International Journal of Fertility & Sterility最新文献

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.

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: This study aims to investigate the effects of carob (Ceratonia siliqua L.) pod extract (CPE) on the viability of human endometrial mesenchymal stromal/stem cells (EnMSCs) and its impact on mRNA and protein expressions of DNA methyltransferases (DNMT1, DNMT3A, and DNMT3B), histone deacetylase 1 (HDAC1), matrix metalloproteinase-2 (MMP2), and cyclooxygenase-2 (COX-2) in endometriotic patients.

Materials and methods: In this experimental study, EnMSCs were derived from endometrium of patients with ovarian endometrioma (OMA-EnMSCs group) and deep infiltrative endometriosis (DIE) samples of 10 endometriosisassociated infertility (EAI) women (E-EnMSCs group) and compared to EnMSCs derived from the endometrium of an endometriosis-free, normal woman as the control group (C-EnMSCs). The metabolic activity of the control and case groups were evaluated by treating them with different concentrations of CPE. Cell viability was analysed by MTT. Real-time reverse transcription-polymerase chain reaction (RT-PCR) and Western blot were used to evaluate the expression of specific genes at the mRNA and protein levels, respectively.

Results: Treatment with 0.8 and 2 μg/mL of CPE downregulated COX-2 and HDAC1 in the E-EnMSC group compared to the C-EnMSCs group. Treatment with 0.8 μg/mL of CPE also decreased MMP2 and DNMT3B gene expressions. The COX-2 and DNMT3A genes were significantly upregulated after treatment with 2 μg/mL of CPE. Expressions of the COX-2, HDAC1, DNMT1, DNMT3A, and DNMT3B peptides decreased in the all three groups after treatment with 0.8 and 2 μg/mL of CPE. Gas chromatography-mass spectroscopy (GC-MS) analysis of CPE identified 14 bioactive compounds. Molecular docking showed the best position of each bioactive compound on the different target proteins that are involved in the process of apoptosis in EnMSCs.

Conclusion: In vitro and in silico analyses of CPE bioactive compounds show that they may downregulate the cell inflammatory pathway involved in the pathophysiology of endometriosis.

Endometriosis is a common gynecological disease that occurs in between 6 and 10% of women who are at reproductive maturity. The presence of endometrial tissue outside the uterine cavity is the defining characteristic of this disease. Although the etiology of endometriosis remains controversial, there is a general consensus that multiple biological processes such as angiogenesis and vasculogenesis, oxidative stress, and inflammation contribute to its complex pathophysiology. Patients' expectations and priorities influence the treatment plan that is selected. For instance, therapy with hormone medications is inappropriate for endometriosis patients who wish to become pregnant since these medications interfere with ovulation. On the other hand, considering that the current endometriosis treatments are associated with recurrence of pain and disease despite the treatment of the disease and have many side effects, the design and application of non-hormonal drugs in this field is very necessary. Therefore, in this article, we tried to have an overview on non-hormonal treatments by considering angiogenesis, oxidative stress, and inflammation as important biological processes involved in endometriosis.

Background: The follicular fluid (FF) of mature oocytes contains a high concentration of growth factors and cytokines that have the potential to influence implantation in either a paracrine or autocrine manner. During the physiological processes of ovulation, FF enters the fallopian tubes in conjunction with the oocyte. The purpose of this study is to evaluate implantation and clinical pregnancy rates following uterine flushing with FF and granulosa cells in infertile women with moderate male factor infertility after ovum retrieval for intracytoplasmic sperm injection (ICSI).

Materials and methods: This phase III randomised clinical trial enrolled 140 women with moderate male factor infertility who intended to undergo ICSI at Royan Infertility Clinic (Tehran, Iran). A computer-generated program and opaque sealed envelopes were used to randomly allocate patients to either an intervention group (n=70) or a control group (n=70). Participants in the intervention group received 2 ml of clear FF (without blood contamination) from 2 to 3 dominant follicles after oocyte retrieval. The control group only underwent uterine cavity catheterisation.

Results: The intervention group had a clinical pregnancy rate of 38.5% (25/65) compared to the control group [42.9% (27/63); P=0.719] and an implantation rate of 24.1% compared to the control group (27%; P=0.408). These rates did not differ between the groups. There were no statistically significant differences between the intervention and control groups in terms of pregnancy-related complications-ectopic pregnancy, blighted ovum or anembryonic pregnancy, and abortion.

Conclusion: Uterine cavity flushing with FF from mature follicles following oocyte retrieval had no effect, either positively or negatively, on clinical pregnancy or implantation rates in women with moderate male factor infertility (registration number: NCT04077970).

Background: Blastocyst stage transfer appears to improve pregnancy outcomes. The aim of this study is to evaluate the pregnancy results between fresh cycle blastocyst stage embryo transfer and cleavage stage embryo transfer in patients who undergo intracytoplasmic sperm injection (ICSI).

Materials and methods: This randomised clinical trial study was conducted at the Infertility Research Centre of Milad Hospital in Mashhad, Iran from 2018 to 2020 on 240 infertile women who presented for their first ICSI procedure. These patients were assigned to receive either cleavage embryo transfer (n=112) or blastocyst stage transfer (n=107). Pregnancy outcomes were measured in both groups.

Results: There were no differences regarding age, body mass index (BMI), serum follicle-stimulating hormone (FSH), duration of infertility, and aetiology of infertility between the groups (P>0.05). There were more follicles, total oocytes, and metaphase II (M2) oocytes in the blastocyst stage group. Considerably more cleavage stage embryos were transferred compared to the number of transferred blastocysts (P=0.001). The blastocyst group had more vitrified embryos than the cleavage group (P=0.000). The rates of implantation (P=0.332), chemical pregnancy (P=0.165), clinical pregnancy (P=0.694), and live births (P=0.727) were higher in the blastocyst group, but they were not significantly different. The rate of abortion was also not significantly higher in the blastocyst group (P=0.296).

Conclusion: Blastocysts transferred in the fresh cycle of an ICSI procedure may be more advantageous compared to cleavage stage embryo transfer (registration number: IRCT20181030041503N1).

Background: There is an ongoing debate about the optimal dosage of gonadotropin-releasing hormone (GnRH) agonist for oocyte triggering in polycystic ovarian syndrome (PCOS) patients at risk for ovarian hyperstimulation syndrome (OHSS). In this study, we intend to ascertain whether the use of repeated doses of a GnRH agonist for oocyte triggering in these patients can enhance the outcomes of controlled ovarian stimulation (COS) for in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles.

Materials and methods: This randomised clinical trial enrolled 70 PCOS women candidates for IVF/ICSI with the standard antagonist protocol at Royan Institute (Tehran, Iran) from May 2020 to June 2022. Patients at risk of OHSS with oestradiol (E2) levels >3000 pg/ml on the day of trigger were randomly assigned to a control or experimental group. Group A (control group) patients received 0.2 mg triptorelin (Decapeptyl^®) for final oocyte maturation. Group B (experimental group) patients received a second dose of 0.1 mg Decapeptyl^®12 hours after their first dose, for a total dose of 0.3 mg. IVF/ICSI outcomes were compared between the groups.

Results: Ultimately, 35 women from the study group and 33 from the control group completed the treatment cycle. Both groups were comparable in terms of demographic characteristics, baseline hormonal profiles, and PCOS phenotypes. The dosage of gonadotropin, stimulation duration, number of retrieved oocytes, oocyte maturation rate, and oocyte recovery ratio did not significantly differ between the groups. No significant differences were found in terms of the number of blastocyst and cleavage embryos, nor the quality of obtained embryos between the groups. The mild to moderate OHSS rate was significantly lower in the study group (P=0.038).

Conclusion: A second dose of GnRH agonist 12 hours after the first dose did not improve the number and maturity of oocytes, or pregnancy outcomes in PCOS patients (registration number: NCT04600986).

Background: Severe oligoasthenoteratozoospermia (OAT), characterized by a reduced sperm count, motility, and altered morphology, presents a significant challenge in the field of male infertility. Platelet-rich plasma (PRP), renowned for its regenerative capabilities, emerges as a potential intervention for this condition. This study aims to explore the impact of PRP on male infertility, focusing specifically on individuals with severe OAT.

Materials and methods: The clinical trial study involved 88 infertile men diagnosed with OAT and devoid of underlying diseases. These participants were referred to the infertility center and subsequently divided into two cohorts: a control (44 individuals) and an intervention group (44 individuals). Patients in the intervention group received 2 cc of PRP in each testicle, prepared by centrifuging the patients autologous blood samples. Sperm parameters and DNA fragmentation index (DFI) of the patients were measured before and after the procedure. Statistical analysis used SPSS version 16 software, with a significance level set at less than 5%.

Results: The statistical analysis revealed a significant difference in concentration (11.32 ± 8.44 vs. 16.06 ± 15.16, P=0.030), progressive motility (8.86 ± 7.79 vs. 11.97 ± 11.82%, P=0.014) and DNA fragmentation (25.62 ± 12.84 vs. 17.23 ± 9.15%, P<0.001) between the control and intervention groups after PRP injection. However, no significant difference was found in normal morphology (1.63 ± 1.44 vs. 1.81 ± 3.68%, P=0.628) and volume (2.13 ± 0.82 vs. 2.24 ± 1.43, P=0.663) between the control and intervention groups after PRP injection.

Conclusion: This study demonstrates the effectiveness of PRP treatment in increasing sperm concentration and motility, while also reducing sperm DNA fragmentation. However, further studies are needed to validate these findings (registration number: IRCT20220317054318N2).

Background: Embryo transfer (ET) is an important step in assisted reproductive technology. Uterine length measurement before ET (ULMbET) enables the determination of catheter length and anatomical variation before the ET. Therefore, in this study, we aim to compare ULMbET and transabdominal ultrasound-guided ET (TAUGET).

Materials and methods: This open-label randomised clinical trial enrolled 264 women who were scheduled for frozen- thawed ET (FET) cycles. The women were randomised to the ULMbET or TAUGET group for ET. The primary outcome of this study was clinical pregnancy.

Results: A total of 132 women were randomly assigned to the ULMbET group and 132 women to the TAUGET group. However, four women in the ULMbET group did not receive the allocated method after randomisation. Finally, 128 women from the ULMbET group and 132 women from the TAUGET group were assessed. No statistically significant differences existed in chemical pregnancy rate (31.3 vs. 36.4%, P=0.384), clinical pregnancy rate (23.4 vs. 28%, P=0.397), and implantation rate (15 vs. 17.8%, P=0.401) between the ULMbET and TAUGET groups, respectively.

Conclusion: The results of this clinical trial show no differences in pregnancy outcomes in FET cycles following ULMbET and TAUGET (registration number: IRCT20110509006420N240).