Journal of Reproduction and Infertility最新文献

Background: Low serum progesterone concentration on the day of frozen embryo transfer (FET) has been associated with adverse pregnancy outcomes. Progesterone supplementation has been shown to improve the outcomes in these cycles. The purpose of the current study was to investigate the prevalence, pregnancy outcomes, and factors associated with rescued FET cycles involving low serum progesterone concentrations.

Methods: A cross-sectional study was conducted on 367 FET cycles with hormonal endometrium preparation (oral estradiol+vaginal progesterone) at Hung Vuong Hospital, Vietnam, from October 2022 to February 2023. Serum progesterone concentrations were measured on the day of FET. All cycles with serum progesterone <10 ng/ml were supplemented with intramuscular progesterone according to the hospital protocol, and outcomes were subsequently observed.

Results: The prevalence of cycles with low serum progesterone concentration was 71.66% (263/367). Factors associated with low serum progesterone were female body weight (ORadj=1.04; 95%CI: 1.0006-1.07) and duration from the last progesterone dose to blood sampling (ORadj=1.11; 95%CI: 1.03-1.19). Despite being rescued with progesterone supplementation, cycles with serum progesterone <10 ng/ml had significantly lower chemical (ORadj=0.52; 95%CI: 0.31-0.89), clinical (ORadj=0.54; 95%CI: 0.31-0.93) and ongoing (ORadj=0.54; 95%CI: 0.31-0.94) pregnancy rates.

Conclusion: A high prevalence of frozen-thawed cycles with low serum progesterone concentrations was observed in this study, which was associated with female body weight and duration from the last progesterone dose to blood sampling. Despite progesterone rescue, lower pregnancy rates were detected in cycles with serum progesterone <10 ng/ml.

Background: Recurrent implantation failure (RIF) refers to the inability to achieve pregnancy after two or three high-quality embryo transfers, representing a significant challenge in in vitro fertilization (IVF). In these women, endometrial perfusion is diminished, and uterine artery resistance is increased. The purpose of this study was to investigate the effect of oral L-arginine on uterine artery resistance and the results of IVF in infertile women with RIF.

Methods: This clinical trial was conducted on 72 infertile women, candidates for frozen embryo transfer, with a history of two previous transfer failures, who were referred to Fatemieh Infertility Center. Patients were randomly divided into two groups of control and intervention. In addition to standard drug treatment and protocol, the intervention group received oral L-arginine supplementation (3 gr daily for 20 days), beginning from the luteal phase. Uterine artery resistance index (RI) and pulsatility index (PI) were measured using two-dimensional Doppler ultrasound. Statistical analysis was performed using SPSS software, version 26, with a significance level set at less than 5%.

Results: Statistical analysis revealed a significant difference in the right uterine artery RI (p=0.002), left uterine artery RI (p=0.019), clinical pregnancy rate (p=0.003), and chemical pregnancy rate (p=0.006) between the two groups.

Conclusion: This study demonstrates that the daily administration of 3 grams of oral L-arginine for 20 days in women with RIF effectively reduces uterine resistance and increases both clinical and biochemical pregnancy rates.

Background: Immune thrombocytopenia (ITP) is an autoimmune condition that affects individuals of all ages, leading to a heightened risk of bleeding. ITP accounts for 5% of all pregnancy-related thrombocytopenia cases with an incidence of 1 in every 1,000 pregnant women. Several conditions can cause thrombocytopenia during pregnancy, making the diagnosis challenging. Current treatment of patients with ITP focuses on maintaining a safe platelet count rather than correcting it to normal levels.

Case presentation: This article presents a case of a 26-year-old patient at 33 weeks of gestation with severe symptoms of thrombocytopenia, evidenced by a platelet count of 1000/mm ³. The patient experienced self-resolving episodes of gingival bleeding, vaginal bleeding, and petechiae on her abdomen, as well as on both upper and lower extremities, over a duration of three days. She was successfully managed with prednisolone and intravenous immunoglobulin (IVIG), resulting in favorable maternal and neonatal outcomes.

Conclusion: While there are currently no universally accepted guidelines for the treatment of ITP, expert consensus recommendations are available. Therefore, treatment should be individualized and closely monitored. A multidisciplinary team approach is essential for the effective management of ITP during pregnancy.

Background: PON3 is associated with high-density lipoprotein (HDL) and plays a protective role against oxidative damage to low-density lipoprotein (LDL). The purpose of the current study was to investigate the effect of semen paraoxonase-3 (PON3) concentration on sperm parameters and DNA fragmentation in both fresh or post-thaw semen.

Methods: This study analyzed PON3 levels in 30 normospermic semen samples obtained from men who attended Dezful Infertility Center and provided informed consent. The samples were analyzed before and after cryopreservation for sperm motility, DNA fragmentation, and seminal PON3 levels. Data analysis was performed using SPSS software and statistical differences were evaluated using ANOVA. A p≤0.05 was considered statistically significant.

Results: There was no significant difference in sperm morphology (p=0.37) and count (p=0.25) before and after freezing at different levels of PON3. The highest levels of progressive motility were observed in samples with the highest PON3 concentrations both before (p=0.01) and after freezing (p=0.02), whereas non-progressive motility was significantly greater in samples with the lowest PON3 concentrations at both time points (p=0.01). Sperm DNA fragmentation significantly decreased before or after freezing as PON3 levels increased (p=0.03).

Conclusion: This study suggests that PON3 levels may serve as an indicator for both sperm motility and DNA fragmentation pre- or post-cryopreservation, potentially contributing to future clinical research.

Background: Infertility and miscarriage are common complications in women with PCOS, and may be linked with metabolic status and thyroid function. However, the role of ANGPTL6 in PCOS-related infertility and miscarriage remains underexplored. Study assessed serum ANGPTL6 levels in Iranian PCOS patients and its association with miscarriage, infertility, and thyroid dysfunction.

Methods: This case-control study included 116 PCOS women (58 with infertility, 58 with a history of miscarriage) and 58 non-PCOS controls. The measurement of ANGPTL6, adiponectin, fasting insulin, and other hormonal parameters were measured using ELISA. Parametric data were analyzed with t-tests and ANOVA, and non-parametric data with Mann-Whitney and Kruskal-Wallis tests. Correlations were assessed using Pearson and Spearman tests. Logistic regression was used predicted PCOS risk. A p<0.05 was considered statistically significant.

Results: ANGPTL6 levels were significantly higher in the PCOS group (48.72±21.41 ng/ml) and the PCOS-miscarriage subgroup (50.16±19.57 ng/ml) compared to the non-PCOS group (41.56±14.74 ng/ml). T4 levels were significantly lower in the PCOS group (2.5±1.9 μg/dl) compared to controls (3.9±4.6 μg/dl, p<0.001). No significant correlation was found between ANGPTL6 and thyroid function tests. A positive correlation was observed between ANGPTL6 and adiponectin in the PCOS group (p<0.01). Logistic regression showed a significant association between ANGPTL6 and the risk of PCOS (OR: 1.02, 95%CI: 1.002-1.038), even after adjusting for age, body mass index (BMI), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR).

Conclusion: Elevated ANGPTL6 levels were correlated with PCOS. Future research is needed to explore the molecular pathways linking ANGPTL6 to PCOS and its interaction with metabolic biomarkers.

Background: Non-obstructive azoospermia (NOA), marked by impaired spermatogenesis, poses challenges in assisted reproduction. Limited data exist comparing chromosomal integrity of testicular versus ejaculated sperm. This study aimed to compare embryo morphokinetics, fertilization abnormalities, and PGT-A outcomes between embryos from ejaculated and testicular sperm in NOA cases.

Methods: This retrospective study analyzed 397 patients from two IVF centers (2015-2023), with 317 using ejaculated sperm and 80 using testicular sperm from NOA patients. Fertilization patterns (2PN, 1PN, ≥3PN), embryo morphokinetics, and aneuploidy rates were assessed. Logistic regression examined factors influencing aneuploidy including male and female age, recurrent implantation failure (RIF), hormone levels, and oocyte quality, while chi-square and t-tests compared groups, with significance at p<0.05.

Results: Embryos derived from testicular sperm developed faster than those from ejaculated sperm (p<0.05). The 2PN fertilization rate was significantly lower, while the 1PN rate was higher in the testicular sperm group (10.1% vs. 16.4%, p=0.020). The rates of ≥3PN anomalies and embryo aneuploidy were similar between groups (p>0.05). Logistic regression identified male age (p=0.001), female age (p=0.007), and RIF (p=0.047) as significant predictors of aneuploidy.

Conclusion: Our study identified advanced parental age and RIF as key predictors of embryo aneuploidy. PGT-A may improve outcomes, especially for older patients or those with RIF, regardless of sperm origin. Embryos from testicular sperm in NOA patients develop faster morphokinetically but show a higher rate of 1PN fertilization than those from ejaculated sperm.

Background: Apoptosis and autophagy play important roles in the development and maturation of the ovaries in women. Any abnormalities in these processes may lead to conditions such as polycystic ovary syndrome (PCOS); therefore, evaluating the synergistic effects of apoptosis and autophagy in PCOS patients may explain the complexity of this disease.

Methods: This study included 68 patients diagnosed with PCOS and 66 non-PCOS women as control subjects, with ages ranging from 20 to 45 years. The serum levels and gene expression of Beclin-1 and programmed cell death 1 (PD-1) were assessed using ELISA and RT-PCR, respectively.

Results: Serum Beclin-1 and PD-1 levels were considerably higher in women with PCOS compared to the control group (p<0.0001). Significant overexpression of Beclin-1 and PD-1 genes was observed in PCOS patients compared to the control group (p=0.019 and <0.0001). Higher Beclin-1 and PD-1 gene expression was observed in PCOS patients over 25 compared to controls over and under 25 (p<0.05) years of age. In obese PCOS patients (waist-hip ratio >0.8), gene expression of Beclin-1 and PD-1 was significantly higher than in controls (p<0.01). Beclin-1 gene overexpression was detected in PCOS patients with a family history of PCOS compared to those without such history (p<0.05). The statistical analysis demonstrated a positive association between hormonal profile, autophagy, and apoptosis in PCOS patients.

Conclusion: These findings suggest that Beclin-1 and PD-1 may have a significant role in the development of PCOS. The study highlights the potential of targeting Beclin-1 and PD-1 as future directions for immunotherapeutic intervention in PCOS.

Background: The recurrence of benign ovarian mucinous cystadenomas is rare, and the presence of these cysts bilaterally is even more uncommon. Overall, 11 cases in our literature review were identified. Of these recurrences, only two cases were bilateral. The management of ovarian cysts in young patients is challenging, especially if they recur. Laparoscopic surgery is the most common intervention for ovarian cysts and a conservative approach using ovarian cystectomy is preferred in women in the reproductive age group.

Case presentation: A 16-year-old nulliparous female was admitted with persistent lower abdominal pain and bloating. A pelvic magnetic resonance imaging showed large bilateral cystic and multiloculated adnexal masses arising from her ovaries. Her tumor markers were normal. The patient underwent three seperate ovarian cystectomies over a seven-year period from the age of sixteen due to recurrent large bilateral benign ovarian mucinous cystadenomas. Repeated histological examinations were the same after each case. Given her age and the history of multiple ovarian surgeries, she was referred to the fertility clinic to explore options for oocyte cryopreservation.

Conclusion: This unusual case of bilateral recurrent benign ovarian mucinous cystadenomas underscores the importance of early laparoscopy and cystectomy as a recommended approach. Postoperative transvaginal ultrasound scans during follow-up may assist in the early detection of recurrence cases. Clinicians should strongly consider referring young patients with a history of repeated adnexal surgeries to infertility treatment centers for fertility preservation.

Background: The use of the time-lapse (TL) technology in infertility treatment centers has expanded, and the findings indicate its positive effect on embryo development, selection and increased pregnancy success rates. The purpose of the current study was to compare TL culture system and conventional incubator (CI) on IVF outcomes.

Methods: A total of 4,769 infertile couples undergoing IVF programs were enrolled in the study. The participants were categorized into two groups according to the embryo culture system, with 2,184 patients assigned to TL incubator and 2,585 to CI group. The outcomes measured included fertilization rate, proportion of top-quality embryos on day 3 and 5, and clinical pregnancy rate. Statistical analyses were conducted utilizing the Mann-Whitney U test and chi-square test. A p<0.05 indicated significance.

Results: This study revealed significantly higher fertilization rates and top-quality blastocysts in the TL group in comparison to CI group (p<0.001). Despite these differences, a comparable clinical pregnancy rate was observed between the two culture systems, with rates of 45.7% for TL and 41.1% for CI (p=0.169). These findings remained consistent in the good prognosis group, but not in the poor prognosis group. In the poor prognosis group, the TL culture system significantly improved fertilization rates (p<0.001), while the rates of top-quality cleavage and blastocyst formation were comparable between the two systems (p=0.075).

Conclusion: Based on the findings of the study, time-lapse culture system demonstrated superior performance compared to the conventional incubator system in generating top-quality blastocysts.