Journal of Human Reproductive Sciences最新文献

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.

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.