mohammad ebrahim parsanezhad

Hysterosalpingography is a vital diagnostic method for identifying anatomical causes of infertility, often used as a cost-effective screening test. This study aimed to investigate hysterosalpingography results in infertile women.

A quantitative, descriptive, and analytic cross-sectional study was conducted on 180 infertile couples referred to Ghadir Maternal and Child Hospital in Shiraz, Iran between February and July 2015-2016. Data were collected from patient records and hysterosalpingography findings. A questionnaire encompassing demographic information and hysterosalpingography results was utilized. Qualitative and quantitative variables were described using frequency and mean± standard deviation. Data were analyzed using Kolmogorov-Smirnov normality test, Chi-square, and generalized linear models via IBM SPSS version 22.

Hysterosalpingography (HSG) revealed that 145 women (80.6%) exhibited normal uterine and tubal findings, while 35 women (19.4%) displayed abnormal results (classified as normal and abnormal HSG findings). Women with abnormal hysterosalpingography were observed to have a higher likelihood of primary infertility (OR=3.8, 95%CI (1.427-10.10), P=0.008). Furthermore, the study assessed the impact of Body Mass Index (BMI) and identified that women in the abnormal HSG group had a higher body mass index (OR=0.89, 95%CI (0.794-0.992), P=0.035).

Tubal adhesion stemming from undiagnosed and untreated sexual infections can lead to primary infertility. Limited resources may hinder timely detection and treatment access, exacerbating the issue. The correlation between obesity and infertility could be attributed to an unhealthy lifestyle in low-income families. Encouraging health education within low to middle-income communities is recommended to prevent sexually transmitted infections and promote healthier lifestyles, ultimately reducing the incidence of primary infertility.

As the world's population increases, the incidence of infertility is increasing, and infertility is now considered to affect 8–12% of couples worldwide. Assisted reproductive technology (ART) such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) is revolutionizing the field of reproductive medicine and strives continuously to provide infertile patients with access to appropriate and efficient treatments. However, some causes leading to total/low fertilization rate in ART have been addressed. Phospholipase C zeta (PLCζ) is the main sperm-specific factor responsible for triggering oocyte activation (OA). Therefore, PLCζ abnormalities, including low and absent expression as well as its mutation has been described as one of the fertility rate inducers resulted from the oocyte activation deficiency and sperm parameters abnormalities and failed IVF and ICSI cycles. In this review article we have aimed to focus on the latest information of the PLCζ published data in the Web of Science, Scopus, Science Direct and PubMed databases and resulted in the failed IVF and ICSI and recurrent ICSI and IVF failure. In addition the investigations on PLCζ gene and its coded protein in the animals have been also reported.

Studies have shown that the change in PLCζ expression and its mutations can cause a decrease in the fertilization rate due to egg activation defects and abnormalities in sperm parameters and failure in ART.

The Coronavirus disease 2019 (COVID-19) pandemic has raised concerns regarding the application of assisted reproductive technology (ART) in the world. Many ART programs have been delayed or continued with new precautions due to the ambiguity about vertical transmission and pregnancy safety. Regarding the possible risks of SARS-CoV-2 infection on ART and the resultant embryos, this study aimed to investigate the presence of SARS-CoV-2 in follicular fluid, granulosa cells, and oocytes of COVID-19-infected women undergoing ART.

COVID-19-positive polymerase chain reaction tests were reported for five women undergoing ART cycles on the day of oocyte retrieval. SARS-CoV-2 tests were performed on oocytes, granulosa cells, and follicular fluid obtained from these COVID-19-infected women.

SARS-CoV-2 RNA was detected only in one follicular fluid sample; however, other follicular fluid samples, granulosa cells, and oocytes were negative regarding viral RNA.

Given the unknown effects of COVID-19 on human reproduction and ART, strict precautions should be taken during the COVID-19 pandemic.

The current research was established to make a comparison between the delayed-start GnRH antagonist and flare-up GnRH agonist protocols in poor response patients.

The present study is a randomized, prospective, controlled trial that was performed on 150 women who referred to two distinct in vitro fertilization (IVF) centers in Iran. Patients were randomly assigned to two experimental groups, as one group was treated with the delayed-start GnRH antagonist protocol (delayed-start group), while another group was treated with the flare-up protocol (flare-up group).

The serum concentrations of estradiol and progesterone, along with the thickness of endometrial tissue and the number of follicles ≥13 mm was significantly increased in the delayed-start group compared with the flare-up group. Also, the number of total oocytes, retrieved mature oocytes, total embryos, fertilized oocytes, as well as the quality of embryos were markedly higher in the delayed-start group when compared with the flare-up group. No statistically significant difference was found in the rates of fertilization, implantation, and pregnancy between the two experimental groups.

According to the above evidence, it seems that the effect of delayed-start protocol on ovarian responsiveness was more pronounced during controlled ovarian stimulation in comparison with the flare-up protocol and the delayed start protocol probably lead to better implantation and pregnancy rates in comparison with the flare up agonist protocol cycle in poor responders.

Insulin resistance (IR) occurs in 50-70% of women with polycystic ovary syndrome (PCOS) and can be applied as a pre-diabetic feature in PCOS.

In this study, indirect methods including fasting blood sugar (FBS), fasting insulin (FI), FBS/FI ratio, and quantitative insulin sensitivity check index (QUICKI) were compared with the homeostasis model assessment of insulin resistance (HOMA-IR) as a standard technique. The association of IR to sex hormone-binding globulin (SHBG) and several hormones was also analyzed.

This cross-sectional study was performed on 74 PCOS women. Sensitivity and specificity of each IR method was calculated based on HOMA-IR. Hormonal profiles of the patients were compared between the groups with defined normal and abnormal values of IR.

Triglyceride levels had a positive association with FBS and HOMA-IR (p = 0.002 and p = 0.01, respectively) with a negative association to QUICKI and SHBG (p = 0.02 and p = 0.02, respectively). SHBG showed a significant negative association with FBS (p = 0.001). Dehydroepiandrosterone sulfate showed a positive association with FI (p = 0.002). Seven PCOS women showed abnormal SHBG levels (< 36 nmol/L) while expressed normal values of the rest of the studied variables. FI and QUICKI had the highest sensitivity while FBS/FI and QUICKI had the highest specificity when HOMA-IR was applied as a standard test.

SHBG and Triglyceride had a significant negative and positive association with IR, respectively. HOMA-IR followed by FI and QUICKI is the most sensitive test for the detection of IR. SHBG levels can be a helpful biomarker for the diagnosis of PCOS.

The purpose of this study was to compare the effects of Glycyrrhiza glabra (Licorice), a cyclooxyge- nase-2 inhibitor (Celecoxib) and a gonadotropin-releasing hormone analog (Diphereline®), with a control group on endometrial implants in rats. In this experimental study, endometriosis was induced in rats by auto transplantation and after confirmation, the rats were divided into 4 groups that were treated for 6 weeks with normal saline (0.5 ml/day, orally), licorice extract (3000 mg/kg/day, orally), celecoxib (50 mg/kg, twice a day, orally) or diphereline (3 mg/kg, intramuscularly). At the end of treatments, the mean area, volume, histopathology and hemosiderin-laden macrophage (HLM) counts of the endometrial implants were evaluated and compared among the four groups. The mean area, volume and HLM counts of the implants in the licorice group were significantly lower than those of the control group (P<0.001). The histopathologic grades of endometrial implants were significantly decreased by licorice compared to the control group (P<0.001). There was no significant change in the mentioned parameters in rats treated with celecoxib compared to the control group. Diphereline was the most potent agent for suppressing the growth of endometrial implants in terms of all of the above-mentioned parameters. Licorice decreased the growth and histopathologic grades of auto-transplanted endometrial implants. However, while celcoxib had no significant effect, diphereline showed the highest potency for decreasing the endome- trial growth. Licorice may have the potential to be used as an alternative medication for the treatment of endometriosis.

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction that usually occurs after gonadotropin stimulation, followed by human chorionic gonadotropin administration, for infertility treatment. The existing knowledge about the pathophysiology, risk factors, and primary and secondary methods for the prevention of OHSS is reviewed in this manuscript. The clinical manifestations and characteristics of mild, moderate, severe, and critical forms of the syndrome are defined. The methods of handling affected cases as outpatient or in-hospital management methods as well as indications for hospitalization are summarized in this review. The clinical and biochemical routes of assessing and monitoring hospitalized patients with OHSS, various drugs and medical treatment strategies including indications for aspiration of the ascitic fluid and pleural effusion, and also rare indications for surgery are briefly explained in this article. Severe OHSS, which two decades ago was considered an iatrogenic life-threatening condition, can now be effectively prevented or managed during the early stages. An OHSS-free clinic can be established nowadays by carefully considering the endocrinology of ovulation and using appropriate and dose-adjusted pharmaceutical agents, which are summarized and discussed in this review.

Y chromosome deletions (YCDs) in azoospermia factor (AZF) region are associated with ab- normal spermatogenesis and may lead to azoospermia or severe oligozoospermia. Assisted reproductive tech- nologies (ART) by intracytoplasmic sperm injection (ICSI) and testicular sperm extraction (TESE) are com- monly required for infertility management of patients carrying YCDs. The aim of this study was to estimate the frequency of YCDs, to find the most frequent variant in infertile men candidate for ART and to compare YCD distribution with a control fertile group. The semen parameters, hormonal profiles and ART outcomes of the infertile group were studied.
This case-control study consisted of 97 oligozoospermic or non-obstructive azoospermic (NOA) infertile men, who had undergone ART, as the case group and 100 fertile men as the control group. DNA samples were extracted from blood samples taken from all 197 participants and YCDs were identified by multiplex polymerase chain reaction (PCR) of eight known sequence-tagged sites. The chi-square test was used to compare the mean values of hormone and sperm parameters between the two groups. P No YCD was detected in the control group. However, 20 out of 97 (20.6%) infertile men had a YCD. AZFc, AZFbc and AZFabc deletions were detected in 15 (75%), four (20%) and one (5%) YCD-positive patients. No fer- tilization or clinical pregnancy was seen following ICSI in this sub-group with YCD. The mean level of FSH was significantly higher in the group with YCD (28.45 ± 22.2 vs. 4.8 ± 3.17 and 10.83 ± 7.23 in YCD-negative patients with and without clinical pregnancy respectively).
YCD is frequent among NOA men and YCD screening before ART and patient counseling is thus strongly recommended.

Endocrine abnormalities related to polycystic ovary Syndrome (PCOS) are important problems.

To compare serum leptin levels between infertile women with and without PCOS. To rank sensitivity of six indirect methods for detection of insulin resistance (IR) and to evaluate the association between leptin and IR in PCOS group.

This Case-controlled study performed on 189 infertile women referred to Shiraz Mother and Child Hospital during 2012-2015. Ninety-nine PCOS cases according to Rotterdam criteria were compared to 90 cases without PCOS. Serum leptin, body mass index (BMI), several hormones, and their correlation coefficients with leptin were compared. IR in PCOS women was measured by indirect methods, including fasting blood sugar (FBS), fasting insulin (FI), glucose/insulin, homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and MacAuley index. Association between IR and leptin was evaluated. Independent sample t-test and Pearson’s test were used.

Infertile women with PCOS had higher BMI (26.47±3.62 vs. 24.82±5.18 kg/m2) and serum leptin levels (41.79±187.89 vs. 19.38±12.57 ng/mL). Leptin showed significant association with weight and BMI in both groups (p

BMI and IR have positive association with serum leptin in PCOS infertile women. HOMA-IR followed by FI and QUICKI is the most sensitive test for detection of IR.

Despite the large number of papers published on the efficiency of different exogenous gonadotropins, no confirmed protocol exists. Therefore, the aim of the present study was to compare the efficacy of 4 exogenous gonadotropins in IVF/ICSI cycles.
This study, performed from January 2014 to May 2014, recruited 160 women referred to Ghadir Mother and Child Hospital and Dena Hospital, Shiraz, Iran. The patients underwent standard downregulation and were randomly divided into 4 groups of A, B, C, and D and were administered hMG, hFSH, rFSH, and combined sequential hFSH/rFSH, respectively. Then, the duration of stimulation, number of oocytes and embryos as well as their quality, implantation rate, biochemical and clinical pregnancy rate, and live birth rate in each group were evaluated.
Group D patients required significantly fewer ampoules of FSH than did the women in groups A, B, and C (P=0.004). The duration of stimulation was significantly longer in group C than in groups A and D (P=0.030). The serum estradiol level was significantly higher in group D than in groups B and C (P=0.005). A significantly higher number of large-sized follicles was observed in group D than in group B (P=0.036).
Our data revealed no statistically significant differences in the mean oocyte number, embryo quality, clinical pregnancy rate, or live birth rate between the hMG, hFSH, rFSH, and sequential hFSH/rFSH protocols. However, several differences in the duration of stimulation, serum estradiol levels, and number of large-sized follicles were detected between the groups.

Diminished ovarian reserve (DOR) significantly decreases the success rate of the assisted reproductive technique (ART). In this study, we assessed the effect of melatonin on the ART outcomes in women with DOR. A double-blinded, randomized, clinical trial was performed on 80 women with DOR as a pilot study in Shiraz, between 2014 and 2015. DOR was defined as the presence of 2 of the following 3 criteria: 1) anti-Müllerian hormone ≤1, 2) folliclestimulating hormone ≥10, and 3) bilateral antral follicle count ≤6. The women received 3 mg/d melatonin or a placebo since the fifth day of one cycle prior to gonadotropin stimulation and continued the treatment up to the time of ovum pickup. The ART outcomes were compared between the groups using SPSS software. Finally, there were 32 women in the case and 34 in the placebo groups. The mean age and basal ovarian reserve test were the same between the groups. The serum estradiol level on the triggering day was significantly higher in the case group (P=0.005). The mean number of MII oocytes was higher in the case group, but the difference did not reach statistical significance. Number of the patients who had mature MII oocytes (P=0.014), top-quality embryos with grade 1 (P=0.049), and embryos with grades 1 and 2 (P=0.014) was higher among the women who received melatonin. However, the other ART outcomes were not different between the groups. The serum estradiol level was higher and more women with DOR had good-quality oocytes and embryos after receiving melatonin; however, no other outcome was different between the case and control groups.

Insulin resistance and hyperinsulinemia are common among the women with polycystic ovarian syndrome (PCOS). Familial aggregation of PCOS has implications on the role of heredity in this disease. The aim of this study was to evaluate insulin resistance among the fathers, mothers, and siblings of the women with PCOS referring to the clinics affiliated to Shiraz University of Medical Sciences. The present case-control study was conducted on 107 individuals as the case group and 107 individuals as the control group. After recording their height and weight, blood samples were obtained from all the participants in order to assay their serum insulin and blood sugar. Then, the participants were supposed to drink 75 gr glucose solutions and after lapsing 2 hours, blood samples were again taken from all the participants. Finally, the data were analyzed using independent t-test, Fisher's exact test, and chi-square test. P-values less than 0.05 were considered asstatically significant. All the statistical analyses were performed through the SPSS statistical software (ver. 11.5). A significant difference was found between the two groups regarding glucose intolerance, obesity, and insulin resistance according to Homeostasis Model Assessment Index (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI), and fasting insulin indexes (P<0.05). Moreover, a significant association was observed between android obesity and glucose intolerance (P<0.05), body mass index (≥ 30 Kg/m2), and type II diabetes in the two groups. The first-degree relatives of the women suffering from polycystic ovarian syndrome constitute a risk group and early identification of insulin resistance may prevent the onset and progression of the disease.

To evaluate the effectiveness of intrauterine injection of recombinant human chorionic gonadotropin (rhCG) before embryo transfer (ET). In this randomized placebo-controlled clinical trial, a total number of 182 infertile patients undergoing their first in vitro fertilization/ intracytoplasmic sperm injection (IVF-ICSI) cycles were randomly assigned to receive 250μg intrauterine rhCG (n=84) or placebo (n=98) before ET. The implantation and pregnancy rates were compared between groups. Patients who received intrauterine rhCG before ET had significantly higher implantation (36.9% vs. 22.4%; p=0.035), clinical pregnancy rates (34.5% vs. 20.4%; p=0.044) and ongoing pregnancy rate (32.1% vs. 18.4%; p=0.032) when compared to those who received placebo. The abortion (2.4% vs. 2.0%; p=0.929) and ectopic pregnancy rates (1.2% vs. 1.0%; p=0.976) were comparable between groups of rhCG and placebo, respectively. Intrauterine injection of 250μg of rhCG before ET significantly improves the implantation and pregnancy rates in IVF/ICSI cycles.

Unexplained infertility is still a challenging issue as to its causes, appropriate management and treatment. Evidence implicates early embryopathy or implantation failure as likely causes. This study aims to investigate the effect of local endometrial injury on pregnancy rate in selected unexplained infertile patients. This was a randomized clinical trial conducted in Shiraz University infertility clinic of Ghadir hospital. A total of 217 women with unexplained infertility aged 23-35 years old were randomly divided into two study groups through block randomization. After superovulation by clomiphene-citrate and gonadotropins and when the dominant follicles reached 18-20 mm, patients were randomly assigned to undergo endometrial local injury at posterior uterine wall by piplle endometrial sampling (n=114) or mock pipette biopsy (n=103) during pre-ovulatory days (when spontaneous urinary LH surge was detected). Then all the patients were instructed to follow a regularly timed intercourse. The pregnancy rate was significantly higher in the endometrial injury group compared to the control group [17/114 (14.9%) vs. 6/103 (5.8%) (OR: 2.83 95% CI: 1.07-7.49, p=0.03]. The abortion rate was comparable between two groups (17.64% vs. 14.28%; p=0.701). Local mechanical injury of the endometrium can enhance the uterine receptivity and facilitates the embryo implantation. This simple, easy, and cost effective procedure is worth considering in selective unexplained infertility patients who implantation failure is the likely causes of infertility before complex treatments. This procedure may help reduce psychological tensions and high expenses imposed through such interventions

Chromium picolinate could be effective in clomiphen citrate resistant PCOS patients. To compare the effects of chromium picolinate vs. metformin in clomiphen citrate resistant PCOS patients. The present randomized clinical trial was performed on 92 women with clomiphen citrate-resistant PCOS at the clinics which were affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The subjects were randomly assigned to two groups receiving either chromium picolinate (200μg daily) or metformin (1500mg daily) for 3 months. Anthropometric and hormonal profile were measured and compared both before and after the treatment. Ovulation and pregnancy rate was measured in the two study groups, as well. Chromium picolinate significantly decreased fasting blood sugar (FBS) after 3 months of treatment (p=0.042). In the same way, the serum levels of fasting insulin had significantly decreased leading to an increase in insulin sensitivity as measured by QUICKI index (p=0.014). In comparison to the patients who received chromium picolinate, those who received metformin had significantly lower levels of testosterone (p=0.001) and free testosterone (p=0.001) after 3 months of treatment. Nevertheless, no significant difference was found between the two study groups regarding ovulation (p=0.417) and pregnancy rates (p=0.500). Chromium picolinate decreased FBS and insulin levels and, thus, increased insulin sensitivity in clomiphene citrate-resistance PCOS women. These effects were comparable with metformin; however, metformin treatment was associated with decreased hyperandrogenism. Overall, chromium picolinate was better tolerated compared to metformin; nonetheless, the two study groups were not significantly different regarding ovulation and pregnancy rates.

This case was an extremely rare form of cervical dysgenesis that presented with cyclic pain. Diagnostic laparoscopy and vaginoscopy showed the presence of a blind uterus at the level of the internal cervical os with a normal vagina and exocervix. Müllerian ducts are the embryologic origin for the uterus, cervix and upper part of the vagina. Müllerian duct migration initiates from the upper part of the Müllerian system. Therefore an obstructed uterus is usually associated with cervical and upper vaginal anomalies. This case was unusual because of the presence of an isolated segmental atresia at the level of the internal cervical os. However the vaginal portion of the cervix, vagina and urinary system were normal. We theorized that the absence of an appropriate fusion between the Müllerian duct and its underlying mesoderm, loss of cell-to-cell communication and special gene expression during a critical time period or a vascular accident between 12–22 weeks of gestation might have caused this anomaly. The patient underwent a laparotomy to create a utero-cervical canal using a peritoneal graft.

Women with polycystic ovarian syndrome (PCOS) have twice the risk for metabolic syndrome as compared to women from the general population. Mothers and sisters of affected women also have an increased prevalence of metabolic syndrome. The aim of the study was to determine the prevalence of metabolic syndrome in fathers of patients with PCOS.

34 fathers of PCOS patients were evaluated. The control group was 34 fathers of normal women. The data were obtained from the clinical history and personal interview with the patients, the controls and their fathers at Shiraz University of Medical Sciences in 2009. Prevalence of metabolic syndrome was determined according to Adult Treatment Panel index III (ATPIII) and International Diabetes Federation (IDF) criteria. Also incidence of hypertension and impaired glucose tolerance test, insulin resistance and diabetes type II were considered in both groups.

According to ATPIII and IDF criteria, the prevalence of metabolic disorders was 29.35% and 41.17 in the fathers of the PCOS patients and 8.85% and 11.76 % in the fathers of the control group, respectively (p <0.008 and p<0.007, respectively). Also incidence of hypertension and impaired glcose tolerance test was significantly higher in fathers of the PCOS patients than control group (p< 0.05.

Our findings indicate that the fathers of women with PCOS have higher prevalence of metabolic syndrome and higher risk of developing hypertension and impaired glucose tolerance and diabetes.

In order to evaluate the role ofketoconazole in the prevention of ovarian hyperstimulation syndrome (OHSS) in women with polycystic ovary syndrome (PCOS) undergoing ovarian stimulation with gonadotropins, a prospective, randomized, double-blind, placebo controlled study was done on one-hundred and nine PCOS women that had been refeiTed to be treated by gonadotropins. Alll09 women were assigned for random allocation. Group A (50 patients) received two ampoules ofhMG beginning on day 2 or 3 of the cycle and ketoconazole (50 mg/every 48 hours) starting on the first day ofhMG treatment. Group B (51 patients) received the same protocol ofhMG combined with one tablet of placebo every 48 hours. Main outcome measures were follicular development, E2levels, and pregnancy rate. The total number ofhMG ampoules and duration oftreatment to attain ovarian stimulation was higher in group A (pConclusion