International Journal of Reproductive Biomedicine最新文献

[This corrects the article DOI: 10.18502/ijrm.v22i9.17475.].

Background: The interpretation of Down syndrome screening results in assisted reproductive technology (ART) pregnancies is challenging. Despite the high psychological burden that false positive results impose on parents, studies that have addressed interpretation of both serum and sonographic markers in both rounds of screening for Down syndrome diagnosis in post-ART pregnancies are limited.

Objective: This review study investigated the types of serum screening and imaging for prenatal diagnosis of Down syndrome in ART pregnancies to know and correctly interpret the results of prenatal screenings in these pregnancies.

Materials and methods: In this systematic review, an extensive search was conducted in Persian and English in PubMed, Web of Science, Scopus, SID, and Google Scholar without any time limit until January 2024 using appropriate keywords. PRISMA guideline, STROBE, and CONSORT checklists were used.

Results: Review of 30 articles showed in the first screening, pregnancy-associated plasma protein-A was significantly lower than normal values compared to spontaneous pregnancies, while free beta-human chorionic gonadotropin, especially in the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) was significantly higher. Some studies also indicated an increase in nuchal translucency in the first trimester of pregnancies resulting from ART. Biochemical markers of second screening, in some studies, showed an increase in inhibin-A, a decrease in α-fetoprotein, and unconjugated estriol were evident compared to normal values.

Conclusion: Marker levels may be different for the presence of ovulation-stimulating hormones, multiple corpora lutea, twins or multiplets, type of IVF, and changes in egg cytoplasm in ICSI. Study suggests concentration of maternal serum markers, especially free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A, should be adjusted differently for each ART (IVF and ICSI separately).

Background: Several recent studies have shown the beneficial effect of platelet-rich plasma (PRP) in improving endometrial function in cases with repeated implantation failure and thin endometrium. However, the mechanism of this effect is unclear.

Objective: To investigate the direct effect of PRP on the implantation process during embryo transfer (ET) in cases without an obvious history of abnormality on implantation.

Materials and methods: In this randomized clinical trial study, 55 infertile women (20-40 yr) who were candidates for intracytoplasmic sperm injection referred to the Infertility Center of Fatemiyeh hospital in Hamadan, Iran between September 2022 and 2023were randomly divided into intervention and control groups. In the intervention group, PRP was added to the ET medium, while in the control group, a routine ET medium was used. After ET, chemical and clinical pregnancy were measured.

Results: In the intervention and control groups beta human chorionic gonadotropin positivity 14 days after transfer was 33.3% and 39.3%, consecutively (p = 0.646). On day 21 post-transfer, a gestational sac was observed in 33.3% and 35.7% of cases (p = 0.646). By 28 days after transfer fetal heart activity was detected in 33.3% and 35.7% of cases (p = 0.631).

Conclusion: The addition of autologous PRP at the time of ET does not have a direct positive effect on embryo implantation, and the observation of positive effects in previous studies may be indirectly on the uterine microenvironment, which requires time.

Background: Aflatoxin B1 (AFB1) contamination of foods and animal feeds is a public health issue. Exposure to AFB1 induces oxidative stress and can cause male reproductive toxicity. Melatonin (MLT) is a neuro-hormone produced by the pineal gland and the testis and is known as a potent antioxidant.

Objective: This study aims to determine the protective effect of MLT on testicular tissue alterations, sperm parameter indexes, and in vitro fertility assays in mice treated with AFB1.

Materials and methods: In this experimental study, 28 adult male NMRI mice (8-10 wk old, 25-27 gr) were divided randomly into 4 groups: control, MLT (20 mg/kg/day, intraperitoneally), AFB1 (50 $\mu$ g/kg/day, intraperitoneally) and MLT+AFB1. After 35 consecutive days, testis histological changes, sperm quality parameters, the rate of sperm with DNA damage, and in vitro fertilization outcomes up to the blastocyst stage were surveyed and compared between groups.

Results: Our results showed that AFB1 administration induced histological alterations in the testis and significantly decreased all the sperm parameters and in vitro fertility (fertilization and blastocyst formation rates) compared to control. Additionally, the percentages of immature sperms and sperms with DNA damage significantly (p $<$ 0.001) increased in the AFB1-treated group. MLT treatment in the MLT+AFB1group significantly increased testis quality and sperm parameters and improved in vitro fertilizaton rate and in vitro embryonic development.

Conclusion: These findings demonstrated that MLT can compensate for the adverse effects of AFB1 on the quality of testicular tissue, sperm parameters, sperm DNA, and in vitro fertilization outcomes.

Background: Recent studies reveal an association between increased cell-free fetal (cff) nucleic acid in maternal blood and pregnancy challenges like loss, pre-eclampsia, growth restriction, and preterm labor.

Objective: This article assesses the role of cff nucleic acids as potential diagnostic markers for the prediction and monitoring progression of severe pregnancy-related complications.

Materials and methods: In this systematic review and meta-analysis, various databases were searched. Original articles reporting on the role of cff nucleic acids in predicting the complications of pregnancy were included. I square test and funnel plot were used to analyze heterogeneity and publication bias, respectively. The quality of studies was assessed using the critical appraisal checklists for studies created by the Joanna Briggs Institute.

Results: 70 publications were selected for the final qualitative analysis. Articles were published between 2010 and 2023, and most studies were conducted in the USA and China. The majority of studies were conducted on the quantity of cff-DNA (n = 40), and the remaining on microRNA (n = 18), messenger RNA (n = 11), and cell-free RNA (n = 1). The pooled sensitivity of cff nucleic acids for detecting trisomy was found to be 90.9 (95% CI: 80.9-100%). MicroRNA levels were significantly increased in participants with gestational diabetes mellitus, with a standardized mean difference of 1.22 (95% CI: -0.90-3.34).

Conclusion: Fetal nucleic acids can serve as accurate noninvasive diagnostic tools for predicting serious complications during pregnancy.

Background: Endometrial compaction (EC) is an ultrasound evaluation method that may predict assisted reproductive technology outcomes.

Objective: This study aimed to assess the impact of EC on assisted reproductive technology outcomes in frozen embryo transfer cycles with hormone replacement therapy.

Materials and methods: In this cross-sectional study, 100 women who underwent first or second frozen embryo transfer cycle at Yazd Reproductive Sciences Institute, Yazd, Iran from June to October 2024 were included. Endometrial thickness was compared between the day of starting progesterone and embryo transfer day. Then participants were divided into 2 groups, no compaction and compaction group. Biochemical, clinical, and ongoing pregnancy rates (OPR) were assessed between the 2 groups.

Results: Statistically significant differences were observed in biochemical, clinical, and OPR between the compaction and no compaction groups. Logistic regression analysis demonstrated significantly higher pregnancy rates in EC 10-15% and $>$ 15%. We found a significant influence of EC 10-15% (p = 0.02, p = 0.01, p = 0.01), and EC $>$ 15% (p = 0.002, p = 0.001, and p = 0.002) on biochemical, clinical, and OPR, respectively.

Conclusion: EC after progesterone administration in hormone replacement therapy-frozen embryo transfer cycles can increase biochemical, clinical, and OPR. The percentage of EC changes also influence the outcomes of these cycles.

Background: Restoring fertility in male cancer individuals through testicular tissue transplantation faces challenges due to hypoxia-induced loss of spermatogonial stem cells (SSCs). Hydrogel encapsulation was explored to minimize hypoxic damage in testicular tissue transplantation. For this purpose, human amnion membrane (hAM)-derived hydrogel could be an alternative.

Objective: The potential of hAM-derived hydrogel to support testis tissue grafts was evaluated.

Materials and methods: In this experimental study, testicular tissue samples (1-3 mm³) were obtained from 16 male NMRI mice (4-5 wk, 22 $\pm$ 2 gr). These tissue fragments were either encapsulated within a hydrogel derived from a hAM or left unencapsulated (control) prior to being autologously transplanted beneath the dorsal skin of mice subjected to hemilateral or bilateral orchiectomy. The grafted testicular tissues were histologically evaluated for key parameters, including the integrity of seminiferous tubules, survival of SSCs, Sertoli cell functionality, as well as hypoxia and apoptosis on day 21.

Results: No significant differences were observed between groups regarding ST integrity, number of SSCs, Sertoli cell functionality, or the rate of hypoxia-inducible factor 1-alpha and apoptosis (p $\le$ 0.05).

Conclusion: In conclusion, this study demonstrated no effect of hAM hydrogel encapsulation on the outcomes of testicular tissue transplantation.

Background: Polycystic ovarian syndrome (PCOS) is a complex disorder that affects the endocrine, metabolic, and reproductive systems. While controlled ovarian hyperstimulation can increase the number of oocytes retrieved and improve the number of good-quality embryos, it may also negatively affect oocyte maturity, embryo quality, endometrial receptivity, and pregnancy outcomes.

Objective: This study aimed to find out if ovarian hyperstimulation syndrome (OHSS) has negative effects on intracytoplasmic sperm injection outcomes in a sample of PCOS women.

Materials and methods: In this cross-sectional study, data of 84 PCOS women who underwent controlled ovarian stimulation using a flexible antagonist protocol-treated intracytoplasmic sperm injection cycles referred to the Infertility Department of Higher Institute for the Diagnosis of Infertility and Assisted Reproduction Techniques, Baghdad, Iraq between January 2020 and December 2023 was extracted from their medical records. Participants were categorized into 2 groups after undergoing controlled ovarian hyperstimulation protocol: PCOS with OHSS (n = 54) and PCOS without OHSS (n = 30). The dosage was tailored based on age, body mass index, and response to previous stimulation cycles, if applicable. The trigger was administered using decapeptyl 0.2 mg alone or in combination with recombinant human chorionic gonadotrophin, depending on the estradiol levels at the time of the trigger.

Results: Significant differences were observed in the duration of stimulation (p = 0.005), oocyte yield (p = 0.001), mature oocytes (p = 0.001), and fertilized oocytes (p = 0.036); however, no significant difference was observed, neither in number of good quality embryos (p = 0.52) nor in pregnancy rate (p = 0.54) after fresh and frozen embryo transfer between the 2 groups.

Conclusion: OHSS does not affect the embryo quality or pregnancy rate in PCOS women.

Background: Studies have shown that endometriosis significantly has a negative impact on women's mental health and quality of life (QoL), resulting in these participants experiencing a diminished QoL.

Objective: This study aimed to evaluate the effect of laparoscopic surgery on the severity of pain and the QoL of women with different types of endometriosis.

Materials and methods: In this follow-up study 50 women with endometriosis, who underwent laparoscopic surgery, who met a high visual analog score ( $>$ 6) with impaired QoL, lack of response to analgesics, infertility with pain unresponsive to assisted reproductive therapy, and involvement of other organs such as the bowel or ureter at the Amir Al Momenin hospital, Zabol, Iran, from August 2022 to January 2023 were enrolled. The participants were categorized into 2 groups: those with stage IV endometriosis and those with lower stages (I-III). Groups according to the higher occurrence of grade 4 endometriosis, as 55.1% were affected by it. The pain score was measured using the visual analog score, and the participants' QoL score was measured using the endometriosis health profile questionnaire.

Results: The mean age of participants was 32 yr, with a standard deviation of 8.6 yr. Participants were divided into 2 groups: those with grade 4 endometriosis (55.1%) and those with a grade lower than 4, as classified by the American Society for Reproductive Medicine. Over 12 months, both groups experienced a significant decrease in pain severity and QoL scores (p $<$ 0.0001). However, the changes in pain and QoL scores between the 2 groups were not statistically significant (p = 0.520 and p = 0.984, respectively).

Conclusion: Laparoscopic treatment can reduce pain and QoL scores (increase the QoL indices) in women with endometriosis, regardless of the disease's severity.

Of all pregnant women in the United States an average of 1.5% reported to have type 1 or type 2 diabetes mellitus. Our review article will discuss and explore the relationship between pre-pregnancy diabetes and its adverse outcomes in mothers and neonates. Diabetes in pregnancy can cause a myriad of complications, many of which are related to microvascular changes, including diabetic nephropathy and retinopathy associated with preterm delivery, cesarean sections, and intrauterine growth restriction. Pregnant patients with diabetes also have an increased risk of pre-eclampsia, likely due to complications related to abnormal structure and function of the placenta. In addition, cardiovascular complications are more common and may present antepartum, intrapartum, or postpartum. Adverse neonatal outcomes that have been observed in diabetic pregnancies include fetal stillbirth and perinatal death, macrosomia, congenital malformations, respiratory distress, and neurological impairments. These complications explain the increased morbidity and mortality rate of infants of diabetic mothers, and the increased frequency of neonatal intensive care unit hospitalizations after birth. Diabetes in pregnancy causes a spectrum of changes in the maternal-fetal interface. This review addresses the placental changes during pregnancy and its adverse maternal and neonatal outcomes. We strongly believe the material discussed in this article can help in understanding the effects of diabetes during pregnancy which will ultimately aid in designing interventions to prevent these adverse outcomes.