Clinical and Experimental Reproductive Medicine-CERM最新文献

The importance of maintaining adequate levels of vitamin D for optimal male sexual health is highlighted by recent evidence suggesting a link between vitamin D insufficiency and erectile dysfunction (ED). This review examines current research that indicates an association between decreased serum concentrations of 25-hydroxyvitamin D (25(OH)D), specifically levels below 20 ng/mL, and a higher prevalence of ED, including severe cases. Studies have shown a significant correlation between a decrease of 10 ng/mL in 25(OH)D levels and a 12% increase in the prevalence of ED. The active form of vitamin D, calcitriol, facilitates the synthesis of nitric oxide, a potent vasodilator crucial for penile erection. Additionally, vitamin D supplementation has been shown to improve erectile function by enhancing endothelial vasodilation and arterial blood flow. It is essential to maintain serum 25(OH)D levels within the recommended range of 20 to 50 ng/mL, given the connection between vascular disorders and ED. A comprehensive approach, including dietary changes, consistent physical activity, and lifestyle modifications, is necessary to prevent ED. While vitamin D deficiency may contribute to ED, it is crucial to recognize that ED is multifactorial and should be addressed by considering all underlying causes. Individuals consistently experiencing symptoms of ED are advised to consult healthcare professionals for appropriate therapeutic interventions. This review emphasizes the importance of considering serum vitamin D levels when assessing male sexual health and calls for further research to clarify the role of vitamin D in the etiology and treatment of ED.

Objective: Endometriosis (Endo) involves inflammation and angiogenesis within lesions, potentially causing embryo implantation failure. Paeonia lactiflora (PL) root exhibits anti-angiogenic and anti-inflammatory properties. This experiment investigated the therapeutic effects of PL on endometriotic lesion atrophy and embryo implantation following in vitro fertilization (IVF).

Methods: Female mice (n=32) were allocated into treatment and sham groups. Endo was induced through xenograft transplantation of rat endometrium to anterior abdominal walls of recipient (Endo) mice. PL root was extracted, phytochemically characterized, and orally administered (1.06 mg PL/20 g mouse) for 17 consecutive days. Through IVF, cultured mouse embryos were implanted into Endo mouse uteri. Ten days post-IVF, samples were collected, including intra-abdominal fluid for measurement of vascular endothelial growth factor (VEGF) and tumor necrosis factor α (TNF-α) using enzyme-linked immunosorbent assay. Embryo-containing uteri underwent trypan blue staining, while uterus fragments were stained with hematoxylin and eosin and analyzed for leukemia inhibitory factor (LIF) gene expression using quantitative polymerase chain reaction. The number of embryo implantation sites and diameter of endometriotic lesions were recorded. Data were analyzed using SPSS ver. 19, with p-values <0.05 considered to indicate statistical significance.

Results: Following Endo induction, TNF-α and VEGF levels and lesion diameter increased (p<0.05). LIF gene expression and embryo implantation rate decreased (p<0.05). After PL extract administration to Endo mice, TNF-α levels, VEGF levels, and lesion diameter decreased (p<0.05), while LIF gene expression and implantation rate increased (p<0.05).

Conclusion: PL extract (1.06 mg/20 g mouse) decreases TNF-α and VEGF levels, suppressing inflammation and angiogenesis and causing endometriotic lesion atrophy. Furthermore, PL increases uterine LIF gene expression, promoting successful implantation post-IVF in Endo mice.

Objective: This study investigated oxidative stress and its impact on sperm quality in men with infertility, focusing on lipid peroxidation and the activity of antioxidant enzymes-catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx)-in seminal fluid.

Methods: This study was conducted from January 2021 to January 2023 and involved 163 male patients who had been experiencing infertility for over a year. The participants were categorized according to semen quality. Semen samples were analyzed for sperm concentration, motility, and morphology following the World Health Organization guidelines. Oxidative stress was evaluated by measuring levels of malondialdehyde (MDA), an indicator of lipid peroxidation, as well as the activity of CAT, SOD, and GPx. Ethical approval and informed consent were obtained from all participants.

Results: Semen quality and oxidative stress were evaluated in cases of male infertility, with patients categorized into five groups: normozoospermia, oligozoospermia, asthenozoospermia, teratozoospermia, and oligo-astheno-teratozoospermia. The pathological groups exhibited significant reductions in sperm count, motility, and morphology. Additionally, lipid peroxidation, as shown by increased MDA levels, was significantly elevated in all pathological groups. The activities of CAT, SOD, and GPx were significantly diminished in these groups, with the most substantial declines noted in the oligo-astheno-teratozoospermia group.

Conclusion: Oxidative stress, indicated by elevated MDA levels, was correlated with poor sperm quality. The decreased activity of antioxidant enzymes in pathological semen implies that a weakened antioxidant defense contributes to sperm dysfunction. These findings suggest that antioxidant interventions could improve sperm quality in men experiencing infertility, though additional research is required.

Objective: In this study, we investigated whether adding autologous platelet-rich plasma (PRP) to the culture medium affects embryo development and clinical outcomes in patients with recurrent implantation failure (RIF).

Methods: This study included 201 patients with previous RIF. Of these, 77 opted to receive the treatment and were assigned to the PRP group, and 124 declined and were assigned to the control group. In the PRP group, normally fertilized embryos were cultured in medium supplemented with 5% PRP, whereas embryos in the control group were cultured without PRP. Embryo transfer was performed on day 3 after evaluation of embryo quality. A comparative analysis was then conducted between the two groups, focusing on embryo quality and clinical outcomes.

Results: Although no significant differences were observed in fertilization or cleavage rates, the PRP group had a significantly higher proportion of good-quality embryos with at least six cells on day 3 than the control group. The clinical pregnancy and implantation rates in the PRP group were also significantly higher than those in the control group. Furthermore, the ongoing pregnancy rate was notably higher in the PRP group, and successful live births were achieved. Miscarriage rates were similar between groups.

Conclusion: Incorporating PRP as an additive into the culture medium improved embryo quality and increased implantation, clinical pregnancy, and ongoing pregnancy rates.

To assess the effects of endometrial scratch injury (ESI) in infertile couples seeking fertility through non-in vitro fertilization (IVF) cycles. We conducted a comprehensive search of MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Library, and Google Scholar from their inception through August 2023. The search terms included 'endometrial scratch,' 'infertility,' 'implantation,' 'intrauterine insemination (IUI),' and their corresponding MeSH terms. We included all published and unpublished randomized controlled trials involving ESI in women undergoing either natural or IUI cycles. The ESIs varied in severity and were performed during either the follicular or luteal phase of the same or preceding cycle. Our review encompassed 32 studies, totaling 5,897 participants. Of these, seven studies with 1,094 participants assessed ESI in natural cycles, while 25 studies with 4,803 participants evaluated it in IUI cycles. The data extracted included trial location, number of participants, inclusion and exclusion criteria for participants, details of the ESI, and outcome parameters (trial registration: CRD42023434127). ESI significantly increased the clinical pregnancy rate (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.72 to 2.47; p<0.001), ongoing pregnancy/live birth rate (OR, 1.68; 95% CI, 1.32 to 2.13; p<0.001), and chemical pregnancy rate (OR, 2.32; 95% CI, 1.79 to 3.00; p<0.001). However, it had no significant effect on the rates of multiple pregnancy, miscarriage, and ectopic pregnancy (p>0.05). ESI improved the clinical pregnancy rate, ongoing pregnancy/live birth rate, and chemical pregnancy rate in both natural and IUI cycles.

Objective: The Korean government implemented national insurance coverage for infertility treatment in 2017 and established a nationwide infertility treatment data collection system in 2018. This report analyzes infertility treatment cycles performed in 2022 based on this national registry.

Methods: Data were retrospectively collected from 201 certified infertility treatment institutions in Korea. Standardized treatment forms for intrauterine insemination (IUI) and in vitro fertilization (IVF) were submitted to the Health Insurance Review and Assessment Service for all infertility treatment cycles conducted in 2022.

Results: A total of 200,007 infertility treatment cycles were reported in 2022, consisting of 33,137 IUI cycles and 166,870 IVF cycles. Among IVF cycles, 64.6% were initiated for fresh embryo transfers and 35.4% for frozen-thawed embryo transfers. In IVF cycles, the overall clinical pregnancy rate per embryo transfer was 30.2% for fresh and 42.0% for frozen-thawed embryo transfers. The proportion of single embryo transfers has risen steadily since 2019. The most common indication for IVF was diminished ovarian reserve, while IUI was mainly performed for unexplained or male factor infertility.

Conclusion: Nationwide infertility treatment cycle reporting in Korea has enabled detailed monitoring of infertility treatment trends and outcomes. The data show a substantial increase in IVF utilization, a growing preference for frozen-thawed embryo transfer, and broader adoption of single embryo transfer consistent with global practices. Further integration with birth outcome data and longitudinal patient tracking will be essential to evaluate cumulative success rates and overall effectiveness. This national registry provides a foundation for optimizing infertility care and facilitates international benchmarking.

Objective: To evaluate the long-term effects of dutasteride on male fertility and determine the cutoff treatment duration that causes significant and persistent decreases in semen parameters.

Methods: This was a single-center, randomized, controlled study that evaluated 200 men (ages 28 to 39 years). Forty men were allocated to each study group, divided according to the duration of dutasteride treatment, as follows: <6 months (group 1), 6-12 months (group 2), 13-18 months (group 3), 19-24 months (group 4), and >24 months (group 5). All subjects received dutasteride 0.5 mg/day for management of androgenetic alopecia then discontinued dutasteride for 6 months.

Results: The baseline mean testosterone level in the study subjects was 4.8 ng/mL. No significant differences were found between study groups in sperm concentration, normal morphology, and vitality. Semen volume and sperm total/progressive motility were significantly reduced as the duration of dutasteride treatment increased. All study groups showed an increase in total sperm motility and semen volume after discontinuation of dutasteride. Compared with group 1, groups 2-5 showed significant decreases in semen volume and sperm total motility, with the odds ratios becoming smaller as the duration of dutasteride treatment increased. Receiver operating characteristic analysis showed the cutoff values for persistent impairment of semen volume and total sperm motility to be 17.8 and 20.3 months, respectively.

Conclusion: Long-term use of dutasteride may lead to male infertility by persistently impairing semen volume and sperm motility.

Objective: An undescended testis (UDT) is a testicle that has not moved into the scrotum before birth. UDTs are linked to reduced fertility, primarily due to compromised semen quality and potential dysfunction in Sertoli and Leydig cells. Additionally, the Wilms tumor 1 (WT1) gene is crucial for spermatogenesis, as it regulates the polarity of Sertoli cells and the steroidogenesis in Leydig cells. Our study aimed to identify novel UDT-causing WT1 variants within a cohort of 60 unrelated men with infertile hypergonadotropic hypogonadism.

Methods: In this case-control study, the coding regions and the intronic boundaries of the second and ninth exon of WT1 were sequenced using Sanger sequencing. DNA from 60 fertile men served as the control group. In silico analysis of the variants was also conducted.

Results: The study identified multiple intronic and exonic variations in both the patient and control groups. Notably, a haplotype consisting of two heterozygous C>T variations in the intronic region of the splice donor site of exon 9 was observed in 11 patients but was absent in the control group. Of these variations, only one has been previously reported in Single Nucleotide Polymorphism Database (dbSNP) as rs587776576 (NC_000011.10: g.32391967C>T; NM_000378.4:c.1372+14G>A).

Conclusion: The rs587776576 mutation is pathogenic. It exhibited a significant association (p=0.022), indicating its association with infertility and UDT in the Iranian population. This research could broaden the spectrum of WT1 variations and underscore the importance of these variants in the genetic etiology of UDT and infertility. These findings provide a foundation for clinical diagnosis and genetic counseling.

Objective: Mixed gonadal dysgenesis is characterized by abnormal genital appearance and chromosomal mosaicism. A wide spectrum of clinical manifestations can occur, ranging from females (with or without Turner syndrome) to phenotypically normal males with some degree of genital ambiguity. In this context, uncommon mosaic karyotypes are associated with distinctive phenotypic characteristics. Here, we present the case of an 18-year-old girl with primary amenorrhea, delayed puberty, and a rare mosaic karyotype pattern.

Methods: Clinical data were collected, and karyotyping was performed on peripheral blood samples. Polymerase chain reaction amplification for the sex-determining region Y protein (SRY) gene was also conducted.

Results: The patient presented with delayed puberty and primary amenorrhea. Her hormonal profile was consistent with hypergonadotropic hypogonadism. Pelvic magnetic resonance imaging revealed a small uterus. Echocardiography identified the presence of a bicuspid aortic valve. Karyotyping demonstrated a 46,XY/45,X/46,X,r(Y) pattern, indicating mosaicism for monosomy X and two cell lines: 45,X and 46,X,r(Y). The SRY gene was detected. Gonadal pathological investigation confirmed streak gonads consistent with gonadal dysgenesis and evidence of gonadoblastoma.

Conclusion: Complicated cases with mosaic chromosomal patterns can exhibit a wide range of phenotypic features, from apparently normal males with variable external genitalia to females with or without characteristics of Turner syndrome. These phenotypic discrepancies are not directly related to the number of mosaic cells or the specific location of Y chromosome breakage. Therefore, in cases of primary amenorrhea with genotype-phenotype discrepancies, a multidisciplinary approach is essential to guide appropriate sex determination and management.

Objective: This study aimed to investigate the effects of specific probiotic strains on the endocrine activity of Leydig cells, which are essential for testosterone production. We focused on the potential influence of probiotics on testosterone synthesis and mitochondrial functionality within these cells.

Methods: The TM3 Leydig cell line was utilized to assess the effects of three probiotic strains: Lacticaseibacillus rhamnosus, Limosilactobacillus fermentum, and Bifidobacterium longum subsp. longum. The analyses evaluated key aspects of Leydig cell function, including endocrine signaling pathways, cellular proliferation, gene and protein expression related to testosterone biosynthesis, and mitochondrial function.

Results: The probiotic strains significantly enhanced the expression of key proteins involved in testosterone synthesis and upregulated mitochondrial activity compared to control cells. Notably, these effects were observed across all three probiotic strains, suggesting a positive impact on both testosterone production and mitochondrial function.

Conclusion: The findings suggest that probiotic supplementation can modulate testosterone synthesis and improve mitochondrial functionality in Leydig cells. These results underscore the potential of probiotics as modulators of male reproductive health, with possible therapeutic applications in conditions such as male hypogonadism.