Journal of Reproduction and Infertility最新文献

Background: In women with polycystic ovary syndrome (PCOS), the optimal endometrial preparation strategy for frozen embryo transfer (FET) remains unclear. This clinical trial aimed to compare a long-term protocol with a stimulated cycle protocol in FET cycles of PCOS women, with clinical pregnancy rate per embryo transfer as the primary outcome.

Methods: This non-randomized, open-label, two-arm clinical trial was conducted at Fatemieh Hamedan Hospital, Iran, involving 340 women with PCOS. Participants were allocated to the long-term or stimulated cycle protocols based on clinical scheduling and physician decision. The long-term protocol included low-dose combined oral contraceptives for 14 days, GnRH agonist downregulation, estradiol valerate (4-6 mg/day for ≥10 days), and progesterone before embryo transfer. The stimulated cycle protocol involved recombinant FSH with ultrasound monitoring, hCG trigger for oocyte maturation, and intramuscular progesterone (50 mg/day) for luteal phase support. For each participant one FET cycle was analyzed.

Results: Baseline characteristics were similar between groups (n=170 each). The long-term protocol showed higher clinical pregnancy rates (35.9%) compared to the stimulated cycle (22.9%) (OR=1.92; 95%CI: 1.15-3.19; p=0.011). Chemical pregnancy rates also favored the long-term protocol (34.7% vs. 21.8%) (OR=1.91; 95%CI: 1.17-3.09; p=0.008). Endometrial thickness was significantly greater in the long-term protocol (8.7±0.9 mm vs. 8.4±0.8 mm; p=0.004).

Conclusion: Although the long-term protocol showed higher clinical pregnancy rates in unadjusted analyses, after adjusting for confounders, protocol type was not independently associated with clinical pregnancy. Larger randomized trials are needed to confirm these findings, and adverse outcomes should be assessed in future studies.

Background: Few studies evaluated cavum septum pellucidum (CSP) and corpus callosum (CC) indices in late gestation. This study assessed CSP and CC indices, along with frontal lobe measurements, and examined correlations among parameters.

Methods: A cross-sectional study was conducted at Imam Khomeini Hospital Complex on 150 fetuses at ≥36 weeks' gestation. Transabdominal ultrasound was used to measure CSP length, width, trace length, and area in the axial view; frontal lobe thickness from anterior and posterior CSP margins in horizontal and vertical directions; and CC lengths and thicknesses. CSP trace length and area were also obtained in the midsagittal view. Data were analyzed using SPSS 23.

Results: Mean gestational age, biparietal diameter (BPD), head circumference (HC), and estimated fetal weight (EFW) were 37.56±1.08 weeks, 90.73±3.20 mm, 326.58±10.59 mm, and 2987.82±333.68 gr. In the trans-thalamic view, median CSP length, width, trace length, and area were 8.92 mm, 6.05 mm, 2.81 mm, and 0.49 mm ². Median CSP height in the coronal view was 5.85 mm. In the midsagittal view, mean CC outer-to-outer length, inner-to-inner length, CSP trace length, and CSP area were 41.31±4.81 mm, 29.73±4.17 mm, 2.56±0.63 mm, and 0.36±0.19 mm ². All CC and CSP indices correlated significantly with HC (p<0.05). Frontal bone-to-CSP anterior and posterior distances in axial and near-field views also correlated with HC (p=0.0001).

Conclusion: This study provides normative measurements for CC, CSP, and frontal lobe indices at ≥36 weeks' gestation. These values support late-gestation brain assessment and early identification of newborns potentially at risk for neurodevelopmental concerns.

Background: Low-dose aspirin (ASA) is used in obstetrics for different indications, mainly to prevent preeclampsia. This study investigated the underlying mechanism of ASA's effect on the fetus's cardiovascular functions.

Methods: 42 pregnant women at 18-24 weeks of gestation, identified as high-risk for preeclampsia, received 160 mg of ASA daily. Fetal Doppler ultrasound was performed before and three weeks after ASA treatment, assessing ductus venosus, middle cerebral, umbilical, and uterine arteries pulsatility indices as well as pulmonary, aorta, and superior vena cava (SVC) diameters in the three-vessel view, including pulmonary/aorta and SVC/aorta ratios. All analyses were performed using SPSS software version 27, with a significance threshold set at p<0.05. A paired t-test was used to assess differences in means. The Chi-square and Fisher's exact test analyzed nominal variables.

Results: Post-intervention analysis revealed significant improvements in abnormal uterine artery resistance (p<0.001) and abnormal pulsatility index of the umbilical artery, middle cerebral artery, and ductus venosus (p<0.001 for all). Moreover, 160 mg/day aspirin administration significantly increased mitral E/A (early filling velocity/atrial contraction velocity: 0.397±0.029; p<0.001), diameters of aorta (4.390±0.852; p<0.001), pulmonary artery (4.895±1.087; p<0.001), and SVC (2.511±0.535; p<0.001), while significantly decreasing left ventricular myocardial performance index (p<0.05).

Conclusion: Daily administration of 160 mg of aspirin enhances fetal vascular and cardiac function. Evaluating fetal cardiovascular parameters beyond routine uterine artery Doppler, especially in high-risk pregnancies, and initiating ASA therapy in cases of insidious abnormalities, may help delay or prevent fetal complications such as intrauterine growth restriction (IUGR) by improving cardiovascular function.

Background: Reactive oxygen species (ROS) are critical factors for oocyte maturation and early embryogenesis; however, excessive ROS can induce oxidative stress, impairing mitochondrial function, DNA integrity, and embryo competence. The role of oxidative status in buffalo follicular fluid (FF) remains underexplored. This study assessed the relationship between total oxidant status (TOS) in buffalo FF and the developmental competence of oocytes retrieved by ovum pick-up (OPU) for subsequent in vitro fertilization (OPU-IVF).

Methods: Follicular fluid and cumulus-oocyte complexes (COCs) were collected from 62 healthy buffaloes. Oocytes were matured and fertilized in vitro, and the animals were classified based on blastocyst yield: G1 (no blastocysts), G2 (≥2 blastocysts), and G3 (>3 blastocysts). TOS was measured spectrophotometrically. The relationship between TOS and oocyte competence was analyzed by ROC (G1 vs. G3) and Spearman correlation (G1 vs. G2), with p<0.05 considered statistically significant.

Results: G2 group with >2 blastocyst exhibited lower TOS levels (1.10±0.51 μmol H₂O₂ Eq/L) than G1 (2.15±0.92; p=0.004), with higher follicle counts, oocyte yield, cleavage rate, and blastocyst production (p<0.05). ROC analysis identified a TOS threshold of 1.12 μmol H₂O₂ Eq/L (area under the curve [AUC]=0.851), and TOS inversely correlated with the proportion of high-quality blastocysts (r=-0.553, p= 0.021).

Conclusion: Elevated oxidative stress in FF compromises oocyte developmental competence and embryo quality. TOS may serve as a predictive biomarker, supporting antioxidant-based optimization of assisted reproductive technology (ART) in buffalo.

Background: The aim of this study was to analyze the trends of multiple births at both national and provincial levels in Iran from 2014 to 2023.

Methods: Data on the number of live births and multiple births from 2014 to 2023 at national and provincial levels were obtained from the Iran's Bureau of Vital Statistics. The multiple birth rate (MBR), defined as the number of live births from multiple births per 1,000 live births, was calculated annually. To examine temporal trends and detect significant changes in MBR over the study period, joinpoint regression analysis was performed. Annual percent change (APC) and average annual percent change (AAPC) were calculated for the entire period.

Result: The national AAPC in the MBR was estimated at 2.38% (95%CI: 1.95 to 2.76) over the entire study period. A significant shift in trend was identified in 2020. Specifically, the APC from 2014 to 2020 was 0.24%. However, from 2020 to 2023, the APC markedly increased to 6.8%, reflecting a substantial rise in MBR during this latter period. Furthermore, the study findings demonstrated that nearly all provinces across the country have exhibited an upward trend in MBR in recent years.

Conclusion: The increasing trend of multiple births in Iran aligns with global patterns. Several factors may have contributed to this rise, including increased maternal age at childbirth, higher prevalence of infertility, expanded use of assisted reproductive technologies (ARTs), and shifts in population policies.

Background: The supplementation of human chorionic gonadotropin (hCG) into culture medium in rescue in vitro maturation (r-IVM) has been reported to improve the maturation rates of immature oocytes derived from stimulated cycles. However, the impact of this enrichment on embryo quality is yet to be understood. The purpose of the current study was to investigate the effect of hCG on the embryo quality following r-IVM.

Methods: A total of 152 immature oocytes consisting of germinal vesicles (GV) and metaphase I (MI) were collected and classified into 1) control group (n=73; GV=22, MI=51) cultured in culture medium only, and 2) experimental group (n=79; GV= 23, MI=56) cultured in culture medium supplemented with 0.5 IU hCG. Study parameters were analyzed using Student's T-test or Kruskal Wallis and chi-square at a 95% confidence level.

Results: After 24 hr, the maturation rate of the control and experimental groups was comparable (57% vs. 70%, p=0.58). Following intracytoplasmic sperm injection (ICSI), the fertilization rate was significantly higher in the experimental group than in the control group (49% vs. 36%; p=0.03). However, the number of good-quality embryos was similar in the groups (16% vs. 6%).

Conclusion: Our study suggests that hCG supplementation into the culture medium during r-IVM does not affect embryo quality but improves the fertilization rate. Further research is needed to scrutinize the role of hCG in fertilization.

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most prevalent hepatic disorder exclusive to pregnancy, associated with significant maternal morbidity and increased risk of adverse perinatal outcomes. Recurrence in subsequent pregnancies and comorbidities such as gestational diabetes and hypertensive disorders further complicate clinical management. This case presentation, an attempted to describe the diagnostic and therapeutic challenges in managing recurrent ICP, especially in the context of overlapping maternal comorbidities and limited diagnostic resources.

Case presentation: A case of a 32-year-old Iranian woman, gravida 3 para 2, with a history of one intrauterine fetal death and one neonatal death, was ultimately diagnosed with recurrent ICP. In her third pregnancy, elevated bile acid levels were confirmed by routine monitoring from 20 weeks' gestation, peaking at 333 μmol/L by 32 weeks. Despite intensive medical therapy including ursodeoxycholic acid, hydroxychloroquine, corticosteroids, and low-molecular-weight heparin, her pruritus worsened and bile acid levels escalated, prompting preterm cesarean delivery. The neonate experienced complications, including respiratory distress, suspected Hirsch-sprung's disease, sepsis, and hyperbilirubinemia. Management included continuous positive airway pressure (CPAP), broad-spectrum antibiotics, surgery, phototherapy, and parenteral nutrition. Multidisciplinary intervention enabled neonatal recovery, and maternal symptoms resolved postpartum.

Conclusion: This case underscores the complexities of managing recurrent ICP, particularly in resource-limited settings. It highlights the critical need for early diagnosis, vigilant monitoring, and a multidisciplinary approach to mitigate the risk of stillbirth and improve perinatal outcomes. Additionally, it suggests that recurrent ICP may present earlier or with greater intensity in subsequent pregnancies, necessitating more comprehensive surveillance and tailored management strategies for affected mothers.

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.