Iranian Journal of Reproductive Medicine最新文献

Background: The omega-3 (ω-3) fatty acid eicosapentaenoic acid (EPA) is currently used in the clinic as a nutritional supplement to improve infertility, particularly in women with polycystic ovarian syndrome (PCOS).

Objective: The present study was designed to investigate the effect of EPA on insulin-like growth factor 1 (IGF-1) and cyclooxygenase 2 (COX-2) gene expression in primary cultured granulosa cells from patients undergoing in vitro fertilization (IVF), and also to compare this effect with those in granulosa cells of PCOS patients.

Materials and methods: In this experimental study, human granulosa cells were isolated from follicular fluid of normal and PCOS women undergoing IVF by hyaluronidase digestions, followed by Percoll gradient centrifugation. Cells were cultured in vitro, exposed to a range of concentrations of the EPA (25-100 µM) for 24 hr, and investigated with respect to COX-2 and IGF-1 gene expression by real time-PCR.

Results: In both groups, all doses of the EPA significantly induced IGF-1 mRNA gene expression compared to the untreated control. High doses of EPA in the presence of recombinant (r) FSH produced a stimulatory effect on IGF-1 and a suppressive effect (p=0.01) on the COX-2 gene expression, which were more pronounced in granulosa cells from PCOS patients.

Conclusion: EPA affect diversely the gene expression of IGF-1 and COX-2 in granulosa cells, which were more pronounced in PCOS compared to control. These findings represent the possible underlying molecular mechanisms for the positive impact of the ω-3 fatty acids on reproduction, especially in patients with PCOS.

Background: Sarcoma botryoides of cervix is a rare variant of rhabdomyosarcomas (RMS) of female genital tract. It is usually diagnosed in first or second decade of life. In this case report, we aimed to present a 21 year-old nulligravid patient who was diagnosed with embryonal RMS of the cervix, to discuss the treatment options that have been stated in the literature, and to highlight the advantage of fertility sparing management in these young patients.

Case: We report a 21-year-old nulligravid woman complaining about a mass protruding from introitus, which was represented with a 8×7 cm "grape-like" cervical polyp on speculum examination. The histopathologic examination of the biopsy taken was combined with immunohistochemical staining with desmin, myogenin, S100, vimentin, and myoglobin. Colposcopy, second biopsy, and positron emission tomography were used during the follow-up. The histopathologic examination revealed embryonal RMS of cervix. She received three cycles of combination chemotherapy, doxorubicin and ifosfamide. She refused to have a surgery because of an unplanned, desired pregnancy at two months after the chemotherapy. She was lost during the follow-up. After having an uneventful pregnancy and a successful delivery, she reapplied at postpartum 6(th) month. Colposcopic evaluation revealed a local polypoid area, the histopathologic examination of biopsy suggested recurrence even though positron emission tomography scans were unremarkable. Therefore complementary treatment was planned as conization and pelvic lymphadenectomy. The histopathology revealed no residual tumor on the conization material and no involvement of pelvic lymph nodes.

Conclusion: Fertility sparing management, including doxorubicin and ifosfamid combination in chemotherapy step, can be management option. Pregnancy and successful delivery is possible during the treatment. Colposcopy has importance for early detection of recurrences.

Background: Premature luteinization during in vitro fertilization was commonly happened before the introduction of GnRh analogues. High level of unwanted progesterone is associated with adverse pregnancy outcome and is thought to be induced by inappropriate LH elevation.

Objective: To evaluate the progesterone level on the day of Human Chorionic Gonadotropin (HCG) triggering in GnRh agonist and antagonist protocols, and its correlation with clinical pregnancy rate and miscarriage rate.

Materials and methods: One hundred and seven women underwent intracytoplasmic sperm injection with long agonist protocol (n=46) or antagonist protocol (n=61). Blood sample was obtained from each patient for progesterone level measurement in HCG administration day, then patients were divided into two groups according to their serum progesterone levels on the HCG triggering day: progesterone level <1.2 ng/ml, and progesterone level ≥1.2 ng/ml. Clinical pregnancy and miscarriage rates were evaluated as main outcomes and biochemical pregnancy rate and implantation rate were considered as secondary outcomes.

Results: The increased prevalence rate of premature progesterone (progesterone level ≥1.2 ng/ml) in total patients was 13.1% (14/107) and in long agonist protocol group and antagonist protocol group was 15.2% (7/46) and 11.5% (7/61) respectively. Premature progesterone rise had no significant correlation with clinical pregnancy rate in total patients (p=0.174), agonist protocol (p=0.545), and antagonist protocol (p=0.129). Also premature progesterone rise had no significant association with miscarriage rate in total patients (p=0.077), agonist protocol group (p=0.383) and antagonist protocol group (p=0.087).

Conclusion: A significant rise in progesterone levels at the time of HCG triggering doesn't lead to decrease in pregnancy rate and implantation rate and increase in miscarriage rate.

Background: Central obesity and hyperinsulinaemia of polycystic ovary syndrome (PCOS) are associated with chronic sympathetic over activity.

Objective: To evaluate the autonomic functions and to indicate the superiority, if any, for those functions in the diagnosis of sympathetic over activity in PCOS women.

Materials and methods: Sixty-four PCOS patients and 40 women served as the control group were studied. The two groups were subdivided according to the body mass index (BMI) into two obese and non-obese groups. Waist:hip ratio (WHR), plasma epinephrine level was estimated, sympathetic skin response (SSR); postural orthostatic tachycardia syndrome, heart rate variability (HRV), and valsalva ratio were measured in both groups.

Results: Compared to the control group, obese PCOS patients demonstrated higher BMI and WHR, reduced palmar SSR latency and higher amplitude, altered HRV, higher plasma epinephrine level, and rapid pulse rate. Moreover, non-obese patients show reduced palmar SSR latency and higher amplitude, higher plasma epinephrine level, and higher pulse rate. BMI and WHR of the patients were positively correlated with plasma epinephrine level; while the HRV was negatively correlated WHR.

Conclusion: Women with PCOS exhibits altered autonomic function and sympathoexcitation is more pronounced in obese than non-obese patients; therefor the SSR could be useful auxiliary electrophysiological test to predict autonomic dysfunction in those patients. Receiver operating characteristics curve demonstrate the pulse rate in standing position as the autonomic function test that is superior to others in predicting sympathetic over activity in those patients.

Background: Methamphetamine (MA) is one of most common illicit drugs which were reported that nearly half of MA consumers are women. MA can cross through placenta and affects pregnancy and fetus development.

Objective: Our aim was to evaluate effects of injected MA on crown-rump length, head and placental circumference, body weight, histological changes and apoptosis in fetus.

Materials and methods: Twenty-four NMRI pregnant mice were randomly divided into five groups. First, second and third groups were injected intraperitoneally 10 mg/kg/day MA during gestational days (GD): GD1-7, GD8-14, and GD1-14, respectively. Forth group, as sham, was injected saline from GD1-14, and finally control which was received neither MA nor saline. On GD15 cervical dislocated pregnant mice, fetus and placenta were weighed and fetus crown-rump length was measured. Hematoxylin and Eosin staining and TUNEL assay were applied to assess histological changes and apoptosis respectively.

Results: Fetus body weight and crown-rump length showed significant decrease in third compared to first and second groups (p≤0.001). There were significant differences in head circumference in control and sham compared to third group (0.5 (0.5-0.6), 0.6 (0.5-0.8), 0.4 (0.4-0.5) cm respectively, p≤0.001). Also fetus that treated with MA showed lower placenta circumference compared to control and sham groups. Histological changes such as exencephaly, hemorrhage and immature fetus were observed in second and third groups. Apoptotic cells in second and third groups were higher than controls, but differences were not significant.

Conclusion: It seems MA abuse during pregnancy can cause morphological and histological changes in mice fetus but the exact mechanism remains unclear.

Background: Recently there is a focus on the antioxidants as adjuvant treatment of polycystic ovary syndrome (PCOS), the most endocrinopathy in reproductive age women.

Objective: The aim of this review is answer to the question whether antioxidants are effective for managing of hormonal and metabolic problems in women with PCOS based on first degree evidences from Iran.

Materials and methods: A systematic review of clinical trials was done in Persian and international databases including PubMed, Scientific Information Database, Google Scholar, Iran Medex, and Magiran up to 2013. Keywords were including polycystic ovary syndrome, Iran, vitamin, antioxidant. From 440 potential studies found electronically, 11 studies; including 444 women in intervention and 390 women in control groups. Intervention in three studies was Calcium-vitamin D or calcitriol; in three studies was ω-3 fatty acids; in two studies was N-acetyl cysteine; in one study was folic acid; in one study was Zinc; and in one study was Soy.

Results: Finally, 11 studies that were relevant and met the inclusion criteria reviewed. There were 7 studies in English and 4 studies in Persian. We couldn't include all studies because all full texts were not accessible.

Conclusion: The results showed that antioxidants and vitamins have positive effects on management of PCOS women. Although it seems more studies is necessary in this field.

Background: Intrauterine insemination (IUI) is one of the most appropriate and cost-effective methods in infertility treatment.

Objective: We aimed to investigate effect of vaginal misoprostol on pregnancy rate after IUI.

Materials and methods: Two hundred and ten infertile women who were referred to Infertility Clinic of Alzahra Hospital by an indication of IUI during 2012-2013 were randomly assigned to receive 200 µg vaginal misoprostol (n=105) or vaginal placebo (n=105) after IUI. For detecting pregnancy, past 2 weeks, beta human chorionic gonadotropin evaluation was made and if positive, transvaginal sonography was done for evaluation of pregnancy 2-3 weeks later and clinical pregnancy was recorded.

Results: Pregnancy had been noted in 24 patients in misoprotol (22.9%) and 27 patients in placebo (25.7%) groups that this difference was not significant (p=0.748). In misoprostol group, 3 case of nausea and vomiting (2.9%) had been observed.

Conclusion: According to the results, administering 200 µg vaginal misoprostol after IUI doesn't have significant effect on the success rate of IUI.

Background: Preeclampsia is a disorder of pregnancy without any specific reasons that characterized by high blood pressure and large amounts of protein in the urine. This disorder is caused by multiple factors and finding any factor related to this disorder can help on time prevention of this disease.

Objective: In this study, serum levels of calcium (Ca), magnesium (Mg) and zinc (Zn) were evaluated in preeclampsia women and compared to normotensive ones.

Materials and methods: This was a case-control study on 40 normotensive pregnancies as controls, 20 mild and 20 severe preeclamptic pregnancies as case groups. The women were studied in their 28-40 weeks of pregnancy. Simple random sampling was done based on inclusion and exclusion criteria and data were collected by blood sampling.

Results: The serum Ca levels of 4.96±0.62, 4.89±0.34, 5.05±0.35 mg/dL, Mg levels of 0.83±0.08, 0.85±0.11, 0.84±0.11 mg/dL and Zn levels of 107.55±22.74, 108.00±22.40, 107.50±22.30 mg/dL was detected in normotensive, mild and severe preeclampsia, respectively. Statistical analysis revealed that there were no significant differences between three groups in serum levels of Ca (p=0.6), Mg (p=0.827) and Zn (p=0.997).

Conclusion: The findings of this study showed that the assessment of serum Ca, Mg and Zn levels does not have any clinical values for predicting and/or managing of preeclampsia. However, based on the positive relationship between serum Ca and Mg concentration and the severity of preeclampsia in this study, we recommend assessment of serum levels of these two mineral elements as indices of the severity of preeclampsia.

Background: Progesterone has been suggested to contribute to the regulation of spermatogenesis and to facilitate the production of viable sperm. Investigations have showed that polymorphism of progesterone receptor (PGR) is associated with some diseases.

Objective: To analyze the potential relationship between male infertility and the +331G/A and progins polymorphisms of PGR gene.

Materials and methods: The cross-sectional study was carried out at the Department of Male Reproduction, Reproductive Medical Center, the Second Hospital of Jilin University. The restriction fragment length polymorphism (RFLP) technique was used to detect gene point mutations. Of the 145 semen samples analyzed, 35 were asthenozoospermic, 50 were oligoasthenozoospermic, 21 were azoospermic, 11 were teratozoospermic and 28 were from fertile male subjects.

Results: Statistical analyses revealed that the genotypes of the +331G/A polymorphisms were in Hardy-Weinberg equilibrium in both the fertile ((2)=0, p=0.534) and oligospermic groups ((2)=0.021, p=0.537). Similarly, the genotypes of the progins polymorphisms were also in Hardy-Weinberg equilibrium in both the fertile ((2)=0, p=1) and oligospermic groups ((2)=0.005, p=1).

Conclusion: Our results indicated that polymorphisms of the +331G/A and progins of the PGR gene are unrelated to male infertility, at least in a Chinese population.

Background: Stanozolol (ST) is a synthetic anabolic-androgenic steroid often abused by athletes. An increasing body of evidence points towards the role of ST misuses in the pathogenesis of a wide range of adverse effects including reprotoxicity.

Objective: The aim of this study was to analyze the possible reproprotective effect of royal jelly (RJ) as an efficient antioxidant in ST-treated mice.

Materials and methods: Adult male mice were divided into four groups (n=5). Two groups of mice received ST (4.6 mg/kg/day) via gavage for 35 days. RJ was given orally to one of these groups at the dose level of 100 mg/kg body weight per day synchronously. Untreated control group and RJ-only treated group were also included. Epididymal sperm characteristics and in vitro fertilizing capacity were evaluated after 35 days.

Results: ST treatment caused a significant (p<0.05) decrease in sperm count and motility and fertilization rate along with poor blastocyst formation and increased sperm DNA damage. Moreover, the incidence of apoptosis and abnormality in spermatozoa was significantly (p<0.05) higher in ST-exposed mice than those of control. The above-mentioned parameters were restored to near normal level by RJ co-administration.

Conclusion: Data from the current study suggest that RJ has a potential repro-protective action against ST-induced reproductive toxicity in mice. However, clinical studies are warranted to investigate such an effect in human subjects.