Journal of Human Reproductive Sciences最新文献

Background: An increasing number of studies have demonstrated that excessive proliferation and apoptosis play a pivotal role in the development of endometriosis.

Aim: The aim of the study was to evaluate the expression of long non-coding RNA (lncRNA) FAS-AS1, FAS, soluble Fas (sFas) and caspase-3 in patients with different stages of endometriosis.

Setting and design: The design of the study was a cross-sectional study.

Materials and methods: The relative expression of lncRNA FAS-AS1 and FAs gene was evaluated by the quantitative real-time polymerase chain reaction in 60 ectopic endometrial samples from women with endometriosis in relation to 85 normal endometrial tissues from healthy women, whereas the protein level of sFAs in the peritoneal fluid samples and cleaved caspase-3 in ectopic and normal endometrial tissue samples were determined using the enzyme-linked immunosorbent assay and western blot, respectively. Furthermore, in silico analyses were performed to investigate protein-protein interactions as well as molecular function and cellular location of selected proteins.

Statistical analysis used: The student's t-test was used to analyse the difference between the means of the two groups.

Results: The expression of FAS and sFas increased in endometriosis tissues as compared to the control group (P < 0.05). However, lncRNA FAS-AS1 and cleaved caspase-3 decreased in ectopic endometrial tissues compared to normal endometrial tissues and low lncRNA FAS-AS1 expression was correlated with disease stages. In addition, the in silico analysis revealed the importance of FAS/caspase3 in the biological processes involved in the development of endometriosis.

Conclusion: The current study suggests that lncRNA FAS-AS1 may function as an ectopic endometriotic suppressor. Moreover, the results showed that severity of endometriosis is also closely correlated with the expression of lncRNA FAS-AS1 and sFAS.

Background: Male infertility emerges as an important cause during the evaluation of infertile couples. Varicocele is a well-known cause of male infertility. The role of seminal lactoferrin, an iron-binding glycoprotein, in male fertility is unclear and needs further investigation. Recently, it has been linked to some sperm abnormalities and subfertility.

Aim: This study aims to detect seminal lactoferrin levels in infertile men with varicocele and their relation to semen parameters and fertility status. We investigated a possible link between seminal lactoferrin and iron.

Settings and design: A cross-sectional study was conducted through the outpatient clinic.

Materials and methods: Seventy-five individuals were included in 3 groups (33 infertile men with varicocele, 25 infertile men without varicocele and 17 fertile participants without varicocele). Conventional semen analysis was conducted, and seminal plasma was obtained in all groups to detect lactoferrin and iron levels.

Statistical analysis used: Statistical analysis was performed by SPSS version 24.

Results: In infertile men with varicocele, seminal lactoferrin (155.92 ± 8.4 ng/ml, P = 0.296) and iron levels (260.71 ± 38.3 μg/dl, P = 0.409) were not significantly different from other groups. There was a positive correlation between seminal lactoferrin, iron levels and sperm concentrations and counts. Seminal iron and lactoferrin were significant independent predictors of sperm concentration. A negative correlation was reported between seminal lactoferrin levels and age. Lactoferrin in seminal plasma was not correlated with seminal iron.

Conclusion: Infertile men with varicocele have seminal lactoferrin levels comparable to other infertile men and possibly fertile individuals. Iron concentrations are not linked to lactoferrin levels in seminal plasma.

Background: Ovulation induction (OI) in patients with polycystic ovary syndrome (PCOS) remains challenging, and several biomarkers have been evaluated for their ability to predict ovulation. The predictive ability of candidate biomarkers, particularly with letrozole-based therapy in infertile PCOS women, remains inconclusive as it is yet to be evaluated in a prospective study.

Aim: To assess the role of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinising hormone (LH)/FSH ratio, testosterone and free androgen index (FAI) as predictors of ovarian response to letrozole-based OI therapy during OI cycles in infertile women with PCOS from North India.

Settings and design: A prospective cohort study was conducted in a tertiary care hospital in north India.

Materials and methods: The study enrolled 80 infertile women with PCOS, diagnosed according to the Rotterdam criteria. OI was conducted using letrozole with or without human menopausal gonadotropin. Baseline endocrine and metabolic parameters, including serum AMH, FSH, LH, testosterone and FAI levels, were measured using ELISA or chemiluminescence methods on day 2 of the menstrual cycle. Follicular response to OI was monitored by transvaginal ultrasonography.

Statistical analysis used: Descriptive and inferential statistical analyses were conducted, including Mann-Whitney, Kruskal-Wallis, Independent t-test, analysis of variance, Fisher's exact test and receiver operating characteristic curve analysis. Data were processed using Microsoft Excel and analysed with SPSS software, version 25.0. P < 0.05 was considered statistically significant.

Results: Of 80 women enrolled, 74 responded to letrozole-based OI, while six were non-responders. Body mass index (BMI), serum testosterone and pre-treatment AMH levels significantly correlated with follicular response, with higher values linked to reduced responsiveness. The likelihood ratio+ (95% confidence interval) was 3.32 (2.45-5.06) for AMH, 1.97 (1.03-3.78) for BMI and 1.93 (1.22-3.08) for testosterone. The odds ratio for AMH was 2.88 (1.01-8.21) and 1.25 (1.02-1.53) for BMI. An AMH cut-off of ≤16.43 ng/mL predicted ovarian response with an AUC of 0.88.

Conclusions: Pre-treatment AMH levels, along with BMI and serum testosterone, are significant predictors of ovarian response to letrozole-based OI in infertile women with PCOS.

Background: Recurrent pregnancy loss (RPL) often stems from a hypercoagulable state that exacerbates conditions such as antiphospholipid syndrome (APS) and thrombophilia, leading to early placental issues. Although treatments such as low-molecular-weight heparin (LMWH) and low-dose aspirin (LDA) are used, outcomes vary. This study proposes using first-trimester Doppler ultrasound - specifically, uterine radial artery resistance index (URa-RI) at 8 weeks and uterine artery pulsatility index (Ut-PI) with pre-diastolic notching (Ut-notch) at 11-13 weeks - to better predict successful pregnancies and reduce risks of adverse outcomes.

Aim: The aim of this study was to evaluate URa-RI, Ut-PI and Ut-notch between successful pregnancy and not successful and between pregnancy with adverse events and without.

Settings and design: The study was conducted in a clinical setting, using a retrospective cohort design on a sample of 72 patients with a history of two or more RPL episodes.

Materials and methods: Data on URa-RI measured at 8 weeks and Ut-PI and Ut-notch measured at 11-13 weeks were collected. Maternal characteristics - including age, BMI, number of pregnancy losses, etiopathology and immuno-inflammatory response - were considered in the analysis.

Statistical analysis used: Comparative statistical analysis was performed on URa-RI, Ut-PI and Ut-notch data, evaluating their associations with pregnancy success and adverse outcomes. Variables were statistically compared between successful and unsuccessful pregnancies and also analysed for adverse events. Analysis was performed using SPSS (IBM, 27^th edition). Chi-square tests were applied to nominal categories and multivariate logistic regression adjusted for age, body mass index (BMI), previous pregnancy losses, etiopathology and antinuclear antibody positivity. Primary outcomes (URa-RI, Ut-PI and Ut-notch) were reported with odds ratios and 95% confidence intervals (CIs).

Results: Low URa-RI (<0.45) at 8 weeks gives a 16.4 times higher chance for the management to be successful and result in a healthy take-home baby (95% CI = 4.4-61, P < 0.0001). The mean URa-RI was also significantly higher in unsuccessful pregnancy (0.50 ± 0.09 vs. 0.38 ± 0.04, P < 0.0001). High Ut-PI and positive Ut-notch result in a significant increase of adverse event risk, which are 19.4 times and 8.1 times, respectively (95% CI = 4.2-51.6 and 3.12-20.5, P < 0.0001).

Conclusion: This study demonstrates the utility of first-trimester Doppler ultrasound (URa-RI, Ut-PI and Ut-notch) in predicting pregnancy success and adverse events in patients with RPL, particularly those managed with LMWH and LDA. These ultrasound markers may provide valuable guidance in managing and anticipating outcomes in RPL cases related to thrombophilia and APS.

Background: Intrauterine insemination (IUI) is an effective and inexpensive method of managing patients with unexplained and male factor infertility. It is attempted before proceeding to more invasive assisted reproductive techniques such as in vitro fertilisation and intracytoplasmic sperm injection. Numerous semen parameters have been assessed to indicate successful outcomes with IUI. It is debatable to what extent morphological parameters influence the IUI success.

Aim: We aimed to study the association of sperm morphology and other semen parameters in post-wash inseminated samples with clinical pregnancy rate (CPR) among the couples undergoing IUI.

Settings and design: This was a prospective cohort study conducted between March 2022 and January 2024 in the Department of Obstetrics and Gynaecology, Women and Children's Hospital, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.

Materials and methods: A total of 127 couples presenting with infertility (underwent 246 IUI cycles) were included after written informed consent from study participants, semen collection was done and pre-wash and post-wash semen were analysed as per the World Health Organization Sixth Edition Laboratory Manual for sperm morphology.

Statistical analysis used: Demographic data, semen analysis parameters and CPR results were compared and analysed using SPSS version 19.0.

Results: Among 246 IUI cycles, post-wash sperm morphology was normal in 47.6% and teratozoospermia was noted in 52.4%. Clinical pregnancy was reported in 10.6% (n = 26) of couples, of which 6.1% (n = 15) had post-wash normal sperm morphology and 4.5% (n = 11) had post-wash teratozoospermia. When categorised by strict morphology ≤1%, 2%-3%, 4%-5% and ≥5%, the CPR was 0.0%, 12.0%, 12.6% and 12.9%, respectively. Even though clinical pregnancy was noted only with >1% sperm morphology, there was no significant association between sperm morphology and CPR.

Conclusion: No significant differences in CPR were noted following IUI in couples with post-wash normal and abnormal sperm morphology. Hence, the current study findings suggest that sperm morphology should not be a criterion to exclude couples from undergoing IUI.

Background: Cancer treatments such as chemotherapy and radiotherapy often compromise fertility by damaging gonadal function, creating a critical need for fertility preservation options. Despite advancements in fertility preservation techniques, there is a significant lack of research focused on their application in Asian cancer patients and their utilisation remains underexplored in this population.

Aim: This study aims to evaluate the utilisation rates and outcomes of cryopreserved gametes in cancer patients who underwent fertility preservation before their cancer treatment.

Settings and design: This retrospective study was conducted at our hospital from January 2003 to May 2023. It investigated the utilisation of cryopreserved gametes in 557 male patients aged 15-50 years and 39 female patients aged 15-40 years who opted for fertility preservation before chemotherapy or radiotherapy.

Materials and methods: Data were retrospectively collected, including patient demographics and fertility preservation outcomes. Various fertility preservation methods were employed based on patient suitability and availability. Participants were surveyed to identify reasons for non-utilisation of cryopreserved gametes. All data were collected and analysed following institutional ethical guidelines.

Statistical analysis used: Descriptive statistics were used to calculate utilisation rates and report clinical pregnancy and live birth rates. Reasons for non-usage were categorised into mortality, spontaneous pregnancies, financial constraints and social factors.

Results: Out of 596 participants, only 11 utilised their cryopreserved gametes, yielding a utilisation rate of 1.8%. Among those who used their gametes, clinical pregnancy rates were 66.66% for males and 50% for females, with live birth rates of 33.33% for males and 50% for females. Non-usage was primarily due to mortality, spontaneous pregnancies, financial constraints and social issues.

Conclusion: The utilisation rate of cryopreserved gametes was low at 1.8%. Challenges such as mortality, financial constraints and social factors highlight the need for improved counselling and a refined approach to fertility preservation, ensuring services better align with patients' future needs.

Background: Polycystic ovary syndrome (PCOS) presents a complex diagnostic challenge due to its heterogeneous nature.

Aim: This study aimed to examine the diagnostic utility of various hormones across different PCOS phenotypes.

Settings and design: This cross-sectional study was carried out in 187 newly diagnosed PCOS women (18-40 years) attending the outdoor clinics of the department of endocrinology and obstetrics and gynaecology of a tertiary care centre in India.

Materials and methods: One hundred and eighty-seven PCOS women based on revised Rotterdam 2003 criteria were recruited. Ninety-four age-matched healthy females were taken as controls. All PCOS women were categorised into four phenotypes (A, B, C and D) based on the National Institute of Health (2012) criteria. Detailed clinical examination and hormonal investigations including testosterone, androstenedione, dehydroepiandrosterone sulphate (DHEAS) and anti-Müllerian hormone (AMH) were performed.

Statistical analysis used: The receiver operating characteristic curve (ROC) was generated to find the diagnostic utility of various hormones by using SPSS version 26.0 software.

Results: The largest PCOS group was phenotype A (33.15%, n = 61) followed by phenotype B (28.6%, n = 52), phenotype D (23.9%, n = 44) and phenotype C (16.3%, n = 30). In ROC analysis, AMH and testosterone (except phenotype D) were good diagnostic parameters for PCOS. AMH cutoffs varied from 4.4 to 5.6 ng/mL with sensitivities and specificities ranging from 86% to 97% and 85% to 100%, respectively, across all PCOS phenotypes. In the entire PCOS cohort, AMH at an optimal cutoff of 5.28 ng/mL had sensitivity and specificity of 87% and 97%, respectively, for the diagnosis of PCOS. Optimal testosterone cutoffs were 29.3, 25.1 and 23.1 ng/dL for phenotypes A, B and C, respectively, with reasonable sensitivities and specificities but not in phenotype D. Luteinising hormone (LH), follicle-stimulating hormone (FSH), LH/FSH ratio, androstenedione and DHEAS had low-to-moderate sensitivity across all phenotypes.

Conclusion: AMH is a useful hormonal diagnostic marker for PCOS across all phenotypes.

Background: Thyroid auto-antibodies could be one of the many causes of infertility in women, especially with polycystic ovarian syndrome (PCOS) with a prevalence of 5%-15%. Patients with anti-thyroid antibodies have shown significantly lower fertilisation rates, implantation rates, lower pregnancy rates and increased risk of first-trimester abortions when compared with those without anti-thyroid antibodies.

Aim: The aim of the study was to assess the prevalence of thyroid auto-antibodies in euthyroid infertile women with PCOS and to compare the prevalence of thyroid autoantibodies in euthyroid infertile women with PCOS and without PCOS.

Settings and design: This is a cross sectional analytical study involving 132 Infertile women with and without PCOS visiting the department of OBG in a tertiary care center. The study was conducted for period of 2 years.

Materials and methods: A total of one hundred two women were enrolled in to the study. Sixty six women (66) had features of PCOS based on Rotterdam's criteria and 66 women were controls without PCOS features. Detailed history and examination were done for all women after taking informed and written consent. Previous hospital records were collected along with all biochemical investigations. The blood sample was collected for hormonal levels and thyroid auto-antibodies (anti-thyroid peroxidase [TPO] and anti-thyroglobulin [TG]) were assessed by enzyme-linked immunosorbent assay. The antibody levels were compared between the two groups along with the other parameters.

Statistical analysis used: Statistical tests were done using SPSS version 26. The Chi-square test or Fisher's exact test would be used to study the association of categorical data like the presence of hirsutism, acne, etc. The association of independent variables with outcome variables was assessed using Chi-square. The P < 0.05 was considered significant with a confidence interval of 95%.

Results: Anti-TPO antibody levels were found to be elevated in 25.4% of the PCOS group in comparison to only 3% of the non-PCOS group. Anti-TG antibodies of >100 U/mL were seen in 23 patients (34.3%) in PCOS group in comparison to two patients (3%) in non-PCOS group (P = 0.001). Both the antibodies (anti-TPO and anti-TG) were present in 21.2% of the PCOS group and 1.5% of the non-PCOS group.

Conclusion: Women with PCOS were found to be 11 times more likely to have anti-TPO antibodies and 20 times more likely to have anti-TG antibodies compared to non-PCOS women. This heightened prevalence of anti-thyroid antibodies suggests that testing for these antibodies may be warranted in women with PCOS, even if they have normal thyroid function. However, further studies with larger sample sizes are needed to validate these findings.