Journal of Reproduction and Infertility最新文献

Background: The association between varicocele and male infertility has always been a subject of ongoing debate. Lactoferrin (LF) belongs to the transferrin family with iron-binding properties and exhibits many beneficial biological properties. The purpose of the current study was to assess seminal levels of LF in infertile oligoasthenoteratozoospermic (OAT) men with varicocele.

Methods: Sixty-nine men were allocated into three groups; healthy fertile men (as controls) (n=20), infertile OAT men without varicocele (n=19), and infertile OAT men with varicocele (n=30). All men underwent history taking, genital examination, semen analysis, and determination levels of seminal LF by ELISA method. Statistical analysis was carried out using Kruskal-Wallis test followed by post-hoc analysis (Conover) for comparisons involving more than two groups, and the Mann-Whitney U test for comparisons between two groups. Spearman correlation test was used to assess the relationship between variables. The p>0.05 was set as statistically significant.

Results: The median seminal LF level of the healthy fertile controls demonstrated significantly increased levels compared to both groups of infertile OAT men with or without varicocele (p<0.000001). The median seminal LF level of the infertile OAT men with varicocele grade III demonstrated a significant decrease compared to infertile OAT men with grade II (p=0.0057). Collectively, seminal LF levels exhibited significant positive correlations with sperm concentration, total sperm motility, and normal sperm morphology.

Conclusion: LF can be an imperative seminal biomarker that decreases in infertile OAT men especially if associated with varicocele.

Background: Ectopic pregnancy remains one of the most common causes of pregnancy-related deaths in the first trimester. About 2.4% of ectopic pregnancies occur in the interstitial part of the fallopian tubes. Given the nonspecific symptoms and the increased risk of hemorrhage associated with interstitial pregnancy localization, early diagnosis is crucial and should be based not only on clinical presentation but also on adjunctive diagnostic modalities. Early diagnosis leads to better treatment-related outcomes. Tubal ectopic pregnancies rarely progress into the second trimester and are typically diagnosed during the first trimester.

Case presentation: A 25-year-old primigravida at 20 weeks of gestation was initially diagnosed with a single live intrauterine pregnancy but presented with hypovolemic shock and was intraoperatively found to have an unruptured ectopic pregnancy. Postoperatively, the patient remained hemodynamically stable and was discharged on the fifth day. To date, the highest gestational age reported for a tubal ectopic pregnancy is 14 weeks.

Conclusion: Ectopic pregnancies should be diagnosed in the first trimester via expert ultrasound. In this case, delayed second-trimester ultrasound in a low-income patient led to missed diagnosis. Clinical judgment must guide antenatal care, and surgery should not be delayed despite an unidentified source of hemoperitoneum.

Background: Accessory cavitated uterine mass (ACUM) is a rare, unclassified Müllerian anomaly characterized by distinct imaging features. It is typically located within the uterus, close to the round ligament, and has a uterus-like structural arrangement. The patient may present with pelvic pain or dysmenorrhea. Most of these cases are misdiagnosed because of a lack of awareness about this unusual entity.

Case presentation: Three cases of ACUM in young patients who experienced prolonged symptoms and had incomplete family structures were reported in this paper. Initially, two of these cases were misdiagnosed during ultrasound examinations (USG). The subsequent magnetic resonance imaging (MRI) revealed characteristic imaging features consistent with ACUM, which provided significant psychological relief to both the patients and their families. Two patients received hormonal therapy, both of whom were unmarried. The third patient, however, indicated a wish to conceive and was therefore initiated on analgesics. All three patients chose to forgo surgical intervention, opting instead for medical management despite its limited success in alleviating their symptoms. This decision was made to minimize obstetric risks associated with surgical interventions in potential future pregnancies.

Conclusion: Laparoscopy or open surgery is the mainstay treatment for a permanent relief from the symptoms. However, surgical treatment should be offered with caution as no data are available in medical literature regarding the effect of surgically induced myometrial scarring on patients' reproductive outcomes. Since most of these patients were young and nulligravida, the therapy had to be personalized in accordance with the patient's preference and family status.

Background: Endometriosis is a prevalent condition among women, often leading to infertility. Laparoscopic surgery is widely employed as a therapeutic intervention for endometriosis. This study investigated the prognostic factors influencing the outcome of laparoscopic surgery for endometriosis.

Methods: This cross-sectional study included 60 women with endometriosis referred for laparoscopic surgery at Amiralmomenin Hospital, Zabol, Iran, between 2022 and 2024. Pain intensity was measured using a visual analog scale (VAS). Statistical analyses were performed using SPSS version 26. Descriptive statistics summarized the data, while univariate analyses (t-tests and chi-square tests) assessed relationships between variables. Multivariate logistic regression identified independent predictors of pain reduction and pregnancy outcomes.

Results: Patients with moderate endometriosis showed statistically significant pain reduction from 8.8 preoperatively to 1.8 at 9 months (p<0.001) and 2.2 at 12 months post-surgery (p=0.003). Those with severe endometriosis had non-significant pain reduction (8 to 6 at 12 months, p=0.12). Both intrauterine (9 to 1.1 at 12 months, p<0.001) and extrauterine involvement groups (8.6 to 3.3, p=0.004) demonstrated significant pain improvement, with no significant difference between the groups (p=0.779). Regarding fertility outcomes, treatment before the age of 30 significantly increased pregnancy likelihood (AOR=20.57, 95%CI 1.4-295.3), while other factors including BMI, CA125 levels, and parity showed no significant associations (all p>0.05).

Conclusion: These preliminary findings suggest that laparoscopic surgery may reduce pain in moderate endometriosis, while the age under 30 may be associated with improved pregnancy outcomes. However, given the study's limited sample size and wide confidence intervals, these results require validation in larger, multicenter cohorts.

Background: Cortical folding during fetal brain development reflects neural maturation. Fetal growth restriction (FGR) may disrupt this process, potentially affecting neurodevelopmental outcomes. Although ultrasound enables noninvasive sulcal assessment, so normative data and objective tools are lacking. The purpose of the current study was to assess the impact of FGR on fetal cortical development using neurosonography and establish a third-trimester nomogram for cortical maturation.

Methods: This prospective study included 425 singleton pregnancies (330 appropriate-for-gestational-age [AGA], 54 symmetrical FGR, and 41 asymmetrical FGR) at 28-36 weeks. Conducted at a Tehran tertiary center (2023-2024), the study included cases with normal anatomy and negative aneuploidy screening. Neurosonographic parameters including Sylvian fissure (SF), insula, parieto-occipital fissure (POF), cavum septum pellucidum (CSP) width, and ventricular diameter were measured and the ratios calculated relative to biparietal diameter (BPD). ANOVA and post-hoc tests were applied and statistical significance was set at p<0.05.

Results: No significant differences in neurosonographic ratios (e.g., SF/Insula, POF/BPD, CSPW/BPD) were found between AGA and FGR groups. However, unadjusted SF and insular depths were reduced in symmetrical FGR fetuses with head circumference (HC) <10th percentile. Asymmetrical FGR showed no differences. A gestational-age-based nomogram was developed for AGA fetuses.

Conclusion: While absolute sulcal measurements vary with head size in FGR, biometric adjustments (e.g., BPD ratios) improve cortical maturation assessment. The study supports ratio-based neurosonography and provides normative data for objective fetal brain evaluation.

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous condition that encompasses several cardiometabolic and endocrinological disorders. Studies have shown that its pathogenesis aligns with several underlying mechanisms associated with recurrent pregnancy loss (RPL). Cellular communication network (CCN)-3 protein is a well-studied adipokine involved in tumorigenesis, organogenesis, inflammation, fibrosis, and glucose metabolism. The purpose of the current study was to determine the association of CCN3 levels with a number of parameters involved in PCOS pathogenesis.

Methods: This is a case-control study including 120 PCOS patients (60 cases with RPL; PCOS-RPL and 60 cases with infertility; PCOS-Inf and 60 healthy controls). Circulating levels of homocysteine and high-sensitivity C-reactive protein (hs-CRP), homocysteine, and CCN3 were measured using ELISA kits.

Results: Circulating levels of CCN3 were significantly elevated in PCOS-RPL and PCOS-Inf subgroups when compared to the control group (7.61±3.03 and 6.85±2.54 vs. 3.12±0.82, p<0.001). Serum CCN3 positively correlated with fasting insulin and homeostatic model assessment of insulin resistance (HOMA-IR) in the control group (p<0.05) and PCOS group (p<0.001). Moreover, CCN3 was significantly associated with PCOS (OR 4.808, 95%CI [2.744-8.423], p<0.001).

Conclusion: According the results of this study CCN3 may be involved in the pathogenesis of PCOS. However, future studies are needed to evaluate the possibility of utilizing CCN3 in the diagnosis and treatment of the disease.

Background: N-acetylcysteine (NAC) is a supplement commonly used in patients with polycystic ovary syndrome (PCOS). The expansion of oocyte-associated cumulus cells (CCs) and the quality of the oocyte are critical factors influencing fertilization rates and clinical pregnancy outcomes in assisted reproductive techniques (ARTs). Genes such as phosphofructokinase (PFKP) and pyruvate kinase isoform M2 (PKM2) are involved in glucose metabolism and are crucial in the regulation of oocyte competence and developmental potential. The purpose of the current study was to evaluate the effects of letrozole and NAC on the expression of PFKP and PKM2 in CCs of PCOS patients undergoing ART.

Methods: The study evaluated 20 PCOS women undergoing ART to assess the effect of letrozole and NAC on the expression levels of PKM2 and PFKP genes in cumulus cells. Women were randomly assigned using a simple randomization method into four groups: control, NAC, letrozole, and NAC plus letrozole, with five women in each group. Gene expression levels of PKM2 and PFKP were measured using real-time PCR.

Results: The expression level of PKM2 was significantly higher in the letrozole plus NAC group compared to the control group (p<0.05). In NAC group, PFKP was significantly expressed compared to the control group (p<0.05). There were no significant differences among the other groups compared to the control group.

Conclusion: NAC can improve the quality of oocytes by increasing the expression level of genes involved in the glucose metabolism (PKM2, PFKP) of CCs, thereby potentially improving ART success rate in PCOS patients. Therefore, administering NAC along with letrozole can have a synergistic effect on increasing the expression level of genes associated with blastocyst quality in PCOS patients.

Background: Cesarean scar pregnancy (CSP) is a rare yet serious condition involving implantation of the gestational sac at the site of a prior cesarean delivery. The management becomes increasingly complex with the addition of placenta percreta. In this paper, a case of CSP complicated by placenta percreta was reported which was successfully managed through a multidisciplinary approach.

Case presentation: A 35-year-old G4P3 woman was diagnosed with CSP at 6 weeks of gestation. Despite counseling on the risks, she opted to continue the pregnancy. Placenta percreta was diagnosed at 18 weeks. A multidisciplinary team monitored the pregnancy closely, leading to the delivery of a healthy infant at 32 weeks via cesarean delivery and subsequent hysterectomy.

Conclusion: Multidisciplinary management and close follow-up are crucial in managing high-risk CSP cases, especially those complicated by abnormal placentation.

Background: Azoospermia, the complete absence of sperm in the ejaculate, is a major cause of male infertility. Sertoli cells are essential for spermatogenesis, and disruptions in innate immune immune pathways, particularly Toll-like receptors (TLRs), may impair their function. This study investigated the expression of TLR1-10 and downstream signaling molecules (MYD88, NFKB, TRIF, IRF3, and TRAM) in Sertoli cells of azoospermic patients.

Methods: Testicular tissue were collected from 20 azoospermic men undergoing testicular sperm extraction (TESE). Patients were categorized into two TESE positive (sperm present, n=10) and TESE negative (sperm absent, n=10). Sertoli cells were isolated using enzyme digestion and purified via fluorescence-activated cell sorting (FACS). Gene expression of TLR1-10 and signaling molecules was quantified by RTPCR. Data were analyzed using independent-samples T-test, with significance set at p< 0.05.

Results: Significant downregulation was detected in TLR10 (20.6-fold, p<0.0001), TLR9 (4.6-fold, p<0.05), TLR7 (4.8-fold, p<0.01), TLR6 (12.4-fold, p<0.05), TLR5 (13.5-fold, p<0.001), TLR4 (3.2-fold, p<0.05), and TLR3 (3.1-fold, p<0.01). Among signaling molecules, MYD88 (4.1-fold, p<0.01) and IRF3 (4.2-fold, p<0.05) showed significant reductions, indicating impaired immune signaling in Sertoli cells of TESE-negative men.

Conclusion: Altered expression of TLRs and associated signaling molecules in Sertoli cells of azoospermic men suggests innate immune dysregulation as a potential mechanism underlying defective spermatogenesis. These findings highlight immune privilege-associated pathways as possible targets for developing diagnostic biomarkers and novel therapeutic approaches for male infertility.