Journal of Human Reproductive Sciences最新文献

Background: Currently lack of consensus regarding the medical treatment of men with Oligoasthenoteratozoospermia (OATS). Letrozole is an aromatase inhibitor and may improve semen quality by stimulating hormone synthesis and spermatogenesis. There is lack of evidence on the efficacy and safety of letrozole as therapy for male infertility.

Aim: To study the efficacy of letrozole in improving semen parameters, hormonal profile of participants with moderate-to-severe OATS and its side effects.

Settings and design: Randomised double-blinded placebo-controlled trials conducted in a tertiary care centre conducted between August 2021 and July 2023. Men with abnormal semen analysis reports between the age group of 21 and 45 years with moderate-to-severe OATS visiting the male infertility clinic were enrolled.

Materials and methods: Fifty-four men were randomised into two groups. Twenty-eight men in A (intervention group) received letrozole, and 24 men in Group B (control group) received a placebo after written informed consent. After 3 months, semen analysis and hormonal parameters were studied.

Statistical analysis used: Data analysis was performed using SPSS version 19 (IBM). Associations between categorical variables in two groups were analysed using the Chi-square test or Fisher's exact test. Continuous variables were compared using the Mann-Whitney test, and independent Students' t-test and pre- and post-treatment comparisons of continuous variables were assessed using a paired t-test or Wilcoxon signed-rank test.

Results: Total sperm count increased by 4.4 (2.8, 8.8) million per ejaculate, sperm concentration by 3.2 (1, 4.4) million/mL and progressive motility by 5.8 ± 7.3% compared to the placebo group, which was statistically significant (P = 0.001). The use of letrozole had minor side effects like headache and nausea. Letrozole use in men with OATS showed a significant improvement in follicle-stimulating hormone by 6.8 ± 5.5 mIU/mL, luteinising hormone by 6.3 ± 3.3 IU/L, testosterone by 193.3 ± 130 ng/dL, with P value of 0.001 and significant fall in oestradiol by 17.6 ± 7.9 pg/mL overall improving T/E ratio by 18.4 ± 8.8.

Conclusion: Letrozole use may result in improving semen parameters in men with moderate-to-severe OATS. However, these findings need to be validated in larger trials.

Background: Previous studies exploring the barriers to weight management have suggested psychological, social and logistical barriers were important reasons for high attrition and non-adherence.

Aim: The aim of this study was to assess the possible reasons for high attrition and non-adherence to lifestyle interventions in a trial setting amongst women with polycystic ovarian syndrome (PCOS) who wish to conceive.

Setting and design: The study was conducted in a tertary level hospital and employed a qualitative study paradigm.

Materials and methods: The study was nested within a feasibility study that explored the possibility of conducting lifestyle interventional trials in women with PCOS who wish to conceive. Eligible participants who refused participation in the trial were interviewed under three major categories: refusal before randomisation, refusal after randomisation and non-adherence.

Statistical analysis used: Thematic analysis was used to analyse textual data.

Results: The participants considered PCOS as a 'fairly common' condition and did not perceive the need to address the impact of PCOS on their health. The second recurring theme was the perception of being overweight as 'healthy' and 'normal' and downplaying lifestyle changes to focus only on fertility treatment for achieving pregnancy. Finally, the decision to pursue weight loss or to discontinue it seems to be a shared decision making among family memebers which limits the ability of the clinicians and healthcare practitioners to effectively deliver appropriate advice on lifestyle interventions.

Conclusion: The current findings would help in planning and designing adequately powered randomised controlled trials to evaluate the impact of lifestyle intervention in women with PCOS.

Background: The studies have shown that the effects of psychological distress on the outcome of in vitro fertilization (IVF) treatment are unclear, and there is still no conclusive empirical evidence that lower anxiety levels lead to better outcomes in assisted reproductive technique treatments.

Aim: the present study was conducted to investigate the impact of perceived anxiety and stress on the outcome of IVF in infertile women in Western Iran.

Settings and design: The current study is a cross-sectional study.

Materials and methods: This study was conducted on infertile women who were candidates for IVF and visited the infertility center at Fatemiyeh Hospital in Hamadan City in the west of Iran from 8 July 2023, to 15 March 2024. The questionnaires were demographic and midwifery characteristics, the Spielberger State-Trait Anxiety Inventory and Perceived Stress Scale-14.

Statistical analysis used: All statistical analyses were performed in SPSS software at a significance level of 0.05.

Results: The stress was significantly associated with metaphase II eggs (r = -0.487), and the number of transferred embryos based on grade (r = -0.562), duration of marriage (r = 0.628), duration of infertility (r = 0.595) and duration of treatment (r = 0.595). There was no significant association between stress and endometrial thickness (P = 0.189). In addition, the anxiety was significantly associated with age (r = 0.509), husband›s age (r = 0.436), endometrial thickness (r = -0.173), metaphase II eggs (r = -0.570), and the number of ‎transferred embryos based on grade (r = -0.610), duration of marriage (r = 0.604), duration of infertility (r = 0.592) and duration of treatment (r = 0.604).

Conclusion: Mean stress and anxiety in infertile women were significantly lower in infertile women with successful IVF. Stress was significantly associated with age, spouse's age, metaphase stage oocytes, embryo grade, duration of marriage and infertility and duration of treatment.

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: 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: 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.