnancies and 8 live births were achieved. In the POR group, 18 pregnancies were reported with 14 live births.

Conclusion: Ovarian fragmentation (OF) appears to be a promising method for treating POI, although large sample randomized controlled trials (RCTs) are necessary to confirm this hypothesis. Regarding POR, surgical techniques do not improve IVF outcomes, and thus should not be proposed, although they may lead to a slight increase in ovarian reserve markers as compared with before treatment. Both clinical and basic science studies are highly demanded to better understand the molecular mechanisms underlying some partially promising results, with the aim of improving currently available techniques.

Background: Diabetes mellitus (DM), one of the most pervasive and enduring metabolic diseases, has been demonstrated to adversely impact male fertility. Conversely, both exercise training and Chrysin have been identified as potential interventions capable of mitigating the deleterious effects of diabetes on spermatogenesis. Thus, the current study aims to explore the individual and combined influences of Chrysin supplementation and running exercise on oxidative stress and germ cell apoptosis in the testicular tissue of diabetic adult rats.

Materials and methods: In this experimental study, the DM was induced by streptozotocin (STZ,50 mg/kg). Rats were divided into control (received STZ solvent), DM-sole, Chrysin-sole (50 mg/kg, daily), moderate-intensity running exercise training (MIRET-sole, warm-up, 5 minutes at 30% of Smax1 (Maximum speed); Moderate intensity exercise, 60 minutes at 60% of Smax1, and recovery, 5 minutes to 30% of Smax1), DM+Chrysin, DM+MIRET, and DM+MIRET+Chrysin. Following 8 weeks, the histopathological changes (Johnson's score, epithelial height, and tubular diameter), testicular malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPX), and the mRNA levels of anti-apoptotic gene Bcl-2 and pro-apoptotic gene Bax was analyzed.

Results: Chrysin solely and simultaneous with MIRET could remarkably (P=0.001) improve the DM-induced histopathological damages, increase the testicular SOD and GPx levels, and decline the DM-increased MDA content. Moreover, our results showed that Chrysin solely and more simultaneously with MIRET could significantly (P=0.001) decrease the mRNA expression of Bax and improve the Bcl-2 expression and rebalance the Bax/Bcl-2 balance.

Conclusion: Our findings showed that co-administration of Chrysin along with MIRET can significantly ameliorate the DM-induced histopathological, and biochemical impairments and reduce the pro-apoptotic impact of DM on testicular tissue.

Background: Despite the remarkable advancements in the use of embryo donation, concerns have arisen regarding its potential effects on the psychological well-being of children conceived through this assisted reproductive technology and their parent-child relationships. The aim of the study is to evaluate children's psychological adjustment and parenting style in families with donor-conceived children and compare them with the normal population.

Materials and methods: A historical cohort study was conducted to assess the psychological adjustment of 31 children aged 3 to 7 years born via embryo donation and to compare the results with those of 30 age-matched children from families who conceived naturally using the Strengths and Difficulties Questionnaire. The sample size was determined using G power, and the samples were selected using a convenient sampling method. Parenting styles within these families were also evaluated using the Baumrind Parenting Styles Inventory through clinical interviews.

Results: Although 8 out of 31 children born through embryo donation (25.8%) and 3 out of 30 children from families with natural conception exhibited psychological maladjustment, this difference was not statistically significant (P=0.249). Furthermore, there were no significant differences in parenting styles between the two groups (P values for permissive, authoritarian, and authoritative parenting styles were 0.424, 0.656, and 0.219, respectively).

Conclusion: The lack of genetic parent-child relationships does not seem to be a dominant factor affecting the psychological adjustment of children or parenting styles.

Background: The effectiveness of changing the type of luteal phase support in patients with poor ovarian response (POR) remains unclear based on the available evidence. This study aimed to compare the effectiveness of various luteal phase support (LPS) methods, including progesterone alone, human chorionic gonadotropin (hCG) alone, and the combination of progesterone with hCG, in these patients.

Materials and methods: In this randomized clinical trial, 375 patients diagnosed with POR based on the Bologna criteria underwent intracytoplasmic sperm injection-embryo transfer (ET) cycles at the Royan Institute between November 2015 and June 2019. The patients were allocated randomly into three different LPS groups on the day of oocyte pickup. In the first group, 1500 IU of hCG on the ET day, as well as 4 days after that were administrated intramuscularly. In the second group, the patients received 1500 IU of hCG IM on the ET day, as well as 3 and 6 days after the ET along with vaginal progesterone suppositories of 400 mg twice daily. For the third group, only vaginal suppositories twice daily were administrated from the day of oocyte pick up until the pregnancy test day. The clinical pregnancy, miscarriage and live birth rates were compared among groups using appropriate statistical tests.

Results: The data analysis indicated that the three groups were comparable, and there were no significant differences among the groups in terms of implantation, clinical pregnancy, miscarriage, and live birth rates. The twin pregnancy rate in the hCG-only group was higher than in the other two groups, although this difference did not reach statistical significance (P=0.060).

Conclusion: Similar pregnancy and live birth rates were observed among different LPS regimens. Interestingly, the use of two boluses of low-dose hCG (1500) was associated with a slight increase in multiple pregnancies. We suggest this effective method, which is easier and more patient-friendly (registration number: NCT02798653).

Background: Pregnant mothers frequently have vitamin D deficiency, which has potential consequences for the health of their unborn children. Prenatal vitamin D administration raises maternal and foetal 25(OH)D levels. This study aims to assess the effects of 25(OH)D supplementation on clinical pregnancy and miscarriage rates in women diagnosed with hyperandrogenic polycystic ovarian syndrome (PCOS).

Materials and methods: This prospective study was conducted on 200 patients with hyperandrogenic PCOS who attended an outpatient infertility clinic at Menoufia University Hospital from March 2021 until March 2022. Participants were divided into two groups-(A) women who received a therapeutic dose of 25(OH)D supplements (n=100) and (B) women who did not receive 25(OH)D supplements (n=100).

Results: The duration needed to reach follicles that were ≥18 mm was significantly higher in group B (16.74 ± 2.57) compared with group A (13.40 ± 2.12). Midluteal progesterone was significantly higher in group A (19.63 ± 2.12) compared with group B (17.74 ± 2.36, P<0.001). Our results indicate that women with adequate 25(OH)D levels are far more likely to experience clinical pregnancies than those with 25(OH)D deficiency.

Conclusion: More research is necessary to determine whether vitamin D supplementation can be a simple and economical solution to increase pregnancy rates. Our study population had a significant 25(OH)D deficit or insufficiency prevalence. Determining 25(OH)D levels as part of a routine infertility assessment may be advantageous.

Background: Unexplained recurrent miscarriage (RM) is still an unsolved reproductive health problem. Inherited thrombophilias have been one of the causes. Mutation in genes encoding coagulation proteins, including prothrombin (PT G20210A) and methylenetetrahydrofolate reductase (MTHFR) genes, increase tendency for venous thromboembolism. This study aimed to evaluate association between polymorphisms in prothrombine and MTHFR genes with RM. We also evaluated association between protein C (PC), protein S (PS), antithrombin III (ATIII), and homocystiene with RM.

Materials and methods: We conducted a case-control study on women with history of miscarriages and healthy controls. Genetic analysis was done using (TaqMan) polymerase chain reaction (PCR) technique and the other tests were performed to check general health indications and thrombophilia markers.

Results: In this study, 195 RM group (group I) participants and 90 healthy controls (group II), PC, PS, ATIII deficiency and Hyperhomocysteinemia were in 7.2, 65.6, 9.2, 10.8% of group I respectively, but was 1.1, 7.8, 2.2, 2.2% of group II. PT G20210A showed two in group I were A/G, no A/G in group II, and no AA carrier in the either group. G allele was observed in 99.5% of the group I and 100% of the group II, while A allele was detected in 0.5% of group I. MTHFR C677T gene showed C/T mutation in 33.3% of group I and 32.2% of group II, while T/T mutation was detected in 12.8% of group I and 8.9% of the group II. C allele was found in 70.5% of group I and 75% of group II, while T allele was found in 29.5% of group I and 25% of group II (P=0.269).

Conclusion: PT G20210A and MTHFR C677T gene mutations are not correlated with RM in the Egyptian population. However, Egyptian women with RM are strongly associated with hyperhomocysteinemia, PC, PS, and ATIII deficiencies (registration number: NCT03209063).

Background: Chromosomal mosaicism, a phenomenon observed in a minority of embryos, showcases its prevalence and inherent unpredictability, leading to variations in embryo mosaic rates across different centers. This research endeavors to assess the prevalence of mosaicism and its characteristics within the scope of our preimplantation genetic testing-A (PGT-A) services in Indonesia. Specifically focusing on our center's experience since 2020, this study aims to elucidate mosaic rates among embryos in our care.

Materials and methods: In a retrospective approach, we collected secondary data sourced from our PGT-A outcomes dating back to 2020. A total of 196 embryos underwent analysis, their characteristics were documented and presented descriptively. Notably, the incidence of specific chromosome abnormalities was outlined. We assess a comparative analysis to investigate the relationship between mosaicism and its corresponding clinical characteristics.

Results: In the analysis of 196 embryos, 106 (54.1%) displayed chromosomal anomalies spanning from low-level mosaicism to whole chromosome aneuploidy. Low mosaicism was observed in 25 (12.8%) of the embryos, while high mosaicism was identified in 8 (4.1%) embryos. Notably, low-level mosaicism predominated in chromosome 9 (n=10, 5.1%), whereas abnormality prevalence was highest in chromosome 21 (n=20, 10.2%). Statistical analysis revealed no significant disparity in mean maternal age among embryos with low-level mosaicism, high mosaicism, and normal chromosomes (33.88 vs. 35 vs. 33.26 years old, respectively). However, a statistically significant difference in mean maternal age (35.84 vs. 33.26 years) was observed between embryos with aneuploidy (monosomy or trisomy) and those with normal chromosomes. Furthermore, a significant difference in high mosaicism rates was detected in patients with unexplained infertility (P<0.05).

Conclusion: In contrast to the study conducted elsewhere, our center had a higher mosaicism rate. Chromosomes 9, 8, and 6 were the most frequently affected. There was a significant difference in the high mosaicism rate for PGT-Arelated unexplained infertility causes.