International Journal of Reproductive Biomedicine最新文献

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age and is associated with various hormonal and metabolic complications.

Objective: This study aimed to investigate the association between PCOS and fibrocystic breast disease (FBD) and to analyze the prevalence of FBD across different PCOS phenotypes.

Materials and methods: In this cross-sectional study, data of 120 women diagnosed with either FBD or PCOS who referred to Kamali hospital, affiliated with Alborz University of Medical Sciences, Karaj, Iran from March 2024-March 2025 were extracted from their medical records. Participants were divided into 2 groups: PCOS (n = 65) and control (n = 55). The prevalence of FBD was compared between the PCOS and control groups. Furthermore, the distribution of FBD across different PCOS phenotypes (A-D) based on the Rotterdam criteria was analyzed. Hormonal profiles (luteinizing hormone, follicle-stimulating hormone, testosterone, estrogen, progesterone, anti-Müllerian hormone) and metabolic parameters were also compared between the groups.

Results: The prevalence of FBD was significantly higher in the PCOS group compared to the control group (58.3% vs. 30%; p = 0.003). The highest prevalence of FBD was observed in phenotype A (81.8%). Logistic regression analysis indicated that having PCOS increased the risk of developing FBD by more than 3 times (odds ratio = 3.12; 95% CI: 1.51-6.45). Levels of luteinizing hormone, follicle-stimulating hormone, and testosterone were significantly elevated in the PCOS group.

Conclusion: The findings of this study indicate that PCOS, particularly in phenotypes associated with hyperandrogenism and anovulation, is significantly associated with an increased prevalence of FBD. These results underscore the importance of breast health screening and monitoring in women with PCOS.

Background: Infertility is the inability to conceive after a year of trying, resulting in unintentional childlessness. A clinical decision-support system can enhance diagnosis, reduce costs, improve access, and increase treatment accuracy.

Objective: This study aimed to present a conceptual model for decision support systems in infertility.

Materials and methods: This developmental study, conducted from April-November 2024 in 3 steps. First, PubMed, Scopus, and Web of Science databases were investigated to identify data for decision support systems in infertility. Next, search engines like Google, Yahoo, and Bing, along with artificial intelligence tools such as ChatGPT, Gemini, and Perplexity, helped identify similar systems. Lastly, opinions from 32 infertility experts were collected via a researcher-made questionnaire, with reliability confirmed by Cronbach's alpha of 0.78 and validity confirmed by content validity ratio of 0.60.

Results: In the first step, 16,310 articles were identified; 10 were selected after removing duplicates and applying inclusion and exclusion criteria. In the second step, 71 relevant systems were identified in search engines; 58 were excluded, leaving 13 for further analysis. In the third step, a researcher-designed questionnaire was distributed to 32 experts, yielding key agreement rates of 94% for monitoring and follow-up, 94% for sperm analysis data, 90% for abortion data, and 82.5% for infertility information from health magazines. Requirements grouped into 4 categories: main features (10 elements), patient info management (19 elements), fertility prediction data (16 elements), and secondary features (3 elements). The model's overall agreement was 85%.

Conclusion: Developing a decision-support system for infertility could enhance clinical care and outcomes; however, challenges include standardizing validation methods and considering ethnic diversity.

Background: Fetus-in-fetu (FIF) is an extremely rare congenital anomaly characterized by the development of a parasitic fetus within the body of its twin. This condition typically results from abnormal embryogenesis in a monochorionic diamniotic pregnancy. Its incidence is estimated to be approximately 1 in 500,000 live births, with fewer than 200 cases reported in medical literature.

Case presentation: We report the case of a 21-yr-old pregnant woman at 35 wk and 1 day of gestation, confirmed by first trimester ultrasound. The nuchal translucency screening was delayed due to the patient's late presentation. Her obstetric history included a normal vaginal delivery 2 years prior, resulting in a healthy full-term female infant. Neither the patient nor her spouse reported any significant medical history, genetic disorders, or hereditary diseases. The patient had received routine prenatal care, including folic acid supplementation from conception and one dose of COVID-19 vaccine. She did not receive specialized high-risk obstetric care and was managed with standard prenatal services at a primary healthcare center. Her initial consultation with a gynecologist occurred on October 14, 2024, when the FIF diagnosis was established. All laboratory investigations were within normal limits.

Conclusion: FIF represents a rare yet clinically significant condition that requires high clinical suspicion for accurate and timely diagnosis. Differentiating FIF from mature cystic teratoma is crucial, as their therapeutic approaches and prognostic outcomes differ substantially. Reporting new cases can enhance our understanding of its pathogenesis and contribute to improved patient outcomes.

Background: Most research on postpartum depression (PPD) has predominantly focused on mothers, leaving a gap in understanding fathers' experiences and help-seeking behaviors.

Objective: This study aims to investigate the paternal PPD, addressing its complex causes and ultimately improving family health.

Materials and methods: In this cross-sectional study, 270 fathers of newborns who referred to healthcare centers in Yazd, Iran from September 2023-September 2024 were enrolled. Participants were asked to fill the Edinburgh questionnaire to examine the prevalence and contributing factors of PPD.

Results: A total of 270 fathers participated, with 146 daughters and 124 sons. The average depression score was 8.7 $\pm$ 6.2. The study found no significant difference in depression rates based on fathers' education level (p = 0.09), the number of children (p = 0.1), or history of newborn neonatal intensive care unit hospitalization (p = 0.5). However, a significant correlation was identified between depression and monthly income (p = 0.002) and having a baby girl (p = 0.03). Overall, 81 fathers (30%) reported experiencing depression.

Conclusion: The findings highlight the need for long-term planning to address paternal depression, emphasizing that healthcare systems should not only focus on maternal mental health but also recognize the psychological challenges faced by fathers. Supporting fathers is crucial for the well-being of both mothers and newborns.

Infertility has increasingly become a global medical challenge. Environmental exposures have been suggested to interfere with reproduction. This review focuses on the impacts of climate and chemical exposures on reproductive functions and assisted pregnancy outcomes in the Eastern Mediterranean region. The search strategy was applied to PubMed and Scopus databases including publications from January 2012-June 2024. 63 studies investigating climatic factors, chemical exposures, trace elements, and smoking among the Eastern Mediterranean region population were included. Around 59% (n = 37) and 36% (n = 23) of the analyzed publications evaluated male factors and female factors, respectively. A decrease in sperm parameters was correlated to high temperatures, bisphenol A, and air dust exposures. Men endocrine reproductive system is negatively affected by phthalates and pesticides containing products. Trace elements showed a double role regarding reproduction. Heavy smokers were found to have poorer semen quality compared to regular smokers. The available evidence summarizing environmental exposures and smoking habits, and infertility assistance outcomes is limited and inconsistently distributed across the studied region. Addressing the vast health disparities and cultural and social discrepancies within the region can enhance public awareness, education, policy, and regulation development.

Diabetes mellitus (DM) is a global health concern impacting male fertility through detrimental effects on sperm chromatin structure and DNA integrity. This review discusses how DM impairs spermatogenesis, primarily through the induction of oxidative stress, which can result in significant DNA fragmentation and compromised chromatin integrity in spermatozoa. We examine evidence suggesting that even men with seemingly normal semen parameters might exhibit hidden sperm DNA damage if diabetic. The reviewed literature consistently reports elevated sperm DNA fragmentation indices and increased susceptibility to denaturation in diabetic men compared to healthy controls. Furthermore, the potential for paternal diabetes to influence offspring health through epigenetic modifications in sperm DNA is discussed. Studies in animal models and human subjects indicate alterations in sperm DNA methylation patterns and microRNA content, suggesting a plausible mechanism for the transgenerational transmission of metabolic traits. Finally, the review examines the potential benefits of diabetes treatment in improving sperm parameters and chromatin integrity. Evidence from clinical studies demonstrates that interventions, particularly intensive glycemic control, can lead to measurable improvements in sperm DNA integrity. A comprehensive search was conducted in major scientific databases, including PubMed, Scopus, and Web of Science, to identify studies examining the impact of DM on male fertility using keywords like "diabetes mellitus", "male infertility", "sperm chromatin structure", "DNA fragmentation", and "epigenetics". This review addresses the critical issue of how DM negatively impacts male fertility by altering sperm chromatin structure and DNA integrity. We explore the potential mechanisms involved and the impact of diabetes treatment on sperm quality. Additionally, the emerging concept of epigenetic inheritance and its potential role in this context is discussed.

Background: Since the outbreak of coronavirus disease 2019 (COVID-19), many studies have provided evidence supporting the adverse effects of this condition on the male reproductive system.

Objective: This study aimed to investigate the acute and chronic effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the Omicron variant, on different aspects of male reproductive function.

Materials and methods: This case-control study was performed at Ganjavian hospital in Dezful, Iran from July 2022-January 2023. Participants were stratified into COVID⁺ (n = 35) and COVID^- (n = 35) groups. The study evaluated semen parameters, SARS-CoV-2 ribonucleic acid, oxidative stress (OS) markers, and sex hormones.

Results: The study revealed significant differences in semen parameters consisting of motility (p $<$ 0.001), progressive motility (p $<$ 0.001), and normal morphology (p = 0.001) between the study groups, as well as within the COVID⁺ group comparing the acute and chronic phases. Sperm motility was significantly impaired during the acute phase of COVID-19 but showed improvement in the chronic phase (p $<$ 0.001), indicating the effect may be temporary. Significant differences were also observed in follicle-stimulating hormone, luteinizing hormone, and OS markers (p $<$ 0.001) between the COVID⁺ and COVID^- groups. However, SARS-CoV-2 ribonucleic acid was not detected in any of the semen samples.

Conclusion: In vaccinated men, acute SARS-CoV-2 Omicron infection impaired semen quality elevated OS, and reduced testosterone. These effects are likely caused by fever and testicular inflammation, which can lead to secondary hypogonadism. Moreover, vaccination could likely improve semen quality, but has no protection against secondary hypogonadism.

Background: Arrest in the progress of labor is one of the important cases of early cesarean section, especially in primiparous mothers, but correct diagnosis of slow progress and measures at the right time based on evidence are the most important issues in the prevalence of cesarean section during vaginal delivery.

Objective: The present study investigated the impact of the World Health Organization labor care guide (WHO LCG) on maternal and neonatal outcomes.

Materials and methods: A comprehensive literature search was performed using PubMed, Scopus, Embase, and Google Scholar up to September 2024. Search terms included "labor care guide", "WHO obstetric guidelines", and "next-generation partogram". Studies evaluating maternal and neonatal outcomes following LCG implementation were included, with no language restrictions. The study followed PRISMA guidelines, and data were analyzed using a random-effects model.

Results: The implementation of the WHO LCG was associated with a significant reduction in cesarean section rates (OR = 0.82; 95% CI: 0.76-0.89). It also significantly shortened the second stage of labor and decreased the need for oxytocin augmentation. No statistically significant differences were observed in severe perineal trauma or postpartum hemorrhage. Similarly, neonatal outcomes -including stillbirth, Apgar score, and admission to the neonatal intensive care unit- showed no significant changes.

Conclusion: The WHO LCG contributes to a measurable reduction in cesarean delivery and pharmacologic intervention rates, without increasing adverse maternal or neonatal outcomes. These findings support its broader application as a standardized approach to evidence-based intrapartum care. Further research is recommended to assess long-term neonatal impacts.

Background: Di (2-ethylhexyl) phthalate (DEHP) is one of the environmental contaminants used in plastic objects, causing damage to the reproductive system. Chrysin (CHr) is an effective flavonoid in honey propolis with antioxidant activities.

Objective: This study aimed to investigate the possible protective effects of CHr on DEHP-induced testicular toxicity in male mice.

Materials and methods: In this experimental study, 50 male NMRI mice (4-6 wk, 20-30 gr) were randomly divided into 5 groups (n = 10/each); group I and II received normal saline and oil, group III received DEHP, group IV received DEHP and CHr, group V were intact treated with CHr. Testis weights were measured. Serum testosterone, luteinizing hormone, and follicle-stimulating hormone levels were evaluated. Also, sperm characteristics and histological changes of the testis were analyzed.

Results: Testis weight was decreased in group receiving DEHP. DEHP also reduced the number of sperms, but the administration of CHr improved them. CHr ameliorated DEHP-induced changes in hormonal levels, especially testosterone (p $<$ 0.01). Morphological evaluation of the testis of DEHP-received mice indicated degenerated germ cells with vacuolated cytoplasm, wide intercellular spaces between germinal layers, and loss of spermatozoa in the center of lumens, all of them improved by CHr.

Conclusion: According to our biochemical and histopathological analyses, DEHP led to severe testicular injury. Our results suggest that CHr, as a free radical scavenger, can decrease tissue damage induced by DEHP, be beneficial in alleviating the toxic effects of DEHP on the male reproductive system, and can also be useful in preventing DEHP effects.

Background: Recurrent implantation failure in assisted reproductive technology is a major challenge. Intrauterine human chorionic gonadotropin (hCG) infusion and hyaluronic acid enriched embryo transfer media have shown individual effects, but their combined effect in these cases undergoing frozen-thawed embryo transfer is unknown.

Objective: This study aims to investigate the effect of combined therapy on pregnancy outcomes.

Materials and methods: This is a single-blind, randomized controlled trial on 158 participants. The cases were randomly assigned to either the intervention group (pretransfer intrauterine hCG infusion and embryo loaded with hyaluronic acid-enriched embryo transfer medium at the time of transfer) or the control group (standard embryo transfer medium). The outcomes were chemical and clinical pregnancy rates, implantation, abortion, and ongoing pregnancy rates.

Results: A total of 158 participants were enrolled in this study in 2 equal groups. The intervention did not significantly improve the overall pregnancy rate compared to control (24% vs. 33.7%, p = 0.30). The results showed that, by controlling variables, the chance of clinical pregnancy in the intervention group was 12% lower than in the control group, although the difference was not statistically significant (p = 0.879). With each increase in the number of embryos, the chance of a pregnancy would be 2.26 times higher. Also, the chance of pregnancy in the morula stage was 68% lower than in the cleavage stage (p $<$ 0.05).

Conclusion: The combined approach of intrauterine hCG infusion and the hyaluronan-enriched embryo transfer medium did not significantly improve the overall pregnancy rate but had a significant effect on specific cases using the embryo at the cleavage stage for transfer and cases that received more than one embryo for transfer.