International Journal Of Fertility and Sterility
Volume:13 Issue: 3, Oct-Dec 2019

Several causes for primary ovarian insufficiency have been described, including iatrogenic and environmental factor, viral infections, chronic disease as well as genetic alterations. Given the large number of genes described in the literature so far, the aim of this review was to collect all the genetic mutations associated with non-syndromic primary ovarian insufficiency. All studies assessing genetic mutations associated with non-syndromic primary ovarian insufficiency were analyzed. For a study to be included in this review, it had to focus on candidate gene screening, or a genome-wide study. Syndromic primary ovarian insufficiency and chromosomal abnormalities were not evaluated. Single gene perturbations having positive correlation with non-syndromic primary ovarian insufficiency included genes on the X chromosome, such as BMP15, PGRMC1, and FMR1; and genes on autosomes, such as GDF9, FIGLA, NOBOX, ESR1, FSHR, and NANOS3. New strategies performed for identifying new genes associated with primary ovarian insufficiency development included linkage analysis in families with multiple affected members, CGH for copy number variations, genome-wide association studies, genome-wide sequencing of exomes, and in the future the next generation sequencing This review, including nearly all the genetic abnormalities and genes associated with non-syndromic primary ovarian insufficiency detected so far, showed the variability of genetic factors in the origin of primary ovarian insufficiency, as ovarian function depends on the expression of multiple genes. These findings may help for future genetic screening studies on large cohort of women.

Rubella infection with in the first trimester of pregnancy may lead to adverse pregnancy outcomes. The present study was conducted to evaluate the immunity against rubella among pregnant Iranian women. The steps of meta-analyses were conducted based on the PRISMA guidelines. To review the associated English and Persian literature, a comprehensive search was conducted among international databases such as Scopus, PubMed/Medline, Science Direct, Cochrane library, Web of Science, and Google Scholar search engine as well as Iranian databases until October 1, 2017 using the following MeSH keywords: ‘Pregnant’, ‘Gestational’, ‘Prenatal care’, ‘Complications of pregnancy’, ‘Pregnancy’, ‘Rubella infection’, ‘Prevalence, ‘Epidemiology’, ‘Immunity’, ‘Immunization’, ‘Antibody’, ‘Iran’, and ‘Immunogenicity’. Random effects model and fixed effects model were respectively used to estimate the rate of rubella immunity and the effect of different variables on the immunity against rubella. The obtained data were analyzed using Comprehensive Meta-Analysis Ver.2. Sixteen studies constituting 8,411 pregnant Iranian women met the inclusion criteria. The overall pooled rubella immunity was 89.8% (95%CI: 86.1-92.6). Rubella immunity rates were 88.6% (95%CI: 80.6-93.6), and 90.4% (95%CI: 87.5-92.8) before and after national vaccine program, respectively. Rubella immunity rates were 90.7% (95% CI: 87.6-93.1) and 87.2% (95% CI: 74.3-94.1) based on the ELISA method and HIA method, respectively. There was no significant association between rubella immunity and vaccination program (P=0.593), diagnostic methods (P = 0.435), geographic regions (P=0.286), quality of the studies (P=0.603), occupation (P = 0.639), residence (P=0.801), and year of the studies (P=0.164), but it was significantly associated with age (P<0.001). Despite a high rubella immunity among pregnant Iranian women, anti-rubella antibody screening is recommended for all women of childbearing age.

To assess the effects of lactobacillus-based medication on pain intensity scores in women with endometriosis. A randomized pilot placebo-controlled trial was done on eligible women who surgically and pathologically were diagnosed with endometriosis. Thirty-seven enrolled participants who have not received hormonal treatment in the last three months, randomized between lactobacillus and placebo groups. Lactobacillus capsules or placebo administrated orally at a daily dose for 8 weeks. Patients assessed for pain severity using Visual Analogue Scale (VAS) scores for dysmenorrhea, dyspareunia and chronic pelvic pain at baseline and after 8 and 12 weeks post intervention. Mean age of participants and mean BMI for the Lactobacillus and control group were comparable. All patients had stage 3 and 4 of disease based on revised American fertility society (AFS) classification of endometriosis. Mean initial pain scores for dysmenorrhea, dyspareunia and chronic pelvic pain were 6.53 ± 2.88, 4.82 ± 3.76 and 4.19 ± 3.53 respectively in the Lactobacillus group. The corresponding initial scores for the control group were 5.60 ± 2.06, 3.67 ± 2.64 and 2.88 ± 2.80 respectively that were comparable for both groups. The amount of pain score decrease for dysmenorrhea and the overall pain after 8 weeks were significantly higher for lactobacillus group compared to the control group. The scores for dysmenorrhea were 6.53 ± 2.88 and 5.60 ± 2.06 in the Lactobacillus and control groups, respectively, before intervention that changed to 3.07 ± 2.49 and 4.47 ± 2.13 (p = 0.018) after 8 weeks. The changes in overall pain score for the Lactobacillus and control group during this period were 7.33 ± 7.00 and 4.11 ± 1.68 respectively (p = 0.017). This study showed some beneficial effects of Lactobacillus administration on the endometriosis related pain.

Toxoplasma gondii is one of the major causes of abortion in pregnant women. Most cases of abortion occur in the acute phase of infection and early pregnancy. In this study, the seroprevalence of anti-Toxoplasma gondii IgM and IgG antibodies was investigated in women with first spontaneous abortion. Also to determine the acute and chronic infections, all IgM and IgG positive serum samples were evaluated using IgG avidity assay. This research is a case-control study on 240 serum samples from women with first spontaneous abortion as the case group and 240 serum samples from women who had a normal delivery referred to hospital for a checkup and had no history of abortion as the control group. The level of IgM and IgG anti-Toxoplasma gondii antibodies were assessed in serum samples using Enzyme-linked immunosorbent assay (ELISA). To discriminate the acute and chronic infections, all IgM positive samples in both groups and IgG positive samples of case group were examined using IgG avidity. The Toxoplasma IgM antibody was detected in 3.3% (8/240) of case group and 0.4% (1/240) of the control group and there was a statistically significant difference between two groups (P=0.019, Odds Ratio=10.266). 47.5% and 46.3% of samples in the case and control groups were positive for Toxoplasma IgG antibody, respectively. Seven out of 8 (87.5%) IgM positive sera from the case group had low IgG avidity indicating the acute infection, whereas all positive IgG sera and 1 IgM positive sample which was related to control group showed a high IgG avidity indicating the chronic infection. Maternal acute toxoplasmosis during pregnancy is raised as one of the factors that increase the chance of spontaneous abortion. It is suggested to provide the necessary health training, especially on the parasite transmission ways to women before marriage, particularly the seronegative women, as well as the serological toxoplasmosis test in women before and during pregnancy is also recommended. PCR and IgG avidity assays should be performed in the medical diagnostic laboratories for accurate distinguishing of the initial infection of toxoplasmosis in the pregnant women.

The aim of this study was to evaluate the impact of Body Mass Index (BMI) and biochemical lipid values on reproductive outcomes of women undergoing Intra Cytoplasmatic Sperm Injection (ICSI) cycles. The study was conducted in the Center of Human Reproductive Physiopathology of University of Catania between April 2017 and March 2018. In this retrospective observational study 114 couples undergoing ICSI cycles since was enrolled. With the women’s informed consent, levels of total cholesterol, LDL-c, HDL-c and triglycerides were determinate and FSH, LH, E2 and PRL samples were obtained on the 3rd day of menstrual cycle. According to variability of BMI, the samples were divided in group A (BMI 18.5 - 24.9 kg/m2); group B (BMI 25 - 29.9 kg/m2); group C (BMI >30 kg/m2). The results were statistically analyzed with Student’s t-test. Fertilization and pregnancy rate were lower in women with BMI>30 than in women with BMI 25-30 and BMI 18-25, despite the negative biochemical lipid panel. Our results demonstrate that an excess of adipose tissue in women undergoing ICSI was not directly related with altered biochemical lipid values. However, overweight and obese patients show poor fertilization and pregnancy rate despite the negative biochemical lipid panel.

Chemotherapy may damage ovaries. L-carnitine (LC) as a type of flavonoid antioxidants and bone marrow stromal cells (BMSCs) as a type of mesenchymal stem cells may recover damaged ovaries. It seems that LC has favorable effects on differentiation, increasing lifespan and decreasing apoptosis in BMSCs. The aim of this study was to investigate the effects of co-administration of BMSCs and LC on damaged ovaries after creating a chemotherapy model with cyclophosphamide in the rat. In this experimental study, BMSCs were cultured and were confirmed by CD markers of stromal cells. Forty female Wistar rats were injected intraperitoneally with cyclophosphamide for 14 days for induction of chemotherapy and ovarian destruction. Then, the rats were randomly divided into four groups: control, LC, BMSCsthe and co-administration of LC and BMSCs. Injection of BMSCs into bilateral ovaries and intraperitoneal injection of LC were performed individually and together. Four weeks later, the levels of serum E2 and FSH using ELISA reader, the number of ovarian follicles at different stages using H&E staining, and the expression of ovarian Bcl-2 and Bax proteins using western blot were assessed. The results showed that the effects of co-administration of BMSCs and LC were significantly more favorable than the control, BMSC and LC groups on the recovery of damaged ovaries (P<0.05). The effect of co-administration of BMSCs and LC is probably more effective than the effect of their separate administration on the recovery of damaged ovaries by chemotherapy.

Infertile females experience some types of distress such as social stress, depression, and sexual dysfunction that may be exacerbated by polycystic ovary syndrome (PCOS). The current study aimed at comparing psychological profile of infertile females with and without PCOS in four domains: infertility stress, depression, sexual dysfunction, and alexithymia. The current case-control study was conducted on 240 infertile females (120 with PCOS and 120 without PCOS) in Fatemeh Azahra Infertility and Reproductive Health Research Center (Babol, Iran) from 2016 to 2017. The following questionnaires were used to collect data: the fertility problem inventory (FPI), the female sexual function index (FSFI), the Beck depression inventory-II (BDI-II), and the Toronto alexithymia scale (TAS-20). Females with PCOS had higher FPI total scores than the ones without PCOS (120.68±29.42 vs.112.83±30.94). Of the subscales of infertility stress, the mean scores of social stress and rejection of a future lifestyle without a child was higher in females with PCOS than the ones without PCOS (P <0.05). Also, the mean total scores of alexithymia symptoms (TAS-20) in females with PCOS were significantly higher than those of the ones without PCOS (59.83±11.36 vs. 55.69±11.52). There was no significant difference between the two groups regarding the mean scores of depression symptoms and sexual function. Infertile females with PCOS experienced higher levels of infertility stress and inability to distinguish and describe their feelings compared with the ones without PCOS. It is suggested that infertility settings should provide more psychosocial support for infertile females with PCOS.

Abortion is a sensitive issue surrounded by social, cultural and religious stigmata. Therefore, estimation of its prevalence involves methodological challenges. The aim of this manuscript is to estimate the abortion prevalence, stratified by type, using a direct and two indirect methods. This cross-sectional study was done in 2016, we recruited 1020 women aging 18-49 years. Three methods were applied to estimate the abortion prevalence: direct question, network scale-up (NSU), and single sample count (SSC). In the direct method, to guarantee anonymity, data were collected by means of a self-administered questionnaire. In other methods, data were collected through gender-matched street-based interviews. The annual rate of abortion estimated by direct and NSU methods were respectively 29 (10 intentional, 4 therapeutic and 15 spontaneous) and 23 (9 intentional, 3 therapeutic, and 11 spontaneous) per 1000 women aging 18-49 years. The annual rate of intentional abortion estimated based on SSC method was higher (15 per 1000 women) than other methods. The present estimates are higher than previously reported ones. The results of three methods more or less supported each other confirming the internal validity of our estimates.

The present study was conducted to develop a decision-making questionnaire for selecting donor conception and assess its psychometric properties in Iranian infertile couples. This scale development study was conducted based on De Vellis’ method (2012) in four steps at Milad Infertility Clinic in Mashhad, Iran. The dimensions of the concept of decision-making were determined in the first step based on the qualitative results obtained from 38 semi-structured in-depth interviews. Items appropriate for the questionnaire were developed in the second step using the qualitative data and a review of literature. In the third step, the research team reviewed and eliminated some of the items. The fourth step evaluated the face, content and construct validity of the questionnaire through exploratory factor analysis on a sample of 220 infertile couples using convenience sampling and also its initial and final reliability. Based on the results of the qualitative study, a pool of 170 items was developed, 101 of which were eliminated after revision due to being ambiguous or repeated or due to their poor face and content validity and initial reliability. The questionnaire was evaluated for its construct validity with 69 items. After the exploratory factor analysis, the DMDCQ was finalized with 51 items and seven factors. All the factors had Cronbach’s alpha values of 0.75-0.87 and intra-class correlation coefficients (ICC) greater than 0.7. This study led to the development of a valid and reliable scale for examining infertile couples’ decision-making about whether or not to use donor conception and the determinants of this decision.

Oxidative stress as a potential cause of poor oocyte quality can influence female reproduction. This study aimed to investigate the effects of melatonin on chemical pregnancy rates of a significant number of polycystic ovary syndrome (PCOS) patients undergoing intrauterine insemination (IUI). In this randomized double-blinded clinical trial, the study samples included 198 PCOS patients fulfilling the inclusion criteria and undergoing the IUI treatment. On the third day of menstruation, a 3-mg melatonin tablet or its placebo was given to the patients according to the randomized study protocol; this prescription was continued until the day of HCG administration. The current study attempted to primarily scrutinize the effect of melatonin administration on the rate of chemical pregnancy and mature follicles during the IUI treatment cycle and secondary determine the endometrial thickness on the day of IUI. The mean age of the participants in the study was 28.9 ± 5.5 years. The chemical pregnancy rate in the group receiving melatonin was about 32%, and this value was 18% in the control group (P = 0.012). Furthermore, it was concluded that the addition of melatonin to the treatment cycle of PCOS individuals could significantly improve the endometrial thickness after the treatment (P <0.001). The results of this study demonstrated that the treatment of PCOS patients undergoing IUI with melatonin significantly improved the rate of chemical pregnancy (IRCTID: IRCT2017021132489N1).

The prevalence of endometriosis in the general population is estimated at 7-10%. Endometriosis is one of the causes of primary and secondary infertility in 30% of women. There are various risk factors for this disease. The present study aimed to determine the association between sexual activity during menstruation and endometriosis. This case-control study recruited 555 women visiting Alzahra Hospital in Tabriz, Northwest of Iran in 2017. The case group comprised 185 women of reproductive age with confirmed endometriosis. The control group comprised 370 women of reproductive age without endometriosis visiting the hospital for other problems. Data were collected using a researcher-made questionnaire based on previous studies. Univariate analysis was performed using the chi-squared test, and multivariate analysis was done using conditional logistic regression to control confounding variables. Based on multivariate logistic regression, the sexual activity of two groups during menstruation was significantly different. Having vaginal intercourse leading to orgasm during menstruation [OR (95% CI) = 5.23 (2.16 to 12.66)] and non-coital sexual activity leading to orgasm during menstruation [OR (95% CI) = 2.90 (1.28 to 6.55)] increase the risk of endometriosis approximately five and three times higher in those women who stated they had vaginal intercourse leading to orgasm during menstruation compared to those who stated they did not. Based on the results, vaginal intercourse or non-coital sexual activity leading to orgasm during menstruation increases the risk of endometriosis.

Since some cytokines such as IL1 and TNFα are factors involved in endometrial receptivity ,we have determined the amount of these two factors in endometrial secretion in the eligible individuals and then, study their relationship with the success or failure of pregnancy in IVF/ICSI cycles. Methods & Materials:  In this non-randomized descriptive study, 76 women selected for their first IVF/ICSI met the study inclusion criteria. All the patients underwent endometrial secretion aspiration prior to oocyte collection. The level of IL-1and TNF-α were analyzed by enzyme-linked immunosorbent assay method using special standard kits. To detect successful implantation and pregnancy patients underwent serum human chorionic gonadotropin measurements and ultrasound evaluation. Of the 76 subjects under study, 33 (43.4%) had positive βHCG and 44 (56.6%) had negative BHCG. Of the patients with positive βHCG, 23 (30.3%) had fetal heart rate in their TVS. Comparison of cytokine levels showed higher concentration of IL1 in the group with successful chemical pregnancy compared to the group with failed pregnancy (p=0.00). However, no significant difference in terms of clinical pregnancy was revealed in IL-1 levels between two groups (p=0.06).when considering TNFα there was no significant difference in the level of TNFα between the two groups either in terms of chemical or clinical pregnancy.(P=08and .0.6 respectively). The current study suggested that higher concentrations of IL-1 in endometrial secretions might be associated with improved endometrial receptivity and IVF outcome. Regarding TNFα no statistically significant differences were seen between the groups with and without successful pregnancy.

2% to 6% of vasectomized men will ultimately seek vasectomy reversal and late stricture and obstruction after operation are relatively common. To find a method for improving of vasovasostomy outcomes, we used intra-operative local mitomycin-C to prevent possible fibrosis and stricture. Design, setting, and participants: 44 patients in our referral center were assigned to two groups randomly during a one year study and data of 40 patients were analyzed. The patients were followed for 6 months after surgery.
Intervention: The case group (n=19) was treated by vasovasostomy with intra-operative local mitomycin-C. The control group (n=21) was underwent standard vasovasostomy. Mean sperm count in mitomycin-C group was significantly higher than the controls, and sperm count more than 20 million/ml in mitomycin-C and control group was 53% and 14%, respectively. In a subgroup where the interval between vasectomy and reversal was 5 to 10 years post reversal azoospermia was absent in mitomycin-C group, but 50% of controls were still azoospermic. Also, 80% of mitomycin-C group had more than 20 million/ml sperms, but all of the controls had less than 20 million/ml sperms. No significant complication was seen. Intra-operative local mitomycin-C in vasovasostomy can be regarded as a safe and efficient technique which has several advantages including lower cost. Increasing of sperm count is the main effect of local mitomycin-C application that is more prominent when the interval between vasectomy and reversal is 5 to 10 years

0:Actins play essential roles in cellular morphogenesis. In mice, the t-actin 1 and 2 genes, which encode actin-like proteins, are specifically expressed in haploid germ cells. Both T-ACTIN 1/ACTLB and T-ACTIN 2/ACTL7A have also been cloned as orthologous genes in humans; they are present on chromosome 9q31.3 as intronless genes. Defects of germ cell-specific genes can introduce infertility without somatic function impairment. We defined T-ACTIN 1 and T-ACTIN 2, which are also specifically expressed in the testis by reverse-transcription polymerase chain reaction (RT-PCR). To examine whether genetic polymorphisms of the T-ACTIN 1 and 2 genes are associated with male infertility, we screened for T-ACTIN 1 and 2 polymorphisms by direct the sequencing of DNA from 282 sterile and 89 fertile Japanese men. We identified five and six single nucleotide polymorphisms (SNPs) in the T-ACTIN 1 and 2 regions, respectively, in 371 subjects. Among these genetic polymorphisms was a novel SNP that was not in the National Center for Biotechnology Information SNP database. Although we could not determine whether these SNPs cause infertility, the prevalence of these genetic polymorphisms may be useful for analyzing polymorphisms in future large-scale genetic analyses.