International Journal of Fertility & Sterility最新文献

Semen quality is considered as an alternative measure for men's fertility. Several studies have examined the association between the hepatitis B virus (HBV) infection and semen quality, but the findings have been inconclusive. This study investigated the effects of HBV on semen quality. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020, as well as Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guideline. In this study, international electronic databases including PubMed (National Library of Medicine), Web of Science, Scopus and Cochrane Library and also Persian databases including Scientific Information Database (SID) and Magiran were searched without a time limit until June 2023. All cohort and case-control studies examining the effects of HBV infection on the semen parameters of infertile men were included in the study. Animal studies, letters to the editor and case reports were excluded. The Newcastle-Ottawa scale was used to evaluate the quality of the included articles. Data analysis was done with Stata software. Of the 913 studies, 13 observational studies comprised a total of 10156 patients were included in this review, nine of which were included in the meta-analysis. The results showed that HBV infection has a negative effect on semen volume (95% confidence interval (CI): [-0.33, -0.09], P<0.001), sperm concentration (95% CI: [-8.53, -2.66], Pv<0.001), sperm motility (95% CI: [-10.06, -3.39], P<0.001), sperm normal morphology (95% CI: [-6.42, -1.06], P<0.001) and sperm viability (95% CI: [-11.64, -0.31], P<0.001). These results suggest that the HBV infection has a negative effect on the semen quality in infertile men. Nonetheless, further research with more robust design is recommended.

Background: Circulating microRNAs (miRNAs or miRs) are key regulators of a wide array of biological processes that aberrantly express under physiological as well as pathological conditions. This study aims to determine whether altered expression of circulating miR-223-3p in plasma is associated with an increased risk of idiopathic recurrent pregnancy loss (iRPL), and if it could be a novel non-invasive biomarker for diagnosis of iRPL.

Materials and methods: In this case and control study, Plasma samples were obtained from 60 women with a history of ≥ 2 consecutive miscarriages and 60 women with at least one full-term pregnancy and no history of miscarriage. The samples were used to assess the expression of circulating miR-223-3p by quantitative real-time polymerase chain reaction (qPCR) and determine the correlation between patient clinico-demographic parameters and miR-223-3p expression levels. We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic accuracy of miR-223-3p for the diagnosis of iRPL.

Results: There was significant up-regulation in miR-223-3p expression in patients with iRPL compared with healthy controls (P=0.002). No significant correlation was found between the expression level of miR-223-3p and the number of miscarriages in iRPL patients (P=0.344). ROC curve analysis revealed that the area under the curve (AUC) value for miR-223-3p was 0.658 [95% confidence interval (95% CI): 0.5590.757, P=0.002).

Conclusion: These results suggest that a higher expression level of circulating miR-223-3p may be closely related with the increased risk of iRPL and possibly serve as a promising non-invasive diagnostic biomarker for iRPL.

Background: Frozen embryo transfer (FET) has been increasingly used due to advancements in cryopreservation techniques and the safety advantages. This study aims to determine various factors influencing the successful FET.

Materials and methods: Retrospective cohort analysis included 1112 women who underwent programmed FET between January 2012 and October 2022, at King Chulalongkorn Memorial Hospital, Thailand. Patient characteristics, embryo characteristics, endometrial preparation protocol, endometrial characteristics (thickness, pattern), embryo transfer procedure (tip and flow during transfer, embryo placement location, the difficulty of the procedure, presence of blood and mucous at catheter), and operator factor were analyzed. Multiple logistic regression analysis was used to assess the relationship between collected variables and successful embryo transfer which is defined by clinical pregnancy.

Results: The overall clinical pregnancy rate was 34.2%. Women aged 35-40 years and >40 years were less likely to have a clinical pregnancy compared to those aged <35 years [adjusted odds ratio (aOR): 0.523; 95% confidence intervals (CI): 0.360-0.757, P<0.001 and aOR: 0.260; 95% CI: 0.152-0.434, P<0.001, respectively]. Obese women with body mass index (BMI) ≥25 kg/m2 were significantly associated with decreased clinical pregnancy (aOR: 0.632; 95% CI: 0.403-0.978, P=0.042) compared to those with normal BMI. Day-3 and day-4 embryo transfer showed a significant decrease in clinical pregnancy compared to blastocyst transfer (aOR: 0.294; 95% CI: 0.173-0.485, P<0.001 and aOR: 0.497; 95% CI: 0.265-0.900, P=0.024). Double embryo transfer (DET) was 1.78 times more likely to have a clinical pregnancy than women with single embryo transfer (SET) (aOR: 1.779; 95% CI: 1.293-2.458, P<0.001). The cycles with endometrial thickness <8 mm were associated with a decrease in clinical pregnancy compared with those with a thickness ≥8 mm (aOR: 0.443; 95% CI: 0.225-0.823, P=0.013).

Conclusion: Older age, obesity, non-blastocyst transfer, single embryo transfer, and endometrial thickness of <8 mm were significantly associated with a decreased clinical pregnancy in programmed FET.

Preeclampsia (PE) remains a significant cause of maternal and neonatal morbidity and mortality, particularly in high-risk pregnancies. The present study aims to assess the efficacy of L-arginine supplementation in preventing PE and improving maternal and neonatal outcomes in high-risk pregnancies. We searched international databases (ISI, PubMed, Scopus, and Embase) and extracted studies that evaluated the efficacy of L-arginine for preventing PE and improving maternal and neonatal outcomes in high-risk pregnancies. The data collected were analysed utilising the random-effects model in Stata (version 15). Out of the collected studies, 10 met the eligibility criteria, comprising a total sample size of 1165 subjects (586 cases and 584 controls). The mean age of the cases was 28 ± 5.05 years, while that of the controls was 27.32 ± 4.58 years. The results revealed that L-arginine was more effective in reducing the incidence of PE than placebo [odds ratio (OR)=0.36, 95% confidence interval (CI): 0.17, 0.77]. Also, the results showed no statistically significant difference between the two groups in systolic blood pressure (SBP; standard mean difference (SMD): -0.35, 95% CI: -91, 21) and diastolic blood pressure (DBP; SMD: -0.50, 95% CI: -1.08, 0.07). There was a statistically significant difference in neonatal birth weight between the two groups (SMD: -0.16, 95% CI: -31, -0.01). No statistically significant difference existed between the two groups in terms of gestational age (SMD: 0.6, 95% CI: -0.06, 0.18). Furthermore, there was no significant difference between the two groups in the APGAR score at one minute (SMD: 0.40, 95% CI: -0.02, 0.82). Our findings revealed that L-arginine supplementation during pregnancy reduced the incidence of PE in high-risk pregnancies. However, it does not significantly improve maternal and neonatal outcomes.

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: 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.

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.

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.