International Journal Of Fertility and Sterility
Volume:3 Issue: 4, Feb-Mar 2010

To evaluate the diagnostic accuracy of transvaginal sonography (TVS) in infertile patients and compare its results with hysteroscopy, as the gold standard. A total of 679 infertile women who underwent both TVS and diagnostic hysteroscopy were retrospectively investigated. TVS was performed in the mid-follicular phase (days 5-8) of their cycles. Sensitivity, specificity, and positive and negative predictive values were calculated for TVS. Hysteroscopy diagnosed endometrial polyps in 197 out of 679 cases (24.5%). TVS confirmed the hysteroscopy findings in 174 of 197 (88.3%) cases. The sensitivity, specificity, and positive and negative predictive values of TVS compared to hysteroscopy in the detection of endometrial polyps were 88.3%, 91.9%, 81.6% and 90.8%, respectively. TVS is both a cost-effective and non-invasive method for the diagnosis of intra-uterine lesions such as polyps. When used in conjunction with a saline infusion, it can be a proper alternative for diagnostic hysteroscopy that saves time and enables the surgeon to perform the operative hystroscopy procedure with greater accuracy.

The purpose of this prospective, randomized study was to compare ovarian response as well as oocytes, embryo yields and pregnancy rates in women who underwent ovulation induction for intracytoplasmic sperm injection (ICSI) with recombinant human FSH (rFSH) alone or in combination with human menopausal gonadotropin (HMG). Out of 300 patients in assisted reproductive technique (ART) cycles who underwent down regulation with GnRH analogue in a long protocol, 64 patients received 150 IU/d r FSH until day six when they were randomly allocated into two study groups: group A, who received rFSH alone (n=32) and group B, (n= 32) who received rFSH and HMG. The total number of ampoules of rFSH, the numbers of oocytes retrieved, embryos and serum concentrations of luteinizing hormone (LH) on the day of hCG administration were similar in both treatment groups. However, the numbers of follicles ≥15mm, serum concentrations of progesterone and estradiol on the day of hCG administration were significantly higher in group B when compared to group A. Although the number of high quality embryos (grades A and B) were significantly better in group B, the number of pregnancies and live birth rates were similar in both groups. The study shows that the addition of LH to rFSH in pituitary – suppressed women undergoing ART improves some parameters of ovarian response, but doesn’t improve overall pregnancy rates.

To assess embryos derived by the transfer of meiosis-II chromosomes (M-II-t) from aged mice oocytes into ooplasms from younger mice to overcome the problem of age-related decline in female fertility. The developmental capacity، karyotype، and ultrastructure of reconstructed oocytes derived from meiosis-II chromosome transplantation from aged mice into the ooplasms of young mice by piezo-micromanipulation were assessed. The survival rate of enucleated young oocytes was 54% and the percent of fertilized reconstructed oocytes was 23%. The rate of embryo development to the two-cell stage after cultivation was 40%. Since 82. 4% of the analyzed embryos derived from reconstructed oocytes had condensed nuclei، it was not possible to analyze their chromosomal integrity. However، 17. 6% of analyzable reconstructed old oocyte derived embryos (old-ODEs)، had normal diploid sets of chromosomes. Major structural differences were not observed between young، old، and M-II-t derived two-cell embryos. Our findings suggested that ooplasms from younger mice may overcome age-associated problems in older mice.

This study was undertaken to investigate the efficiency of two different embryo somatic cell co-culture conditions, tissue culture medium 199 (TCM199)–vero cells and Menezo B2 (B2)-vero cells, for the in vitro developmental quantity and quality of bovine embryos. Bovine oocytes were allowed to mature and subsequently undergo fertilization in vitro. Their presumptive zygotes were cultured in either TCM199 or B2 culture media in conjunction with vero cells for up to nine days. The culture media were refreshed every two days and the proportion of embryos that cleaved and further developed to the morula and blastocyst (early, expand and hatched) stages were recorded. Hatched blastocysts underwent differential staining in order to determine the numbers of inner cell mass (ICM) and tropho ectoderm (TE) and total cell number (TCN). Of the two groups, no significant difference was seen between the proportions of the presumptive zygotes cleaved, those which developed to 8-16 cells, morula and reached days 7or 8 blastocyst stage or hatched. However, the values for TCN and TE of the TCM199-vero embryos were significantly greater than those of B2-vero embryos. The values for ICM/TCN and ICM/TE were significantly greater in the B2-vero group versus the TCM199-vero group. Both TCM199 and B2 culture media in conjunction with vero cells were of the same efficiency when used for in vitro development of bovine presumptive zygotes. However, TCM199 was superior in providing embryos with more embryo cell numbers, whereas B2 medium was superior in providing embryos with greater ICM/TE and ICM/TCN ratios.

Flow cytometry (FCM) has been extensively used to study mammalian sperm in the areas of clinical andrology and reproductive toxicology. FCM provides a powerful advantage over microscopy technique in terms of rapid, accurate and reproducible technology for the quantification of various cell characteristics, including chromatin status. During spermiogenesis, histones are replaced by protamines resulting in a very condensed structure of sperm chromatin. Infertile men have an increased sperm histone: protamine ratio than fertile counterparts. Chromomycin A3 (CMA3) staining represents a useful tool for assessing the packaging quality of sperm chromatin and allows indirect visualization of protamine deficiency. Routinely, fluorescence microscope is used for evaluation of protamine deficiency by CMA3. Considering the advantages of FCM and increasing use of CMA3 in assessment of protamine deficiency in the literature and its possible use as a diagnostic test, the aim of this study is to standardize this procedure for routine laboratory analysis. Semen samples were collected from 85 infertile men who referred to Isfahan Fertility and Infertility Center. A portion of semen sample was used for routine semen analysis according to WHO criteria and the remainder were evaluated to standardize CMA3 staining procedure for fixation, the number of sperm and duration of exposure to CMA3. The results were compared with standard fluorescent microscopic procedure. Percentage CMA3 positive sperm were compared between flow cytometry and standard fluorescent microscopic procedure. Our results show that fixation, the number of sperm and duration of exposure to CMA3 can affect on FCM outcomes. In addition we show that the samples can be fixed, stained with CMA3, stores and then assessed for FCM. The optimal conditions for FCM assessment of CMA3 are: fixation, concentration of 0.25 mg/ml, sperm density of 2 million/ml and exposure for 60 minutes.

In the present study the effects of a hydro-alcoholic saffron (Crocus sativus) extract on pituitary-ovary axis and folliculogenesis were investigated. The aim was to study the possible role of saffron in female fertility and thereby, show its usefulness in treating infertility and reproductive disorders in females. The study consisted of 50 adult female Sprague dawley rats that were divided into five groups of tena control, sham and three experimental groups. The experimental groups received intreperitoneal injections of 1, 2 and 4 dg/kg body weight (B.W) extract, respectively over a ten day period. The control group was untreated and the sham group received only distilled water. After 10 days, blood samples were taken from all groups in order to measure the serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH) estradiol and progesterone hormones. Ovaries were removed, sectioned and examined by light microscope. The results were analyzed by ANOVA and TUKEY tests. Statistical analysis of the results showed a significance increase (p≤0.05) in the levels of FSH and estradiol in the experimental groups that received 2 and 4 dg/kg B.W extract with respect to the control group; while the level of LH hormone only rose in the experimental group that was administered the maximum dose (4 dg/kg). In addition, the results indicated that administration of 2 and 4 dg/kg extract had a significant effect on ovarian weight. Histological studies of the ovarian sections showed that administration of 2 and 4 dg/kg extracts enhanced folliculogenesis and increased the numbers of secondary follicles in the ovary. According to the results of this and other studies, the hydro-alcoholic extract of saffron may enhance pituitary-ovary axis activities, boost the levels of FSH, LH and estradiol in addition to stimulate folliculogenesis in adult female rats.

In surrogate pregnancies genetic parents have little opportunity for early bonding with their infants, either prenatally (in utero) or during the immediate postnatal period. Procedures commonly used to induce lactation include both pharmacologic and nonpharmacologic methods, often in combination. Studies reporting induced lactation are sparse, due to the rarity of augmented lactation. Here we report a case of lactation induction following a surrogate pregnancy. Other methods that can be used to augment lactation are described below. We used metoclopramide in this case due to the success rates reported in previous studies and case reports. Additionally, it is a well tolerated and safe agent.

Heterotopic pregnancy (HP) is the simultaneous occurrence of intra- and extrauterine pregnancies. It is a rare event in spontaneous pregnancies with an incidence of less than 1:15000, however the frequency has increased to 1% in accordance with the widespread use of assisted reproductive techniques (ART). The pre-operative diagnosis of this condition is generally difficult and it would be life threatening for mother and the intrauterine pregnancy. In this report, we present three cases of HP following ART. All cases underwent a standard long protocol and embryo transfers (ET) were performed 48 hours after oocyte retrievals. Finally, two viable intrauterine gestations ended in miscarriages and the third resulted in the delivery of a healthy infant.The possibility of a heterotopic pregnancy following tubal pathologies, endometriosis and pelvic adhesions should be considered by gynecologists during IVF procedures. Moreover by implantation of a single embryo, the incidence of this risky condition will be dramatically reduced.