Journal of Reproduction and Infertility最新文献

Background: Progesterone levels are critical for endometrial receptivity and implantation success in assisted reproductive technology (ART). The purpose of the current study was to determine whether serum progesterone levels on oocyte retrieval day predict pregnancy success in fresh embryo transfers.

Methods: This cross-sectional study was conducted at a university-affiliated infertility clinic in Tehran, Iran, in 2024. Blood samples were collected to analyze serum levels of estradiol (E2), progesterone (P4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) using standardized methods. Student's t-test and the Mann-Whitney U test and Logistic regression were applied for statistical analyses participants. The optimal progesterone cutoff was calculated by receiver operating characteristic (ROC) curve with level of statistical significance of 0.05.

Results: The mean age of participants was 35.56±4.45 years and their mean BMI was 25.98±2.2. Among those who underwent fresh embryo transfer (n=63), 21 had positive serum β-hCG results, and fetal heart rate was detected via ultrasound in 17 patients at six weeks. Progesterone levels were significantly higher in the pregnancy-confirmed group (8.46 ng/ml) in comparison to the non-pregnant group (5.95 ng/ml, p=0.005). Similarly, patients with clinically confirmed pregnancies had significantly higher progesterone levels (8.38 ng/ml) compared to those without clinical pregnancy (6.19 ng/ml, p=0.02). A cutoff of 7.1 ng/ml predicted chemical pregnancy with 76.2% sensitivity and a cutoff of 7.55 ng/ml predicted clinical pregnancy with 71% sensitivity.

Conclusion: Elevated serum progesterone levels on the day of oocyte retrieval may predict positive pregnancy outcomes, highlighting the importance of monitoring progesterone to optimize the success rate of ART.

Background: Amenorrhea is defined as the absence of menstruation in women at reproductive age, caused by imbalanced hormonal interactions. The genes located on X chromosome are linked to the physiology of menstruation and reproduction. Early detection of major chromosomal conditions can be facilitated through karyotyping. The purpose of the current study was to identify and establish the frequency and spectrum of chromosomal anomalies in amenorrhea patients of Eastern Indian population, and to correlate their clinical features with cytogenetic findings.

Methods: From September 2022 to September 2024, 231 women with confirmed amenorrhea were included in the study conducted at inDNA Life Sciences, India. Clinical features of women with amenorrhea were recorded and cytogenetic investigation was carried.

Results: It was revealed that 20.35% of amenorrhea cases exhibited chromosomal anomalies. Among them, 38.30% were classified as numerical anomalies, 25.53% as sex reversal, 19.15% as structural anomalies, and 17.02% as mosaic karyotypes, with X-monosomy identified as the most prevalent anomaly.

Conclusion: The findings emphasize the importance of karyotyping in diagnosis, highlighting its role in early detection and management of female infertility. Karyo-typing has a resolution limit of 4-5 Mb, which disables identification of submicroscopic chromosomal abnormalities. In contrast, chromosomal microarray (CMA) analysis can examine the entire genome at higher resolutions, allowing for the identification of genetic abnormalities that may not be detected by karyotyping. While CMA was excluded from this investigation, it could serve as a valuable technique for future research aimed at identifying submicroscopic chromosomal abnormalities in cytogenetically normal women with amenorrhea.

Background: Chronic endometritis (CE) significantly contributes to repeated implantation failure (RIF). Although antibiotics are common treatments for CE, some patients do not achieve resolution. Therefore, the use of an alternative method involving the administration of ImmuBalance^™ (IMB), a combination of pre- and probiotics, was explored in the current study.

Methods: This retrospective study was conducted between April 2021 and August 2022. A total of 819 women with CE were treated with antibiotics-1 (doxycycline, n=809) or IMB (n=10, Group 1). Following endometrial biopsies, CE was not resolved in 209 out of 819 women. Subsequently, 194 patients were treated with antibiotics-1 (n=4) or -2 (amoxicillin, azithromycin, and metronidazole, n=190), whereas 15 were treated with IMB (n=15, Group 2). After the treatment with antibiotics-2, four women underwent IMB (Group 3). Statistical analysis of the number of plasma cells with CD138 before and after treatment was conducted using Fisher's exact test and p-values <0.05 were considered statistically significant.

Results: CE was treated in 60% of patients (6/10) in Group 1; however, the reduction in CD138 count was not statistically significant (p=0.13). In Groups 2 and 3, CE was treated with a significantly reduced CD138 count (Group 2, p<0.01; Group 3, p=0.04). CE was treated in 100% of cases in Group 2 and 3 (15/15 and 4/4, respectively).

Conclusion: Based on the findings of this study, administration of IMB may be effective in treating CE, especially following antibiotic treatment.

Background: Women experience at least one of the Symptoms of Premenstrual Syndrome (PMS) during the menstrual cycle. The present study aimed to determine the factors that influence PMS occurrence and its severity in the medical students.

Methods: This cross-sectional study was carried out on 369 undergraduate female students of Maragheh University of Medical Sciences, Iran, between September 2021 and April 2022. The sampling method was random and participants were recruited through public announcements. The collected data included the provisional diagnosis of premenstrual syndrome, the Iranian version of Premenstrual Syndrome Screening Tool (PSST), the International Physical Activity Questionnaire (IPAQ), Food Frequency Questionnaire (FFQ), and the self-reported measurement of weight and height. All data and questionnaires were designed and then completed online by participants. The multivariable logistic regression analysis determined the potential predictors of PMS, and p-values less than 0.05 were considered significant.

Results: About 70% of participants had PMS. According to the PSST, 69% of them were positive in terms of the severity of PMS. There was a significant correlation between PMS and the severity of PMS symptoms (p<0.001), BMI (p=0.031), and dietary fat (p=0.013). The odds ratio for PMS, BMI, and dietary fat was 10.314, 1.073, and 1.008, respectively.

Conclusion: The present study demonstrated that among lifestyle factors, dietary fat and BMI play a significant role in premenstrual syndrome. Future studies are needed to identify other factors influencing its occurrence and to propose approaches for improving the quality of life of female medical students during their lifespan.

Background: Longer abstinence time is believed to be associated with the production of reactive oxygen species (ROS), which in excessive amounts may be detrimental to the sperm. To enhance sperm quality, multiple research studies have proposed reducing the duration of abstinence by encouraging consecutive ejaculations. This approach has been shown to improve sperm motility and morphology, which are associated with better ICSI and IUI outcomes. The purpose of the current study was to evaluate sperm quality and fertilization rate, cleavage rate, as well as embryo quality in severe oligoasthenozoospermic men using the consecutive ejaculate collected within an hour of abstinence.

Methods: A prospective study was conducted at Halim Fertility Center from August 2020-April 2022, involving male partners undergoing ICSI treatment who presented with severe oligoasthenozoospermia on their previous semen analysis. The non-parametric Mann-Whitney and Wilcoxon tests were used to analyze the parameters of the groups, including characteristics of the study participants, oocytes and sperm samples, as well as the ICSI outcomes, using a significance level of 5%.

Results: A statistically significant improvement in the sperm total motility was recorded in the consecutive ejaculate compared to the first (31.53±11.73% vs. 22.52±8.85%; p<0.001). Both fertilization and cleavage rates were higher in the consecutive ejaculate group, although they were not statistically significant (61.41±28.04% vs. 55.45±31.76%; p=0.081 and 88.10±28.63% vs. 81.07±36.34%; p=0.262).

Conclusion: Consecutive ejaculates collected within an hour of the first may enhance sperm total motility, fertility, and cleavage rates in male partners with low sperm count and quality undergoing ICSI treatment.

Background: Fresh embryo transfer has been decreasing because of advancements in vitrification techniques and safety concerns related to ovarian hyperresponse. However, in normal responders, clinical outcomes appear to be comparable with those with frozen embryo transfer. This study aimed to determine factors that influence successful fresh embryo transfer.

Methods: This retrospective cohort study included 521 women who underwent in vitro fertilization (IVF) and fresh embryo transfer at King Chulalongkorn Memorial Hospital, Thailand. Patients' clinical data, embryo details, endometrial characteristics (thickness and pattern), and embryo transfer procedures (tip and flow during transfer, embryo placement location, difficulty of the procedure, and presence of blood and mucous at catheter) were analyzed. Chi-square test, Fisher's exact test, Student's t-test, and logistic regression were performed for data analysis. A p-value of <0.05 was considered statistically significant.

Results: The overall clinical pregnancy rate was 17.1%. Women aged >40 years were less likely to have a clinical pregnancy than those aged <35 years (adjusted odds ratio [aOR] 0.422; 95% confidence intervals [CI] 0.196-0.908, p=0.027). Day 3 embryo transfer showed a significant decrease in clinical pregnancy compared with blastocyst transfer (aOR 0.514; 95%CI 0.287-0.923, p=0.026). In the subgroup analysis for blastocyst transfer, women with good-quality blastocyst (≥322) were 2.439 times more likely to have a clinical pregnancy than those with poor-quality blastocysts (aOR 2.439; 95%CI 1.199-4.962, p=0.014).

Conclusion: Advanced age and day 3 embryo transfer were significantly associated with low clinical pregnancy rates in fresh embryo transfer.

Background: The objective of this study was to evaluate the model of spiritual health in relation to psychological distress among infertile women, with perceived social support as a mediator.

Method: In this study, structural equation modeling (SEM) was employed. The study population included all infertile women in Shiraz from which a sample of 250 individuals was selected using a targeted sampling method. The research data were collected by Spiritual Health questionnaire developed by Iranian Academy of Medical Sciences; Depression, Anxiety, and Stress Scale 21 (DASS-21); and Multidimensional Scale of Perceived Social Support (MSPSS). Data analysis was performed using SPSS and AMOS software.

Results: The results demonstrate that the direct impact of spiritual health on psychological distress and perceived social support was statistically significant. Furthermore, a significant indirect effect of spiritual health on psychological distress was identified through perceived social support.

Conclusion: According to the findings of this study, it may be beneficial to address aspects of spiritual health and social support to alleviate psychological distress among infertile women.

Background: The use of intrauterine devices (IUDs) for contraception has increased in many countries. However, their application has some serious complications such as uterine perforation and injury to adjacent organs. The translocated IUD into the bladder is a very rare occurrence.

Case presentation: Our case was a 41-year-old woman whose IUD was accidentally discovered in her bladder during a routine ultrasound. The IUD has migrated from its normal position in the uterus to the bladder. The IUD was successfully removed by cystoscopy without any complications.

Conclusion: The mislocation of an IUD in the bladder, while uncommon, is a possibility that should be considered when the IUD string is not visible during examinations.

Background: The newest NOX isoform, NOX5, has been found in mammalian spermatozoa. Many physiological and pathological situations in spermatozoa are mediated by reactive oxygen species (ROS). NOX5 is the main source of ROS in spermatozoa. Our purpose was to investigate the changes in NOX5 expression and the effect of NOX5 expression on sperm motility, chromatin integrity, and oxidative status in oligoasthenozoospermic compared to normozoospermic men.

Methods: Semen samples were collected from 30 normozoospermic (NS) and 30 oligoasthenozoospermic (OAS) men. NOX5 protein expression in sperm samples was evaluated by immunohistochemistry and western blot. Oxidative stress status was evaluated by total antioxidant capacity (TAC), total oxidant capacity (TOC), and oxidative stress index (OSI) parameters. Chromatin integrity in spermatozoa was evaluated by toluidine blue staining.

Results: NOX5 expression levels were significantly higher in OAS group than in NS group (p<0.001). In addition, chromatin integrity was significantly higher in the OAS group in comparison to NS group (p<0.001). TAC levels were higher in the NS group, but OSI and TOC levels were significantly higher in OAS group (p<0.001). It was found that NOX5 protein expression was positively correlated with oxidative stress and chromatin integrity and negatively correlated with motility (p<0.01).

Conclusion: These results suggest that overexpression of NOX5 may be the source of excessive ROS production and oxidative stress injuries in oligoasthenozoospermic men. Considering that NOX5 expression is positively correlated with oxidative stress and chromatin integrity but negatively correlated with motility, it can be considered a biomarker to be used in assisted reproductive procedures.