International Journal Of Fertility and Sterility
Volume:15 Issue: 4, Oct-Dec 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic struck global health systems with overgrowing demands in many fields of health care; yet, reproductive care, particularly pregnancy care remains a special focus of interest. Pregnancy is a major physiologic change that alters temporarily normal function of many organs, and specifically the immune system. Therefore, pregnant women are more susceptible to respiratory pathogens compared to the others. The current pandemic may have serious consequences on pregnancy whether directly or indirectly. In the present review, direct and indirect possible adverse effects of SARS-CoV-2 infection on female reproductive system by focusing on pregnancy and delivery has been discussed in details. In addition, the pregnancy consequences and whether maternal infection can affect infants were deliberated. The adverse impact of luck down and related psychological complications and obesity on pregnant women were discussed as well. Finally, the effects of SARS-CoV-2 vaccination on maternal health and pregnancy outcome was analyzed.

Monosodium glutamate (MSG) is a flavour enhancer that is used as a food additive (E621) in many parts of the world, especially in East Asian countries. However, in recent studies, it has been used as a neurotoxin because MSG is reported to cause neural degeneration in the hypothalamic arcuate of neonatal animals. The results of several studies show the negative effects of MSG injections on different parts of the hypothalamic-pituitary-gonadal (HPG) axis, in addition to its ability to inhibit secretion many reproductive neuropeptides, neurotrophic factors, and hormones, all of which play vital roles in the regulation of reproductive function. Oral administration or injection of large quantities of MSG into newborn animals results in a decrease in or overabundance of the production of many regulatory peptides of the male and female reproductive systems. In this review, we summarize the results of the most important studies that have examined the effect of oral consumption or injection of MSG on regulatory peptides of the HPG axis.

The purpose of this research was to compare the functional parameters of frozen-thawed Iranian Azaribuffalo spermatozoa with imported semen samples of Italian Mediterranean buffalo (IMB) after the thawing processand 4 hours of incubation. In this experimental study, a total of twenty-four ejaculates from four Iranian Azari buffalobulls were collected. Semen samples were diluted in AndroMed extender at a concentration of 50×106 spermatozoa/ml. The diluted samples were filled in 0.5 ml straws and were frozen in a programmable freezer. For imported semensamples, twenty-four samples of four IMB were used, which were diluted in AndroMed extender and frozen by the sameprocedure. Frozen-thawed sperm motion patterns, mitochondrial activity, membrane integrity, DNA integrity, reactiveoxygen species (ROS), and apoptosis status were evaluated immediately after thawing and 4 hours of incubation. Post-thawed sperm motility, progressive motility (PM), mitochondrial activity, membrane integrity weresignificantly higher in imported semen samples in compare with Iranian Azari buffalo. After 4 hours of incubation,sperm velocity patterns were superior in Iranian Azari semen samples. Moreover, the percentage of sperm cells withun-damaged DNA was higher in Iranian semen samples compared to imported samples at the time 0 of incubation.Following 4 hours of incubation, a significant increase in intracellular ROS level leads to reduced membrane integrity,mitochondrial activity, and DNA integrity in both buffalo breeds. At time 4, Iranian samples showed significantlylower apoptosis and higher dead spermatozoa compared to imported semen samples. Our study showed that the post-thawed quality of Iranian Azari buffalo semen was comparable with imported samples after 4 hours of incubation. Further investigations are recommended to assess the in vitro and in vivofertility rate of both buffalo breeds.

Pomegranate is an ancient fruit containing Punicalagin, which has known as an effective antioxidant.Pomegranate peel was recognized as a phenol and tannin source, and pomegranate seed contains unique fatty acid(Punicic acid). Limited information exists about the influences of pomegranate peel and seed on antioxidant enzymesand proteins in the male reproduction system. This study was performed to determine the pomegranate peel and seedeffects on the expression of antioxidant genes and DJ-1 protein in ram’s testis. In this experimental study, twenty-one mature Iranian rams were randomly divided intothree groups (n=7 in each group), and fed experimental diets consisted of a control diet (C), a diet containing drypomegranate seed pulp (S), and a diet containing pomegranate peel (P) for 80 days. All rams were offered isoenergeticand isonitrogenous rations. Testicular tissue samples were collected, and expression of Gpx1, Gpx4, Prdx4, Prdx5, andSod2 genes was quantified by real-time polymerase chain reaction (RT-PCR). In addition, western blotting was usedto evaluate DJ-1 expression at the protein level. Gpx1 and Sod2 mRNA levels in the peel group were significantly (P<0.05) higher than control. Prdx5 mRNAlevel was increased (P<0.05) in the seeds group than in the control group. Gpx4 and Prdx4 expression were statistically not affected significantly by the experimental diet. Data analysis showed a significant (P<0.05) increase (1.5-fold) in the expression level of DJ-1 in peel groups than in control. The expression of antioxidant genes and DJ-1 protein in ram testes are more influenced by pomegranatepeel than seed.

Ovarian hyperstimulation syndrome (OHSS) is the most notable complication in ovulation induction for assisted reproductive techniques (ARTs) like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Hence, we decided to evaluate the effect of the aromatase inhibitor, letrozole, versus gonadotrophin-releasing hormone (GnRH)-antagonist (ganirelix acetate) on prevention of severity of OHSS and reduction in serum estradiol (E2) levels when administered during the luteal phase after oocyte retrieval in IVF/ICSI cycles. In this prospective single-centred, randomized, parallel-arm study, 122 patients were randomized to receive oral letrozole (n=61, 2.5 mg twice daily) or ganirelix acetate (n=61, 0.25 mg subcutaneously daily) from the day of egg retrieval for the next 7 days. Incidence and severity of early OHSS were the primary endpoints assessed by the signs, symptoms, and laboratory findings of OHSS (e.g., serum E2 levels). The secondary endpoints were patient satisfaction and the additional cost of therapy to prevent the severity of OHSS. Letrozole group had lower incidence of OHSS (13.1%) compared to 19.6% in ganirelix acetate group (P=0.32). Serum E2 levels on post-pick up days 5 and 7 were significantly lower in the letrozole group when compared to the ganirelix acetate group (P=0.001). The majority of the patients in both groups had no major complications. No significant difference was found between the study groups with respect to the incidence of OHSS (P=0.33). The additional cost per IVF cycle for prevention of severity of early-onset OHSS in the letrozole group was 5.32 USD compared to 267.26 USD in the ganirelix acetate group, which was almost fifty times costlier. Letrozole and ganirelix acetate have the same efficiency for the overall prevention of OHSS, whereas letrozole was more effective in preventing moderate OHSS. Letrozole had better patient satisfaction and is cheaper compared to GnRH antagonists (Registration number: CTRI/2020/10/028674).

Recurrent pregnancy loss (RPL) is a multifactorial disorder which affects up to 5% of couples around the world. Several factors are considered to be involved in RPL; but, the etiology remains unexplained in 35-60% of cases. The aim of this study was to assess the frequency of risk factors associated with RPL in a group of our clinic clients, and their pre-implantation genetic screening (PGS) outcome. We designed a retrospective descriptive study among, 602 Iranian couples referred to the Royan Reproductive Clinic (Tehran-Iran) from 2006 to 2018. Their karyotyping test and PGS outcomes were analyzed. PGS had been applied by array comparative genomic hybridization (array-CGH) on embryos from these patients. Also, karyotyping test had been performed using standard cytogenetic techniques. G-banding analysis revealed a frequency of 15.61% chromosomal abnormalities in RPL couples. Also, the reciprocal translocations were more frequent (33/1204 cases) compared to the other structural abnormalities. Pregnancy rate per embryo transferred were 50% with array-CGH approach. Our findings could confirm a positive correlation between chromosomal abnormalities and RPL rate. Applying PGS for the RPL couples, leads to improvement of pregnancy success rate.

Endometriosis is an important cause of chronic pain and infertility. Surgery is considered the gold standard for diagnosis and treatment. In this study, we aim to describe the clinical outcomes of women who undergo laparoscopic surgery for endometriosis. In this cohort study, a total of 174 women who referred to Farmaniyeh Hospital, Tehran, Iran from August 2015 to December 2017 with surgical diagnoses of endometriosis stages III and IV enrolled. The participants’ demographic, gynaecological, and clinical characteristics were recorded and they were asked to use a numeric rating scale (NRS) to record their severity of pain before and three months after surgery. Blood samples were also taken from the patients before and three months after surgery for measurement of serum levels of anti-Müllerian hormone (AMH) and cancer antigen 125 (CA-125). Data were analysed using SPSS version 21. The patients had a mean age of 34.86 ± 6.47 years, 60.9% were married, and 49.4% were housewives. The primary indication for surgery was pain (68.4%), followed by both pain and infertility in the remainder of patients. Types of endometriotic lesions included endometrioma (19%), deep infiltrating endometriosis (DIE, 3.4%), and both endometrioma and DIE (77.6%). There was a reduction in pain from 6.79 ± 2.19 before surgery to 1.48 ± 1.68 after surgery; serum AMH levels reduced from 2.80 ± 1.86 ng/mL to 1.76 ± 1.40 ng/mL and CA-125 reduced from 257.06 ± 220.25 U/mL to 23.27 ± 23.25 U/mL (all P<0.001). Of the 21.2% who experienced recurrence, 13.5% underwent additional surgery. The total additional surgery rate was 2.8%. Of the 55 patients with infertility, 78.1% became pregnant after surgery, 54.5% of which was spontaneous. Surgical treatment of endometriosis had a favourable effect on the patients’ pain and inflammation and resolved the patients’ infertility with a minimal need for additional surgery.

Based on studies on animal models, vitamin D plays an essential role in reproduction by controllingCa and Mg levels. Despite these findings, the effects of vitamin D deficiency and supplementation on the outcome ofassisted reproductive techniques (ART) remain controversial. Therefore, the aim of the present study was to assess therelationship between serum and follicular fluid 25-OH vitamin D levels on reproductive outcomes of infertile women.

This prospective cohort study included 150 infertile women who underwent in vitro fertilization(IVF) or intracytoplasmic sperm injection (ICSI). The participants were allocated to one of the three groups accordingto their serum and follicular fluid 25-OH vitamin D concentrations (less than 10 ng/ml, between 10 and 30 ng/ml and more than 30 ng/ml), and fertilization, cleavage and biochemical and clinical pregnancy rates were compared among the groups. Data was analyzed by SPSS software and using Chi-square and Spearman correlation coefficient.

Serum and follicular fluid vitamin D levels significantly correlated with biochemical (P=0.008), (P=0.003)and clinical pregnancy (P=0.017), (P=0.001) rates respectively . However, the quality of embryos (P=0.125), (P=0.106)and fertilization rate (P=0.082), (P=0.059) were not associated with the level of serum and follicular fluid vitamin D.

This study found that women with higher levels of vitamin D in their serum and follicular fluid are significantly more likely to achieve pregnancy but without affecting the quality of embryo and fertility rate.

The objective of this study is to evaluate artificial oocyte activation (AOA) with calcium ionophore(CaI) in a subsequent attempt at fertilisation in patients after extremely low or failed fertilisation. We assessed improvements in fertilisation, implantation and pregnancy rates as well as cancellation rates in these patients. Finally,was evaluated the result testing in addition to delivery rate and obstetric outcomes in children born after AOA. This was a retrospective observational study conducted in an IVF laboratory of an IVI clinic(IVIRMA Valencia, Spain). One group (509 mature oocytes from 66 patients) received a first intracytoplasmic sperminjection (ICSI) without AOA, which resulted in either a failed fertilisation or very low values (<30%). This group wascompared with a second group (616 mature oocytes from the same 66 patients) that used AOA. Outcome was comparedby McNemar’s test and the dependent t tests. AOA plus CaI resulted in enhanced fertilisation (51 vs. 13.1%), ongoing pregnancy (47 vs. 21.7%), and implantation (31.1 vs. 13.1%) rates, and less chances for cancelling the cycle (22.7 vs. 69.3%). There were no observedadverse effects in obstetric and perinatal outcomes after the use of AOA. Our findings support the use of AOA for a given population of patients where fertilisation was affectedduring previous attempts. After AOA, we observed a significant increase in reproductive success due to the increasednumber of embryos available for embryo selection and, therefore, enhanced chances for success. The use of this artificialtechnique is comforting after checking non-existence of detrimental effects on the offspring.

This study compared outcomes of the standard 6000 IU human chorionic gonadotropin (hCG) triggerwith a dual trigger comprised of 6000 IU hCG and 1 mg leuprolide acetate for final oocyte maturation in an intracytoplasmic sperm injection (ICSI) cycle. By convention, ICSI was performed in most cases at the clinic. In this retrospective study, a total of 50 women were included in each arm. Participantswere matched for age, indication and number of prior assisted reproduction technology (ART) cycles. Women at riskfor ovarian hyperstimulation syndrome (OHSS) were excluded. A flexible gonadotropin releasing hormone (GnRH)antagonist protocol was used and final oocyte maturation was triggered when two leading follicles were >17 mm.Distribution of variables was evaluated visually with histograms. Continuous variables were defined by mean (standarddeviation) or median (25th-75th percentile) depending on distribution characteristics. Categorical variables weredefined by numbers and percentages. Continuous variables were compared between the groups with the t test orMann-Whitney U test as appropriate. Categorical variables were compared by the chi-square test and its derivativesas appropriate. A two-sided P<0.05 indicated statistical significance. Both groups had similar antral follicle counts, median parity (0) and number of previous failed cycles (0).The median number of oocytes (8 vs. 7), metaphase-two oocytes (6 vs. 5.5), blastocysts (1 vs. 1), clinical pregnancyrates (CPR) (28% vs. 22%), ongoing pregnancy rates (OPR) (22% vs. 20%) and pregnancy rate per transfer (53.3%vs 53.8%) were similar between the dual trigger and hCG only groups, respectively. Dual trigger for oocyte maturation stimulation failed to improve the ICSI outcome.

Despite the advances in controlled ovarian stimulation (COS), management of a subgroup of poor ovarian responderpatients may still be challenging. We describe a feasible and simplified protocol, namely the STOP-START protocol,for poor responders defined as Patient-Oriented Strategies Encompassing Individualize D Oocyte Number (POSEIDON)groups 3 and 4, who are unresponsive to COS with maximum dose gonadotrophins. Data of 11 women unresponsiveto COS were reviewed. Mean age of the patients was 36.5 ± 6.0 years. Unresponsiveness was defined as no follicular growth >9 mm and/or estradiol level less than 40 pg/ml after a week of recombinant follicle stimulating hormone (rFSH, 225-300 IU) administration. In that case, COS was stopped and each woman underwent weekly ultrasound assessment to catch a secondary follicular growth. All women showed at least one follicular growth within five to 20 days. Six women (54.5%) had spontaneous follicular growth and the other five required ovarian stimulation. At least one oocyte was retrieved from each one of seven patients (63.6%). The mean number of oocytes retrieved was 1.6 ± 1.4 and five women (45.5%) had at least one grade A embryo. Among all, two women became pregnant successfully and both gave live births (18.2%). In conclusion, STOP-START protocol may potentially be an effective, feasible, and time-saving management option for POSEIDON group 3/4 poor responders who are unresponsive to standard COS treatment with maximum dose gonadotrophins.