International Journal of Reproductive Biomedicine最新文献

Background: The beneficial and long-term effects of ovarian platelet-rich plasma (PRP) in assisted reproductive technology cycles are still debatable.

Objective: The aim of the current study is to determine the effect of ovarian PRP on the outcome of in vitro fertilization in women with poor ovarian response.

Materials and methods: This is a systematic review conducted to address the research question through a structured search process. We searched databases including PubMed, ScienceDirect, Scopus, Web of Science, Embase, Cochrane, and Google Scholar search engine using keywords such as "clinical pregnancy", "live birth", "miscarriage", "poor ovarian response", "platelet-rich plasma", and "in vitro fertilization". The search was conducted without a time limit until December 20, 2024. After screening the titles, abstracts, and full texts of 6646 studies, 14 studies were ultimately selected for inclusion in the review.

Results: In 3 studies, no significant effect was observed on abortion rates, but in 1 study, no abortions were reported in the intervention group, raising concerns about the possible role of this procedure. In 5 studies, PRP significantly increased pregnancy success with in vitro fertilization. In contrast, 6 studies found this effect to be non-significant, and 2 reported inconclusive results. In terms of live birth, 5 studies showed a positive effect of PRP, but 3 studies reported non-significant results, and 2 studies reported inconclusive results. One study showed an increase in ongoing pregnancy rates in the PRP group, and 2 studies showed an increase in implantation.

Conclusion: The effectiveness of ovarian PRP in infertility treatment remains unclear due to conflicting results.

Background: All considerable families are seeking genetic counseling aiming to manage the next pregnancy according to the positive family history of heterogenetic disorders. Prenatal diagnosis utilizing next-generation sequencing provides a significant means to identify the causes of genetic abnormalities, allowing for timely interventions that support informed family planning. This study explores the power of whole-exome sequencing (WES) in uncovering genetic variants in couples who are seeking genetic counseling for their next pregnancy.

Case presentations: In this study, WES was used to identify genetic variations associated with disability in families seeking genetic counseling. 3 families who had at least 1 child with developmental delay (DD) and/or intellectual disability (ID) participated in a genetic counselling clinic, Yazd Reproductive Science Institute, Yazd, Iran to have successful outcomes for the next pregnancy. 3 distinct mutation sites from 3 families were diagnosed, following the WES for affected children with intellectual disabilities. Results showed a homozygous de novo stop-gain mutation in malate dehydrogenase 1gene (NM_005917.4:c.4C $>$ T; p.Arg2Ter), a splice acceptor mutation in the post-glycosylphosphatidylinositol attachment to proteins inositol deacylase 1 gene (NM_024989.4:c.1221-1G $>$ T), and a missense mutation in the lysosomal trafficking regulatorgene (NM_000081.4:c.949G $>$ A; p.Glu317Lys) in each family, respectively.

Conclusion: For cases with DD and unexplained ID, WES is a very successful diagnostic approach. Unfortunately, large Iranian families exhibit significant genetic heterogeneity, highlighting the critical role of de novo variants in diagnosis. The results of this study confirm that proteins inositol deacylase 1, malate dehydrogenase 1, and lysosomal trafficking regulatorare involved in the pathophysiology of ID/DD and the transformative potential of prenatal genetic screening.

Background: Advances in assisted reproductive technology have led to improved outcomes through various innovations. The embryo must hatch from its acellular glycoprotein-based outer layer, the zona pellucida, before it can be implanted. Assisted hatching (AH) is a technique proposed to enhance embryo implantation.

Objective: This study aimed to evaluate the efficacy of AH in improving pregnancy outcomes among women with poor ovarian response (POR) undergoing in vitro fertilization/intracytoplasmic sperm injection.

Materials and methods: A randomized controlled trial was conducted involving 170 women with POR (POSEIDON groups 3 and 4) undergoing in vitro fertilization/intracytoplasmic sperm injection at the Yazd Reproductive Sciences Institute, Yazd, Iran from December 2023-June 2024. Participants were randomly assigned to either the hatching group or the control group. Clinical pregnancy, chemical pregnancy, ongoing pregnancy, and miscarriage rates were compared between the 2 groups.

Results: No significant difference was observed between the hatching and control group in terms of chemical pregnancy (24.4% vs. 17.3%. p = 0.271), clinical pregnancy (23.1% vs. 14.8%, p = 0.183), ongoing pregnancy (16.7% vs. 11.1%, p = 0.310), and miscarriage rates (27.8% vs. 25.0%, p = 0.866). However, a significant difference was observed in the frozen embryo transfer subgroup, with the hatching group demonstrating significantly higher rates of ongoing and clinical pregnancies compared to the control group.

Conclusion: While AH did not demonstrate overall benefits in improving pregnancy outcomes in women with POR, it may enhance the chances of ongoing and clinical pregnancy in frozen embryo transfer cycles.

Background: Obesity and metabolic syndrome (MetS), as components of excess body weight, have reached global epidemic levels.

Objective: The study aimed to investigate the features of the MetS course in men and women of reproductive age.

Materials and methods: This cross-sectional study was conducted with 140 participants aged between 35 and 49 yr at City Polyclinics No. 1, 3, and 4, Aktobe, Kazakhstan from March 2016-2019. Participants were divided into 2 subgroups based on diagnosis of MetS. The case group (with MetS), and the control group (without MetS) (n = 70/each consisted of 40 women and 30 men). Anthropometric, instrumental, and laboratory methods were used to confirm the diagnosis of MetS and determine its features in both groups.

Results: The results showed an increase in the uric acid level in the blood to 431.00 $\pm$ 66.37 $\mu$ mol/L and 5.47 $\pm$ 0.90 mol/day in the urine. Dyslipidemia was also noted in the case group of individuals with high-density lipoprotein levels of 1.22 $\pm$ 0.27 mmol/L vs. 1.32 $\pm$ 0.47 mmol/L in the control group. The testosterone level was 16.4 $\pm$ 3.04 nmol/L in the case group and 20.3 $\pm$ 5.6 nmol/L in the control. The difference in testosterone level was found to be statistically significant (p $<$ 0.01).

Conclusion: The analysis of sex hormone levels did not reveal any stable trends that could be considered diagnostic. That may indicate a correlation with the reproductive age characteristics of the examined individuals (men and women): significant differences between hormone levels were fixed in the case and control groups.

Background: Conflicting evidence from clinical trials on the effects of myo-inositol and D-chiro-inositol on assisted reproductive technology (ART) outcomes in women with polycystic ovarian syndrome (PCOS) necessitates a systematic review and meta-analysis.

Objective: To evaluate the effect of myo-inositol and D-chiro-inositol on ART outcomes in women with PCOS.

Materials and methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Library for studies published from January 2000-2023. Statistical analyses were performed using STATA version 17.

Results: 17 intervention studies were included. myo-inositol/D-chiro-inositol supplementation significantly increased the clinical pregnancy rate (RR: 1.64, 95% CI: 1.25-2.15; I² = 13.5%; p = 0.32) and top-grade embryos (RR: 1.12, 95% CI: 1.02-1.23; I² = 85.43%; p = 0.0001). However, it was associated with reductions in antral follicle count (WMD: -0.78, 95% CI: -1.07 to -0.49; I² = 97.37%; p = 0.001) and anti-Mullerian hormone levels (WMD: -0.46, 95% CI: -0.67 to -0.25; I² = 91.95%; p = 0.001).

Conclusion: This meta-analysis provides reliable evidence on the effects of myo-inositol/D-chiro-inositol on fertility and ovarian function in women with PCOS undergoing ART.

Background: Frozen-thawed embryo transfer (FET) during the endometrial receptivity window is important for implantation.

Objective: This study aims to compare the clinical pregnancy rate in 2 methods of endometrial preparation in FET using the hormone replacement cycle (HRC) and the modified natural cycle (mNC).

Materials and methods: In this randomized clinical trial, 128 infertile women who visited the Imam Khomeini hospital infertility clinic, Sari, Iran between April and October 2024 were randomly assigned to 2 groups (n = 64/each): the mNC frozen embryo transfer group and the HRC group. In the mNC frozen embryo transfer group, ovulation was induced using human chorionic gonadotropin, and the timing of frozen embryo transfer was scheduled based on ovulation. The HRC group received estradiol valerate until the endometrial thickness reached 8 mm, then daily injections of progesterone were added and FET were performed.

Results: The participants had no significant differences in demographic characteristics. The primary outcome was clinical pregnancy rate with no significant difference between two groups (p = 0.282). No significant differences were observed between the mNC and HRC groups regarding the secondary outcome, which included human chorionic gonadotropin positive rate, chemical pregnancy rate, implantation rate, ongoing pregnancy rate, early miscarriage, ectopic pregnancy, twin pregnancy, and cycle cancellation rate. Significant differences were observed in the number of monitoring visits between the mNC frozen embryo transfer and HRC groups (p = 0.001).

Conclusion: Although the results indicate that the impact of both methods is similar, the fact that fewer visits are required in a natural cycle and there is also less need for hormones could make it preferable.

Background: Premature ovarian failure (POF) is a condition characterized by the loss of ovarian function, leading to infertility.

Objective: This study aims to examine how estradiol supplementation impacts the in vitro maturation of immature oocytes in NMRI female mice exhibiting cyclophosphamide-induced POF.

Materials and methods: In this experimental study, 15 female NMRI mice (8-10 wk, 30 $\pm$ 5 gr) were divided into 3 groups: control, sham, and treatment. The treatment group was divided into 3 categories. Treatment group 1, which added 0.5 μg/ml estradiol to the basic culture medium, and treatment groups 2 and 3, which were added to the culture medium, respectively. They added 1 and 1.5 µg/ml of estradiol to their basic culture medium. The treatment group received cyclophosphamide injections for 21 days to induce POF and then was treated with different doses of estradiol. The sham group also received all necessary interventions except estradiol treatment. After the induction, histological studies were conducted on the ovaries of all groups. Additionally, after stimulating and separating the ovules from the ovary, they were cultured in in vitro.

Results: Analysis of oocyte maturity stages showed distinct features. Germinal vesicle oocytes' lowest percentage was in control (3.13%), and highest in sham (76.25%) (p $<$ 0.0001). Estradiol dose inversely affected immature oocyte maturation, with the lowest in treatment group 3. Germinal vesicle breakdown oocyte percentage increased with estradiol dose. Metaphase II oocytes' highest maturation was in control (64.00%), and lowest in sham (5.00%) (p $<$ 0.0001). Treatment groups showed varying rates. Degenerate oocyte percentages were lowest in control (1.80%), and highest in sham (10.27%) (p $<$ 0.0001).

Conclusion: Our study showed that using a dose of 1.5 μg/ml estradiol in vitro results in the highest oocyte maturation in the POF condition and contributes to the existing knowledge on POF and provides insights into potential therapeutic interventions aimed at improving fertility outcomes in individuals with POF.

Background: The number of follicles aspirated during intracytoplasmic sperm injection (ICSI)/in vitro fertilization (IVF) treatment does not always match the number of oocytes recovered.

Objective: This study aimed to assess the oocyte retrieval rate (ORR) distribution data and investigate the risk factors for low ORR in polycystic ovary syndrome (PCOS) cases undergoing IVF/ICSI.

Materials and methods: This prospective cohort study was conducted on 140 women aged between 18 and 40 yr with PCOS who were referred to Arash hospital in Tehran, Iran for ICSI/IVF treatment from March to November 2024. The ratio of obtained oocytes to follicles ( $\ge$ 17 mm) on the trigger day was used to determine the OPR. 140 women were split into 2 groups: one with a low ORR and one with a normal ORR, each separated by one standard deviation from the ORR mean.

Results: No significant difference was observed between the low and normal ORR groups for progesterone levels. A statistically significant difference was observed in terms of estradiol/follicle ratio above 17, number of follicles above 17, and number of retrieved eggs between the low and normal ORR groups. Logistic regression analysis showed that serum estradiol/follicle ratio ( $\ge$ 17 mm) with (OR = 0.96, 95% CI [0.94-0.98], p = 0.001) was a factor affecting low ORR.

Conclusion: Low ORR, which results in fewer embryos and more cycle cancellations, may be caused by low progesterone levels on the trigger day, low estradiol levels/follicles ( $\ge$ 17 mm), and the use of the progestin-primed regimen in PCOS cases.

Background: Adenomyosis is a gynecological disorder characterized by the presence of endometrial tissue within the myometrium, with incidence rates ranging from 10-65% among women of reproductive age.

Objective: This study utilized transcriptomic analysis to identify significant biomarkers associated with inflammation in endometrial tissue from patients with adenomyosis.

Materials and methods: In this bioinformatics study, we utilized publicly available transcriptomic datasets. The research involved the systematic analysis of RNA sequencing data obtained from the NCBI-GEO database. Using a high-throughput RNA sequencing database from GSE190580 and GSE157718, we compared gene expression profiles between endometrium tissues of adenomyosis patients and healthy controls. Subsequently, pathways implicated in adenomyosis were analyzed through the Kyoto Encyclopedia of Genes and Genomes and gene ontology.

Results: Pathway analysis revealed the aberration of inflammation-related pathways, including tumor necrosis factor (TNF) and Ras-related protein 1 signaling. Furthermore, gene ontology analysis uncovered key biological processes, such as macrophage differentiation and extracellular matrix organization, which are central to the inflammatory response in adenomyosis. Candidate biomarkers, including transmembrane protein kinases, were identified as potential therapeutic targets. We found the top 5 genes that play a role in inflammation in adenomyosis, including TNF-α-induced protein 6, matrix metalloproteinase 7, TNF-α-induced protein 3, leukemia inhibitory factor, and serum and glucocorticoid-regulated kinase 1. Statistical significance was determined with adjusted p $<$ 0.05.

Conclusion: These findings enhance our understanding of the molecular mechanisms of adenomyosis and propose novel biomarkers for more effective diagnostic and therapeutic strategies.