Journal of Reproduction and Infertility最新文献

Background: Fumarase deficiency is an autosomal recessive condition characterized by severe neurologic abnormalities due to homozygous mutations in the fumarate hydratase (FH) gene. Heterozygous carriers of FH mutations have increased risk of developing uterine fibroids that can be associated with hereditary leiomyomatosis and renal cell cancer (HLRCC). The association between FH mutations and infertility remains uncertain. The objective of our study was to characterize the infertility diagnoses, treatments, and outcomes in women presenting to a fertility center who were found to be carriers of fumarase deficiency based on the presence of heterozygous FH mutations.

Case presentation: A retrospective case series was conducted including 10 women presenting to an academic fertility center who were found to be FH carriers based on genetic carrier screening. Of the 9 women who were engaged in further workup, 2 had imaging results consistent with uterine fibroids. One woman underwent hysteroscopic myomectomy prior to two courses of ovulation induction with timed intercourse (OI/TIC) followed by one successful cycle of IVF. Of the remaining patients, only 1 woman successfully delivered after a cycle of ovulation induction with intrauterine insemination (OI/IUI). Other patients pursuing OI/IUI, OI/TIC, or monitored natural cycles had unsuccessful experiences.

Conclusion: Patients with infertility who are offered genetic testing should be screened for FH mutations, as the carriers are at risk of developing HLRCC-associated uterine fibroids, which can influence fertility and pregnancy. Additional research is needed to investigate the impacts of FH mutations on infertility.

Background: The purpose of the current study was to evaluate patient-oriented strategies encompassing individualized oocyte number (POSEIDON) criteria, validate stratification of low prognosis women, and prognosticate their reproductive potential in terms of cumulative live birth rate (CLBR) in Indian women.

Methods: Out of 4048 women who underwent IVF/ICSI, 3287 women met the criteria for final evaluation of CLBR. They criteria were divided into (a) group 1a as cases with <4 oocytes retrieved and 1b with 4-9 oocytes retrieved; (b) group 2a as cases with <4 oocytes retrieved and 2b with 4-9 oocytes retrieved; (c) group 3 (<35 years, AMH <1.2 ng/ml, AFC <5); and (d) group 4 (≥35 years, AMH <1.2 ng/ml, AFC <5). Non-POSEIDON group was sub-divided into normo-responders (10-20 oocytes) and hyper-responder (>20 oocytes).

Results: Overall CLBR was two-fold lower in POSEIDON group as compared to non-POSEIDON group (p<0.001). For every one-year increase in the age, the odds of CLBR decreased by 4% (OR 0.96, CI 0.93-0.99) in POSEIDON group and by 5% (OR 0.95, CI 0.92-0.98) in non-POSEIDON group. For every unit increase in number of oocytes retrieved, the odds of CLBR increased by 1.22 times (OR1.22, CI 1.16-1.28) in POSEIDON group and by 1.08 times (OR 1.08, CI 1.05-1.11) in non-POSEIDON group. Among POSEIDON groups, the highest values in CLBR belonged to group 1b followed by 3, 2b, 4, 1a, and 2a.

Conclusion: POSEIDON stratification of low-prognosis women undergoing IVF may be considered valid to prognosticate and counsel women undergoing IVF. Prospective studies will strengthen its validity among different ethnic populations.

L-carnitine, through its antioxidant potential, plays a significant role in reducing ROS production in male genital tract; therefore, fundamental improvements in spermatogenesis process and sperm structural and functional parameters in seminal plasma can be observed by treatment with L-carnitine. A literature search was performed using PubMed (including Medline) from the database earliest inception to 2021. Eligibility criteria included studies on protective effects of L-carnitine against damages to the male reproductive system. Based on the findings of the current study, L-carnitine has an effective potential to protect testis and improve conventional and functional sperm parameters against ROS-induced damages by sperm cryopreservation, busulfan treatment, and radiation.

Background: Amniotic fluid in the uterus is beneficial for the fetus growth and protection due to its nutritional elements as well as its antibacterial and anti-inflammatory properties. Today, body membranes are increasingly being used in multiple fields. The purpose of the current study was evaluation of the antibacterial effects of amniotic fluid and comparison of its effects on pathogenic and probiotic bacteria.

Methods: This experimental study was conducted on amniotic fluid obtained from 43 healthy mothers who gave birth by selective cesarean section. Then, antibacterial effects of amniotic fluids were investigated on 8 standard bacterial strains, including Bacillus cereus, Escherichia coli, Staphylococcus aureus, Shigella flexneri, Pseudomonas aeruginosa, Klebsiella pneumoniae, Bacillus cereus, and Lactobacillus plantarum by agar well-diffusion method. Data analysis was performed by SPSS software, vs. 22 (IBM, US).

Results: Amniotic fluid revealed an inhibitory effect on the growth of bacterial strains. Staphylococcus aureus and Streptococcus pyogenes strains showed growth inhibition in 39% and 17% of samples, respectively. In other bacterial strains, there was growth inhibition in less than 5% of the samples. Also, the zone of growth inhibition for Staphylococcus aureus and Streptococcus pyogenes was significantly higher than the other strains. Amniotic fluid samples had an antibacterial effect on all pathogen strains in general, but not on the Lactobacillus plantarum probiotic strain.

Conclusion: Our findings suggest that the antibacterial effect of amniotic fluid on pathogenic bacteria is significantly higher than the Lactobacillus plantarum as a probiotic one. Overall, the findings support the use of natural substances as alternative therapeutic agents to combat antibiotic resistance.

Background: The relationship between uterine peristalsis before embryo transfer and the success of assisted reproductive techniques (ARTs) has not been properly investigated. In this study, the effect of uterine contractions on embryo implantation in frozen embryo transfer (FET) cycles was investigated to determine whether the frequency of uterine contractions can be used as a quantitative marker to assess endometrial receptivity.

Methods: In this cohort study of 68 eligible FET candidates, one hour before embryo transfer (ET), frequency of uterine contractions was assessed with transvaginal ultrasonography. Patients were followed up for 20 weeks. The association between FET outcomes including clinical pregnancy, abortion, and ectopic pregnancy with uterine contractions was evaluated. Binary logistic regression was conducted to test the association between clinical pregnancy outcomes in different groups. The p<0.05 were considered statistically significant.

Results: Of 68 patients, 25 (36.8%) experienced clinical pregnancy. Multiple logistic regression for omitted confounders (age, BMI, duration, type and cause of infertility) revealed that patients with uterine peristaltic wave frequency less than 2≤ wave/min had higher chance of successful pregnancy compared to those with ≥4 wave/min (odds ratio: 10.8; 95% confidence interval: 1.5-79.4, p=0.019). The Pearson's correlation showed a statistically significant relationship between the frequency of uterine contraction and endometrial thickness (r= 0.42, p=0.002).

Conclusion: Patients with uterine peristalsis of <4.0 wave/min before embryo transfer had a higher chance of successful implantation and pregnancy compared with those with higher contraction frequencies. It seems that measuring uterine contraction frequency before embryo transfer might help to predict pregnancy outcomes.

Background: At present, the damage of male reproductive function caused by electron irradiation, as well as the development of methods for its correction are the relevant topics for further research. In fact, the effect of leukocyte-poor platelet-rich plasma (LP-PRP) growth factors are poorly investigated on different aspects of male fertility.

Methods: In this study, Wistar rats were divided into four groups; I) control which were injected with saline; II and III) groups (n=65) whose testes were locally irradiated with electrons to a dose of 2 Gy (linear accelerator "NOVAC-11"); III) the group (n=30) which received LP-PRP for 11 weeks after irradiation; and IV) animals (n=30) which received only LP-PRP (conditional control). The testes were studied by histological, immunohistochemical (IHC), western blotting, and TUNEL methods using Ki-67, Bcl-2, and p53. Comparison between groups was performed and p<0.01 was set as the level of significance.

Results: The results showed a decrease in the expression levels of Ki-67 and Bcl-2 besides an increase in p53-positive cells by the end of the experiment (p<0.01). After injection of LP-PRP, a gradual restoration of the proliferative activity of gametes was noted, which was confirmed by an increase in the proportion of Ki-67- and Bcl-2-positive germ cells (46.4±2.3, p<0.01 and 23.5±1.1, respectively, p<0.01).

Conclusion: Ki-67 expression and TUNEL analysis in the testes revealed a modulation of the proliferative-apoptotic balance towards apoptosis of germ cells after 2 Gy local electron irradiation. A tendency to restore the proliferative-apoptotic balance was noted after LP-PRP injections as indicated by increase in Ki-67-positive germ cells.

Background: Sperm DNA fragmentation can affect reproductive outcomes in assisted reproductive techniques (ART), and it is a concern in density gradient centrifugation (DGC). By contrast, microfluidic approaches allow the selection of highly motile sperm with low DNA fragmentation index (DFI). The purpose of current study, was to compare the efficacy of a microfluidic device designed in-house in comparison with DGC.

Methods: Nineteen healthy men with normal semen profiles were included in the study. Semen samples were individually aliquoted for three sperm preparation analyses (crude and processed with to either DGC or the microfluidic method). Sperm parameters of the samples were evaluated along with DNA fragmentation using the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) method.

Results: Sperm processed using the microfluidic method showed a significantly lower DFI than those obtained using DGC and in crude semen, with DFI of 1.1%, 3.5%, and 4.9%, respectively. Although the microfluidic method yielded significantly lower sperm concentrations than DGC, no significant differences were observed in total motility, progressive motility, curvilinear velocity, straight-line velocity, or normal morphology.

Conclusion: Using the in-house microfluidic device, sperm with lower DFI was effectively isolated when compared with DGC. The motility and normal morphology rates were comparable among the samples.

Background: Follitropin alfa (FA) is one of the most widely used exogenous gonadotropins in both agonist and antagonist protocols for controlled ovarian stimulation (COS) and in vitro fertilization (IVF). However, reports of its effectiveness are limited, particularly in terms of its impact on overall IVF outcomes and ovarian hyperstimulation syndrome (OHSS). Therefore, in this study, FA competency was investigated by evaluating its effect on IVF outcomes and OHSS, administering agonist and antagonist COS protocols.

Methods: A retrospective study with 120 subjects was conducted. Outcomes comprising the number of retrieved and fertilized oocytes, quality of embryos, and clinical pregnancies were assessed. Statistical correlation between FA dose, IVF outcomes, and the incidence of OHSS was also analyzed. All statistical analyses were performed at 95% confidence level.

Results: There was no significant difference in both protocols regarding retrieved oocytes (p=0.604), fertilized oocytes (p=0.761), embryo quality including good, average, poor embryo (p=0.875, p=0.565, p=0.785), and clinical pregnancy (p= 0.844). However, FA doses in the agonist protocol were shown notably higher (p= 0.001). Negative correlations were also observed between FA dose and the number of retrieved oocytes (r=-0.255, p<0.01), fertilized oocytes (r=-0.296, p<0.01), and good quality embryos (r=-0.231, p<0.05).

Conclusion: Our study suggested that FA yields similar outcomes in both COS protocols, but agonist protocols require higher doses of FA and evaluation of its effect on OHSS is an important area of research for further investigation.

Background: The purpose of the current study was evaluation of the utility of seminal plasma (SP) resistin and leptin in predicting successful surgical sperm retrieval (SSR) in men with non-obstructive azoospermia (NOA).

Methods: This prospective comparative study was conducted in the andrology clinic of a specialized fertility center. In total, 53 NOA men as candidates for either first time micro-testicular sperm extraction (micro-TESE) or repeat micro-TESE and 28 normozoospermic controls were included. ELISA was used for measurement of SP resistin and leptin levels in all participants. Significance level was defined as p<0.05.

Results: The current study demonstrated a significant positive correlation between estradiol (E2) level in serum and SP resistin (r=0.342, p=0.025). Also, there was a highly significant positive correlation between SP leptin and SP resistin (r=0.568, p= 0.001). Interestingly, SP leptin was the only variable that demonstrated a significant correlation with eventful micro-TESE outcome in men who underwent micro-TESE for the first time. Finally, ROC curve showed that SP leptin level of 4.05 ng/ml predicted successful SSR in men who underwent micro-TESE for the first time with a sensitivity of 73.3% and a specificity of 75% as 11 out of 27 (41%) cases showed eventful micro-TESE at or above this cut-off level [AUC of 0.747, 95% CI, lower bound of 0.555, and upper bound of 0.939, p=0.030].

Conclusion: SP leptin can be used as a non-invasive biomarker to predict successful SSR in NOA cases undergoing first time micro-TESE, while SP resistin failed to play the same role.