Journal of Human Reproductive Sciences最新文献

Infertility presents multifaceted challenges that encompass both physical and emotional burdens. Yoga, as a comprehensive system of mind-body medicine, serves as an effective intervention for managing male factor infertility, a complex lifestyle disorder with significant psychosomatic elements. This review explores the transformative role of yoga in addressing both the emotional and physical dimensions of infertility. By incorporating physical postures, breath control and meditation, yoga promotes emotional well-being and enhances reproductive health by improving the integrity of nuclear and mitochondrial genomes as well as the epigenome. In addition, yoga contributes to maintaining sperm telomere length through the regulation of seminal free radical levels and increased telomerase activity, which are crucial for optimal embryo cleavage and the development of high-quality blastocysts. Integrating yoga as an adjunctive therapeutic approach fosters a supportive intrauterine environment and facilitates physiological homoeostasis, thereby increasing the likelihood of successful fertilisation and implantation. Gentle asanas and flowing sequences promote relaxation, alleviate tension and cultivate emotional stability, while meditation aids in emotional healing and resilience during the infertility journey. Specific asanas, such as Baddha Konasana (bound angle pose), Bhujangasana (cobra pose) and Sarvangasana (shoulder stand), stimulate reproductive organs, enhance blood circulation and regulate hormone production. Pranayama techniques further support endocrine balance and overall vitality. Moreover, yoga provides a non-invasive strategy for managing fertility-related conditions leading to improved reproductive health and overall well-being. This review aims to elucidate the comprehensive role of yoga in improving male infertility, focusing on its impact on sperm nuclear and mitochondrial genomes, the epigenome and telomere health. In addition, it underscores the importance of self-care, open communication and shared experiences with partners. Practicing yoga regularly supports psychosocial well-being, promotes holistic healing, enhances physical and mental health and probably helps in improving reproductive health, thereby fostering resilience and self-efficacy throughout the journey of fertility and reproduction.

Background: As the male factor in infertility is on rising trend, we need a promising tool for sperm selection to improve the embryo development.

Aim: The present study compares the embryological and clinical parameters between physiological intracytoplasmic sperm injection (PICSI) and conventional intracytoplasmic sperm injection (ICSI) in abnormal semen parameters.

Settings and design: This was a retrospective cohort study.

Materials and methods: This study was conducted over the duration of 9 months from April to December 2023. One hundred and four patients, who matched the inclusion and exclusion criteria, were enrolled in the study. The adjusted blastulation rate was evaluated as the primary outcome, and the secondary outcomes studied were fertilisation rate, good-quality cleavage stage embryo rate, clinical pregnancy and miscarriage rate.

Statistical analysis used: The outcome measures were calculated using independent Student's t-test, and P < 0.5 was considered statistically significant.

Results: The 104 enrolled patients were divided into two groups. In the study population (n = 51), PICSI was used for sperm selection and the controls (n = 53) used conventional ICSI. The adjusted blastulation rate was statistically significant higher in the PICSI group (43.7%) as compared to the controls (34.2%) (P = 0.022). The fertilisation and cleavage rates were not statistically different amongst the groups. The pregnancy rate (37.2% vs. 32%, P = 0.027) and miscarriage rate (5.3% vs. 11.7%, P = 0.005) were statistically better in the PICSI group.

Conclusion: PICSI may improve treatment outcomes in couples undergoing assisted reproduction for male factor infertility. However, larger randomised controlled trials are needed for validating the current study findings.

Background: Oocyte diameter is crucial for initiating meiosis and supporting the maturation capability, a prerequisite for successful fertilisation and high-quality embryo development. While numerous studies have explored the correlation between oocyte diameter and embryo development capacity in animal models, limited research appears concerning human oocytes.

Aim: This study aims to ascertain whether oocyte diameter can serve as a reliable predictor of oocyte and embryo quality, achieved through its correlation with protein kinase B (Akt) protein levels on cumulus-granulosa cells and blastocyst morphokinetics.

Setting and design: Prospective cohort study included cumulus-granulosa cells collected from 228 mature oocytes of 32 infertile women undergoing in vitro fertilisation treatment. The diameter of the oocytes was measured using the Image J software, and the samples were categorised into three groups based on their diameter: <105.95 µm, 105.96-118.96 µm and >118.97 µm. Quantification of pAkt and Akt protein total of cumulus-granulosa cells exploited the ELISA method. Embryo morphokinetics and anomaly development events were observed at the blastocyst stage to evaluate embryo quality relative to oocyte diameter.

Statistical analysis used: The Kruskal-Wallis test and Chi-square test were used. P <0.05 was considered statistically significant.

Results: The study revealed no notable difference in pAkt and Akt protein total in cumulus-granulosa cells among the three groups (P > 0.05). Likewise, there were no significant differences in morphokinetics and anomaly development except for the S2 parameter and reverse cleavage.

Conclusion: Reflecting on the molecular profile including pAkt, total Akt protein, morphokinetics and anomaly development, it was observed that oocyte diameter does not correlate with its competency and the quality of the resulting embryo. In addition, oocytes with a diameter below 105.95 µm may have an equal potential to develop into top-quality embryos.

Background: Male sexual dysfunction (MSD) is a common occurrence in diabetic patients, which is not routinely assessed in clinical settings.

Aim: The aim of the study was to assess the prevalence of MSD and hypogonadism in young type 2 diabetes mellitus (T2DM) patients aged between 20 and 40 years and its association with duration, glycaemic control and complications of diabetes.

Settings and design: This is a cross-sectional study involving 70 men with T2DM of 20-40 years of age visiting the endocrinology department in a tertiary care centre. This study was conducted from November 2021 to March 2023.

Materials and methods: Seventy subjects satisfying inclusion criteria were included in the study and assessed using the International Index of Erectile Function-15 questionnaire, intravaginal ejaculation latency time, androgen deficiency in ageing male questionnaire, hormonal parameters (Luteinising Hormone, Follicle stimulating hormone, Testosterone and sex hormone-binding globulin) and penile Doppler.

Statistical analysis used: The statistical analysis was done using SPSS version 21. A P < 0.05 is considered statistically significant. Data were checked for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. For determining statistical significance between continuous variables with non-normal data, the Mann-Whitney U test and Kruskal-Wallis tests were used. Pie charts, bar diagrams and scatter plots were used for descriptive statistics. Frequency, percentage, means, median, range and standard deviation were used for all quantitative data. The Chi-square test was used to find a significant association between categorical variables.

Results: Sixty per cent of men had at least one form of MSD. Hypoactive sexual desire disorder (HSDD) - 44.28% was the most common MSD, followed by erectile dysfunction (ED) - 42.85% and ejaculatory disorders - 18.57%. Penile Doppler was done in 15 patients, of whom 9 patients had normal Doppler, venous incompetence was present in 3, followed by mixed (arterial and venous) in 2 and arterial insufficiency in 1 subject. Hypogonadism was present in 27.14% of men and secondary hypogonadism was the most common cause (84.21%). There was a significant association between neuropathy and ED and between hypogonadism and HSDD. There was also a significant association between fasting plasma glucose, post-prandial plasma glucose and MSD.

Conclusion: MSD is common in young T2DM men, which should be given due importance in clinical practice to improve their quality of life. Glycaemic control is of utmost importance in these men.

Background: Interleukin (IL) genes are essential for regulating the immune and inflammatory processes. Epidemiological studies suggest that polymorphisms in IL genes are associated with a higher risk of recurrent pregnancy loss (RPL).

Objective: This study aimed to examine the association between RPL risk and IL gene polymorphisms.

Materials and methods: A comprehensive search of the literature was conducted using PubMed, Google Scholar and Embase to identify relevant studies published until May 30, 2024. A total of 58 studies involving 13,696 participants (both RPL cases and controls) were included. Pooled odds ratios and 95% confidence intervals were calculated using fixed- or random-effects models, as appropriate, with ReviewManager version 5.4, Cochrane RoB Tool 2 and G*Power 3.1 software.

Results: The meta-analysis revealed significant correlations between RPL risk and genetic variations in IL-1β (-511T > C), IL-6 (-174 G > C) and IL-10 (-1082 A > G and-592 C > A), with statistical significance set at P < 0.05. Ethnic subgroup analysis showed that IL-1β (-511T > C) and IL-10 (-592 C > A) variations were strongly associated with RPL risk in Asian populations.

Interpretation: Our research suggests that genetic variations in IL-1β (-511T > C), IL-6 (-174 G > C) and IL-10 (-1082 A > G and-592 C > A) are associated with susceptibility to RPL.

Limitation: Our meta-analysis concentrated exclusively on single-factor studies and did not consider potential confounding variables such as age, environmental influences and lifestyle, which could affect susceptibility to RPL. In addition, the lack of individual raw data prevented us from investigating gene-environment and gene-gene interactions or the influence of other polymorphisms and cytokines in our analysis.

Protocol registration: http://www.osf.io/qhbva.

Fertility preservation (FP) is critical for those members of the transgender community who desire biological offspring in the future. As gender-affirming hormone therapy and gender-affirming surgeries (GASs) negatively affect future fertility potential, awareness amongst care providers and the transgender population regarding FP and family-building options is the need of the hour. As the first case of childbirth after transgender FP and GAS in India, this will be a beacon of hope for transgender family-building options in India.

Background: Vaginal stents play a crucial role in both non-surgical and surgical management of vaginal agenesis. Different types of stents with variable designs and materials have been described in the literature. However, a summary of various stents described in the existing data and their outcome measures needs to be studied.

Objectives: The objective of the study was to identify and summarise different types of vaginal stents used for patients with vaginal agenesis, to identify the design and material of different vaginal stents and to assess the benefit of using that specific vaginal stent.

Materials and methods: The literature search was conducted in the PubMed database for articles from 2000 to 2024 in the English language. An exploration of grey literature was also included through Google Scholar. The articles were included only if they clearly described vaginal stent, its material, design and advantage of using that particular stent, and any study not directly related to the research question or in which vaginal stent was used for cases other than vaginal agenesis/Mayer-Rokitansky-Kuster-Hauser syndrome/Mullerian aplasia or agenesis were not included in this study. Risk of bias assessment was done using an eight-item tool that included domains of selection, ascertainment, causality and reporting.

Results: A total of 133 abstracts appeared in PubMed, of which, 26 titles/abstracts were related to the research question. Based on inclusion and exclusion criteria, seventeen articles were selected for the review. A total of 905 articles were identified from Google Scholar, of which, 7 were chosen to be included. The literature reports the usage of variable vaginal stents which can be hard, soft, solid or hollow with the option of customisation available.

Interpretation: Based on the results of this review, soft stents are better than rigid stents due to increased patient compliance, a critical factor contributing to the success of the treatment. The resilient nature, comfort and lightweight of the silicone material are more suitable than commonly used acrylic material. However, the choice in a particular case may vary.

Limitations: The majority of articles included in this review were case reports. As the duration and frequency of usage of stents affect the outcome, studies need to be done to evaluate the effectiveness of different types of stents to come to identify the best design and material for vaginal stents.

Prospero registration: CRD42024554676.

Background: Thin endometrium, described as endometrial thickness below 7 mm on embryo transfer day in assisted reproduction cycles, is associated with decreased pregnancy rates. Granulocyte colony-stimulating factor (G-CSF) and oestrogen (E) are two medications used for treatment.

Aim: The aim of this study is to demonstrate the effect of combined G-CSF+E treatment on thin endometrium in a rat model.

Settings and design: Gazi University Laboratory Animals Breeding and Experimental Researchers Center provided the veterinary care.

Materials and methods: Forty-eight female rats were divided into 8 groups (6 rats/group). Groups were named as group 1: control, group 2: control that received G-CSF, group 3: control that received E, group 4: control that received G-CSF+E, group 5: thin endometrium model, group 6: thin endometrium model that received G-CSF, group 7: thin endometrium model that received E and group 8: thin endometrium model that received G-CSF+E. Twelve days after the establishment of thin endometrium model, G-CSF and/or E treatment was started and continued for 5 days according to the groups. Tissue specimens were collected at the end of the treatment period. Proliferation, apoptosis and angiogenesis were evaluated.

Statistical analysis used: The data were analysed using one-way analysis of variance and Tamhane post hoc test.

Results: Significant increase in uterine wall and endometrial thickness was detected in the thin endometrium + G-CSF group when compared to the thin endometrium group. G-CSF was demonstrated to cause an extensive proliferative response and induction of angiogenesis in thin endometrium without restoration of endometrial glands. E alone restored thin endometrium to almost normal histology. Morphological changes representing the dominant effects of G-CSF were observed in thin endometrium model receiving G-CSF+E.

Conclusion: G-CSF+E is not an effective treatment modality in thin endometrium rat model.

Background: Polycystic ovarian syndrome (PCOS) is one of the common causes of anovulatory infertility among women in the reproductive age group. Women with PCOS and obesity often have difficulty in conceiving, and they are more prone for developing metabolic syndrome. Lifestyle modification plays a key role in women with PCOS, who are overweight or obese and is recommended as a first line management option. The earlier trials evaluating the role of lifestyle intervention in infertile PCOS women had methodological issues, smaller sample size and high dropout rates and none of these trials reported live birth as their outcome.

Aim: The current study was planned to explore the feasibility of conducting large adequately powered multicentric trial in future in South Asian women with PCOS who desire fertility.

Setting and design: The study was done in the Department of Reproductive Medicine and Surgery & the Department of Endocrinology and Metabolism at a university level tertiary care hospital. The study is an open label, single center, randomized controlled trial.

Materials and methods: A total of 60 PCOS women aged between 18-40 years with body mass index of > 23 kg/m2 who desire fertility, were randomized to individualized lifestyle intervention and usual care. The primary outcome was the dropout rate, and the secondary outcomes were change in body weight, anthropometric parameters, clinical pregnancy rates and the quality of life specific to PCOS after the trial period. All the participants were followed up for 6 months and the outcomes were assessed.

Statistical analysis: Comparison between the intervention and control groups was done using statistical tests using the SPSS and R software.

Results: The dropout rates were significantly higher in the individualized lifestyle intervention arm compared to usual care control arm (19/30, 63% vs 9/30, 30%, P=0.019). We did not find any statistically significant difference in anthropometric measurements, pregnancy rates (P=0.57) and clinical pregnancy rates (P=0.21) and quality of life specific to PCOS compared with sixth month visit from baseline visit.

Conclusion: The current feasibility study showed significantly higher dropout rates in individualized lifestyle intervention arm compared to usual care control arm. The knowledge gained from the feasibility study has been used to design an adequately powered trial to evaluate effectiveness of individualized lifestyle intervention in women with PCOS who wish to conceive.