Clinical and Experimental Reproductive Medicine-CERM最新文献

Objective: This study aimed to assess associations between the peripheral natural killer (pNK) cell percentage and women's age, body mass index (BMI), serum anti-Müllerian hormone (AMH), autoantibodies, and thrombophilia-related markers among infertile women undergoing in vitro fertilization (IVF).

Methods: We enrolled 91 infertile Korean women (mean age 37.7 years [range, 26 to 48]) whose pNK cell percentage was measured either before IVF (22 women) or after ≥1 failed embryo transfer (ET) (69 women) between May 2017 and November 2022 at a single university hospital. Levels of antiphospholipid antibodies, thyroid-stimulating hormone (TSH), anti-thyroglobulin, anti-microsome, anti-nuclear antibodies, antithrombin III, protein C, and protein S were measured. Serum AMH was tested within 1 year of the pNK cell measurement.

Results: The mean pNK cell percentage was 16.69%±7.60%, and 68 women (74.7%) had pNK ≥12%. Univariate analysis of five continuous variables (age, BMI, AMH, TSH, and number of failed ETs) showed that the pNK percentage was negatively associated with BMI (r=-0.213, p=0.043) and AMH (r=-0.213, p=0.049). Among 11 autoantibodies/markers, only β2-glycoprotein 1 immunoglobulin G (IgG) antibody was associated with a difference in pNK percentage (9.75%±4.72% in 4 positive vs. 17.63%±7.77% in 76 negative women, p=0.022). In a multivariate analysis of BMI, AMH, and β2-glycoprotein 1 IgG positivity, AMH (B=-0.249, p=0.028) was significantly negatively associated with the pNK percentage.

Conclusion: The percentage of pNK cells is closely associated with serum AMH levels.

Objective: To compare the outcomes of microscopic subinguinal varicocelectomy versus oral antioxidants in managing male infertility associated with isolated teratozoospermia.

Methods: This multicenter randomized controlled trial was conducted between January 2022 and January 2024. A total of 81 patients with isolated teratozoospermia and clinical varicoceles completed the study; 40 patients underwent varicocele ligation (group A), and 41 patients received oral antioxidants (L-carnitine, vitamin C, and vitamin E) (group B). Sperm morphology, sperm DNA fragmentation (SDF), and the achievement of natural pregnancy were compared between the two groups. Additionally, predictive factors for improvement were analyzed.

Results: All sperm parameters improved significantly following either varicocele ligation or antioxidant treatment. SDF decreased significantly in both groups (p<0.001). The increase in the percentage of normal sperm forms and the reduction in SDF were significantly greater in the varicocele surgery group compared to the antioxidant group (p=0.007 and p=0.013, respectively). The natural pregnancy rate was higher in the varicocele ligation group, with nine patients (22.5%) achieving pregnancy compared to five patients (12.5%) in the antioxidant group. Moreover, the presence of pinpoint and round head abnormalities predicted significantly poorer outcomes following varicocele ligation (p=0.003).

Conclusion: Varicocelectomy appears to be more effective than antioxidants in improving sperm morphology, reducing SDF, and enhancing the natural pregnancy rate in male infertility due to isolated teratozoospermia.

Objective: Tramadol is a centrally acting analgesic with a modest opioid effect similar to morphine and codeine, but less potent; it is mainly prescribed for the treatment of mild to moderate pain. Tramadol exhibits both opioid and non-opioid properties, primarily affecting the central nervous system. Accordingly, the present study was designed to investigate the effects of tramadol on female reproductive function and ovarian toxicity, as well as to examine oocyte survival and follicular development in mice exposed to tramadol.

Methods: Mice were treated with tramadol at 50 mg/kg daily for 3 weeks. Blood levels of the hormones estrogen and progesterone were measured. The ovaries of the mice were subjected to histological, immunohistochemical, and molecular studies.

Results: Our results revealed that tramadol provoked ovarian atrophy by inducing oxidative stress, while also decreasing oocyte survival and impairing follicular development.

Conclusion: Although further research is necessary, the findings indicate that tramadol could reduce fertility in female mice.

Objective: Levofloxacin (LVFX), a fluoroquinolone antibiotic, is used in the treatment of urogenital tract diseases affecting the reproductive system. This study aimed to examine the protective effects of coenzyme Q10 (CoQ10) against LVFX-induced side effects using stereological methods.

Methods: Eighty rats were divided into eight groups: control (distilled water), CoQ10 (10 mg/kg/day), and low dose (25 mg/kg/day), medium dose (50 mg/kg/day), and high dose (100 mg/kg/day) of LVFX (low dose [LD]-LVFX, medium dose [MD]-LVFX, and high dose [HD]-LVFX) with or without CoQ10 administration. Treatments were performed daily for 4 weeks. Sperm parameters, serum testosterone levels, testicular oxidative stress markers, and testicular histology were evaluated.

Results: Sperm count, motility, normal morphology, and viability, as well as serum testosterone levels, were reduced, while malondialdehyde concentrations increased in MD-LVFX and HD-LVFX treated animals compared to controls. MD-LVFX and HD-LVFX treatments produced a 6% to 56% reduction in the volumes, lengths, and diameters of seminiferous tubules and their epithelium, whereas the interstitial tissue volume increased by 43% to 53% in these groups. The numbers of spermatogonia, spermatocytes, spermatids, Sertoli cells, and Leydig cells were reduced by 23% to 76% in animals treated with MD-LVFX and HD-LVFX compared to controls. Notably, all changes observed in the rats receiving CoQ10 were similar to those in the control group, and although most parameters decreased in animals that received LD-LVFX, the differences were not statistically significant relative to controls.

Conclusion: LVFX treatment for 28 days, regardless of dose, adversely affected sperm parameters and testicular tissue. CoQ10 exhibited a protective effect by mitigating the structural and functional impairments induced by LVFX.

Objective: This study investigated the association between vitamin D deficiency and polycystic ovary syndrome (PCOS), focusing on metabolic and endocrine parameters.

Methods: A retrospective analysis with Mendelian randomization (MR) was conducted using clinical data from patients diagnosed with PCOS at Shanxi Provincial People's Hospital from 2019 to 2025. Variables included serum vitamin D levels, anthropometric indices, hormone profiles, and inflammatory markers. Multiple regression models were applied to control for confounders. LASSO logistic regression was used for feature selection and predictive modeling, with model performance assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. A nomogram based on logistic regression was constructed and evaluated using ROC-derived AUC values to determine classification accuracy and translational potential.

Results: Patients with PCOS exhibited higher rates of vitamin D deficiency or insufficiency compared with healthy controls. Vitamin D deficiency was associated with weight gain, insulin resistance, and chronic inflammation. Vitamin D may reduce testosterone levels, suppress interleukin- 6, and influence hepatic sex hormone-binding globulin (SHBG) synthesis, thereby affecting PCOS development. MR analysis further suggested that vitamin D deficiency may worsen PCOS through insulin resistance. Body mass index and testosterone levels were positively associated with PCOS, whereas SHBG was inversely related. The nomogram derived from multivariate modeling demonstrated high predictive accuracy, reliability, and generalizability.

Conclusion: Vitamin D deficiency is significantly associated with PCOS and may contribute to its pathogenesis by exacerbating metabolic dysfunction. MR findings support potential causality. Further studies should assess whether vitamin D supplementation improves clinical outcomes in PCOS.

Objective: In assisted reproductive technology (ART), transferring a single euploid blastocyst optimizes pregnancy outcomes and reduces the risk of multiple gestation. Chromosomal aneuploidy, relatively prevalent among patients of advanced maternal age, remains a leading cause of ART failure. This study investigated the relationships among blastocyst morphology, developmental speed, ploidy status, and sex.

Methods: This retrospective cohort study analyzed 856 blastocysts from 439 patients who underwent minimal stimulation in vitro fertilization (IVF) cycles at the Ojinmed IVF Center, Mongolia, between May 2019 and June 2024. Embryo grading followed the Gardner and Schoolcraft system, assessing blastocyst expansion, inner cell mass grade, trophectoderm (TE) grade, and developmental timing. TE biopsies were evaluated for euploidy, whole or segmental aneuploidy, and mosaicism.

Results: Euploidy, aneuploidy, and mosaicism rates were 49.8%, 33.4%, and 16.8%, respectively, exhibiting significant correlations with maternal age. Women at least 35 years old faced increased aneuploidy risk (adjusted odds ratio [aOR], 3.34; 95% confidence interval [CI], 2.35 to 4.61; p<0.001) and reduced euploidy rates (aOR, 0.29; 95% CI, 0.21 to 0.41; p<0.001). Among morphological parameters, only TE grade significantly predicted ploidy, with TE grade C linked to elevated aneuploidy risk (aOR, 3.06; 95% CI, 1.42 to 6.10; p<0.01). Faster blastocyst expansion was correlated with male sex (aOR, 0.95; 95% CI, 0.91 to 0.99; p=0.03). Segmental and whole-chromosomal abnormalities were exclusively age-related.

Conclusion: Maternal age and TE grade are strong predictors of blastocyst ploidy, and expansion speed is associated with sex. These findings support improved embryo selection strategies to promote successful IVF.

Objective: Letrozole (LE) is the first-line therapy for ovulation induction in polycystic ovary syndrome (PCOS). However, in women who are resistant to standard LE therapy, alternative ovulation induction regimens require further exploration. This study evaluated the efficacy of a novel protocol for stepwise extended LE treatment in patients with anovulatory PCOS undergoing intrauterine insemination who were resistant to the standard dose of 5 mg LE.

Methods: The study included 319 women diagnosed with PCOS. LE treatment was administered in a stepwise manner, starting with 5 mg for 5 days (standard group), followed by an extension for another 2 to 5 days (total 7-10 days; extended group; LE 5 mg), and subsequently escalating the dose to 7.5 mg for 2-5 days (total 12-15 days; non-responder extended group; LE 7.5 mg) within a single cycle. Clinical outcomes included ovulation rate and clinical pregnancy rate (CPR).

Results: Overall, 219 patients responded to standard LE with follicular development, 83 responded to extended LE 5 mg therapy, and 11 responded to extended LE 7.5 mg. CPRs at 10 weeks of gestation were 18.72% in the standard group, 14.45% in the extended LE 5 mg group, and 11.76% in the non-responder extended LE 7.5 mg group, with no statistically significant differences among them. Multiple pregnancies were observed only in the standard group.

Conclusion: The stepwise extended LE regimen appears to be a feasible option for LE-resistant PCOS; however, its efficacy must be further explored and validated in prospective randomized studies.

Objective: Freeze-drying is a promising method for the long-term preservation of sperm; however, it often leads to increased oxidative stress. Green tea (Camellia sinensis [L.] Kuntze) contains polyphenols known for their antioxidant properties. This study aimed to evaluate the in vitro effects of green tea aqueous extract (GTE) on oxidative stress markers and sperm DNA fragmentation (SDF) in freeze-dried human sperm.

Methods: Ten normal semen samples were collected from men aged 20 to 45 years and divided into three groups: conventionally cryopreserved (A), freeze-dried (B), and freeze-dried with pre-incubation in GTE (C). In group C, samples were incubated with 1 mL of GTE at a concentration of 40 μg/mL for 30 minutes prior to freeze-drying. Oxidative stress markers and SDF were assessed 1 month post-preservation, following thawing in group A and rehydration in groups B and C.

Results: Freeze-drying resulted in less DNA damage to sperm compared to cryopreservation (p=0.005). Relative to cryopreservation, incubation with GTE significantly reduced intracellular reactive oxygen species levels (p<0.0001), DNA fragmentation index (p=0.005), and malondialdehyde concentration (p<0.0001) while increasing the percentage of sperm with high mitochondrial membrane potential (p<0.0001) and glutathione concentration (p<0.0001).

Conclusion: Treating normal human sperm with GTE before freeze-drying significantly reduces markers of oxidative stress and promotes indicators of sperm health compared to conventional cryopreservation. These findings suggest that natural antioxidants like GTE may offer a promising therapeutic approach to preserving male fertility with regard to oxidative stress and improving the effectiveness of freeze-drying as an alternative to cryopreservation.

Objective: The interpretation and evaluation of mosaicism in pre-implantation genetic testing for aneuploidy (PGT-A) are complex, and no consensus or standardized criteria are currently available. We investigated whether mosaicism, as assessed by type or level in PGT-A, is correlated with clinical pregnancy and live birth rates.

Methods: This retrospective experimental trial included 207 oocyte retrieval cycles and 124 cycles of single vitrified-warmed blastocyst transfer performed between August 2020 and March 2023 at a single in vitro fertilization center. A total of 124 single vitrified-warmed blastocyst transfer cycles were analyzed for clinical outcomes, stratified by mosaic type and level. We also analyzed the correlations between kinetic characteristics and embryo ploidy.

Results: No significant difference in live birth rates was found between the euploid and low-level mosaic groups (52.9% vs. 35.7%). However, live birth rates were significantly lower in the high-level mosaic group than in the euploid group (52.9% vs. 17.6%, p<0.05). No full-term live births were recorded among the embryos with high-level mosaicism for trisomy and segmental aneuploidy, although three live births were observed in high-level mosaic embryos with monosomy. Furthermore, time to blastocyst development was longer in mosaic embryos than in euploid embryos. However, when analyzed according to mosaic level, the developmental kinetics were not sufficiently distinctive to enable reliable non-invasive prediction of mosaic status.

Conclusion: This study suggests that ranking embryos by the level and type of mosaicism can help maximize post-implantation outcomes. Live birth rates varied according to the type of mosaicism.

Objectives: To evaluate the advantages and disadvantages of hydrocele repair in infertile men. The outcome measures were changes in testicular size, semen analysis, and natural pregnancy rate postoperatively.

Methods: This pilot study was conducted between January 2021 and April 2024. Inclusion criteria were male patients with a 1-year history of infertility associated with symptomatic hydroceles >100 mL and abnormal semen parameters. Thirty-one men underwent hydrocele surgery, while 30 opted for conservative follow-up. Repeat semen analysis and testicular ultrasonography were performed 6 months after surgery.

Results: Primary infertility was reported in 65% of the patients, and two-thirds had unilateral hydroceles. Both groups were comparable in baseline semen parameters, testicular size, and demographic data. The natural pregnancy rate was documented 1 year after surgery. Pregnancy rates were higher in the surgery group than in the conservative group (7 [22.58%] and 5 [16.67%], respectively), although this difference was not statistically significant. No statistically significant differences were observed in semen analysis post-surgery or follow-up. A mild but statistically significant reduction in testicular size was noted after surgery (p<0.001). More than 80% of patients reported satisfaction with the surgery. The overall complication rate was 15%, with only two patients requiring further surgical intervention.

Conclusion: Hydrocelectomy can be offered safely to infertile men. It is associated with high patient satisfaction and minimal side effects. Larger randomized controlled trials are required to confirm its positive effects on natural pregnancy.