International Journal Of Fertility and Sterility
Volume:16 Issue: 4, Oct-Dec 2022

Growth hormone (GH) is a potential treatment in the assisted reproductive technology (ART) to improve endometrial receptivity and thickness. In the current study, we investigated the effect of the intrauterine administration of GH on the endometrial thickness (EMT) and ART outcomes in the patients with refractory thin endometrium.

In this clinical trial study, women with a refractory thin endometrium and a history of one or more frozen embryo transfer (FET) cancellation who were referred to the infertility center of the Tabriz Al-Zahra hospital (Tabriz, Iran) and Milad Infertility Clinic (Tabriz, Iran) received intrauterine injections of GH every other day from day 14 of the menstrual cycle until the EMT reached ≥7 mm in addition to the routine endometrium preparation protocol. EMT was evaluated during the treatment and in the cases with EMT ≥7 mm, biochemical/clinical pregnancy was evaluated after embryo transfer.

Thirty-one women aged 35.29 ± 6.21 years were included in this study. The mean amount of EMT was significantly increased following the GH treatment (7.03 ± 1.23 mm) vs. before treatment (5.14 ± 1.1 mm, P<0.001). The EMT reached ≥7 mm in the 65% patients (20/31). Also, the embryo transfer resulted in pregnancy in the patients, biochemical pregnancy: 9/20 (45%) and clinical pregnancy: 7/20 (35%). There was a positive correlation between EMT on the day 13 of cycle (before the treatment) and the maximum EMT (r=0.577 and P=0.001). The EMT was statistically different on the embryo transfer day between clinically pregnant and non-pregnant women (7.18 ± 0.56 vs. 6.21 ± 0.72 mm, P=0.007).

The intrauterine administration of GH could be an appropriate therapeutic strategy for patients with refractory thin endometrium. This treatment could significantly increase the EMT as well as implantation and pregnancy rates in these patients (registration number: IRCT20210220050429N1).

Gonadotropin-releasing hormone antagonist (GnRH-ant), widely adopted protocol, is more in line with the physiological processes, and induces a shorter and more cost-effective ovarian stimulation. In order to assess the success rate of embryo transferring (ET) in the antagonist in vitro fertilization (IVF) cycles, we compared the fresh ET with the frozen ET outcomes.

In this retrospective cohort study, one hundred five cases of ET of the infertility clinic of the Besat hospital (Kurdistan, Iran) between March 2014 to March 2020 that were treated with antagonist cycle (both fresh and frozen) were analyzed. The difference between the two groups in baseline data and reproductive outcomes were evaluated using Independent sample t test, Mann-Whitney U test, Chi-squared test, and Fisher's exact test in SPSS software (version 22).

Out of 105 cases, 48 and 57 were in the fresh and frozen ET groups, respectively. The participants age was 35.75 ± 4.9 Y. In the fresh ET group, and 33.98 ± 5.1 Y in the frozen ET group. The percentage of chemical pregnancy was 12 (25%) in the fresh ET group and 15 (26.3%) in the frozen ET group (P=0.8); Clinical pregnancy rate was 11 (22.9%) in the fresh ET group and 11 (19.3%) in the frozen ET group (P=0.6); the rate of abortion in the fresh ET group was 3 (6.3%, P=0.2), and in the frozen ET group was 8 (14%, P=0.2); and the live birth rate was 9 (18.8%) in the fresh ET group, in comparison with 7 (12.3%) in the frozen ET group (P=0.3).

Not statistically significant, the percentage of chemical pregnancy and abortion were higher in the frozen ET group. The percentage of clinical pregnancy and live birth were higher in the fresh ET group.

Deep infiltrating endometriosis (DIE) is described as an endometriotic tissue that penetrates more than 5 mm under the peritoneal surface. It’s suggested that trans vaginal sonography (TVS) is 79% sensitive and 94% specific in the assessment of intestinal DIE. Considering the possibility that DIE ultrasonography (rectal and\or vaginal ultrasonography) might be more accurate, we designed this study to assess this study to evaluate the accuracy of DIE ultrasonography.

In this retrospective cross-sectional study, we designed and conducted this study from 2019 to 2020 on patients suspected of severe endometriosis. Our patients underwent ultrasonographic imaging and based on the results became candidates for surgery. We compared histopathological results with sonographic findings using crosstabulation and chi-square tests were used to measure accuracy. P<0.05 were considered statistically significant.

Following pathological assessments of 109 cases, 97 cases had ovarian endometrioma, 42 cases had intestinal involvement and 56 cases had uterosacral DIE. The results for accuracy were as the following; uterosacral ligament (USL) involvement SE: 96.4% and SP: 59.1%; intestinal involvement SE: 97.6% and SP: 73.8%; and Cul de sac involvement with SE: 100% and SP: 50.8%. With regards to ovarian endometrioma, ultrasonographic imaging was 99.0% sensitive and 84.6% specific. With regards to intestinal involvement, ultrasonography performed a reliable overall diagnosis (97.6% sensitive and 73.8% specific). However, the results showed lower accuracy regarding the level of intestinal involvement. The accuracy for other sites and cavities was low except for ovarian endometrioma.

The results of the present study demonstrated that pre-operative TVS and Transrectal ultrasound (TRUS) can be a helpful paraclinical tool in the assessment and diagnosis of DIE and endometriosis in general and particularly with adnexal and bowel lesions, it can have some shortcomings with respect to cul de sac and USLs.

Overweight and obesity are associated with cardiometabolic risk in polycystic ovary syndrome (PCOS). Lifestyle adjustment, such as increasing physical activity, is a first-line strategy to treat PCOS. The current study aims to compare and examine the effect of high intensity intermittent training (HIIT) and combined (COM) training on some anthropometric indices and aerobic performance in PCOS females.

This randomized controlled clinical trial was conducted on 45 women with PCOS divided into three groups receiving HIIT (n=15), COM interventions (n=15) or control group (n=15) for eight weeks. Some anthropometric indices factors including weight, body mass index (BMI), waist to hip ratio (WHR), body fat percent (FP), and visceral adipose tissue (VAT) as well as VO2max were measured at the baseline at the eighth week. Data were analyzed by one-way ANOVA test. Tukey post hoc tests were used to compare the pair differences.

After eight-week intervention, weight, BMI, WHR, FP, and VAT decreased significantly in both groups of COM and HIIT (P<0.05) relative to the control group. There were no differences between HIIT group and COM group in terms of these variables (P>0.05). VO2max increased significantly after COM and HIIT interventions relative to the control group (P=0.001); however, HIIT was statically more effective than COM (P=0.011).

The current study revealed that both HIIT and COM trainings could be beneficial in improving some anthropometric indices in addition to aerobic capacity, although HIIT was more effective on aerobic performance (registration number: IRCT20130812014333N143).

The aim of this study was to determine the effect of couples coping enhancement counseling (CCEC) on stress and dyadic coping of infertile couples.

In this parallel randomized controlled trial study in 2020, seventy infertile couples were randomly divided into case and control groups. The intervention was performed in 7 sessions of couple counseling based on CCEC for the intervention group, no intervention was performed in the control group. Fertility Problem Inventory, Dyadic Coping Inventory and demographics questionnaires were completed by both couples separately before the intervention and 4 weeks after the last consultation session. Data were analyzed using IBM SPSS statistics 24 and statistical tests such as mean ± SD, frequency, percentage, Independent t test, Mann-Whitney test, Chi-square test or Fisher’s exact test and Analysis of covariance. Significant level was considered less than 0.05.

The mean stress scores of women in the intervention group before and after intervention decreased from (156.83 ± 23.57) to (139.43 ± 22.39) and the mean scores of dyadic coping increased from (126.83 ± 19.89) to (138.26 ± 16.92), these differences were statistically significant (P<0.001), also the mean stress scores of men in the intervention group before and after the intervention decreased from (143.80 ± 23.40) to (128.03 ± 22.24), the mean scores of dyadic coping increased (131.34 ± 20.67) to (136.40 ± 19.38), these differences were statistically significant (P<0.001).

Positive effects of CCEC were observed in reducing infertility stress and increasing dyadic coping in both women and men after the intervention, the effect of the intervention on women was greater than that of men. As a result, this intervention can play an important role in reducing stress and increasing the solidarity and support of infertile couples for infertility treatments (registration number: IRCT20120215009014N367).

Granulocyte colony stimulating factor (GCSF) has been introduced as an immunomodulatory agent by increasing implantation rate in vitro fertilization (IVF) patients but it has not been studied in intrauterine insemination (IUI) patients. The aim of this study is to answer the role of GCSF in implantation rate of IUI.

In this prospective double-blind randomized control trial, 320 eligible patients were enrolled, who were referred to the referral infertility clinic of Shiraz University of Medical Sciences from February 2018 till the end of 2019. They were divided into two groups randomly. After collecting the demographic data, all patients received clomiphene citrate from the 5th day of the menstruation cycle for 5 days. 50-150 units of recombinant purified follicle-stimulating factor (FSH) were started from the 8th day of the cycle. Follicle monitoring was done by transvaginal sonography till a mature follicle of 18 mm or more was developed. Human chorionic gonadotropin (HCG) injection was done in both groups with intrauterine administration of 300 μg GCSF in the case group and normal saline in the control group simultaneously. After 36 hours, IUI was performed. The clinical pregnancy, miscarriage, and ongoing pregnancy rates of both groups were calculated by SPSS software.

The results showed improvement of clinical pregnancy rate [15.38% vs. 13.81% OR=1.17 (0.62-2.21)], miscarriage rate [3.84% vs. 5.26% OR=0.74 (0.25-2.20)] and ongoing pregnancy rate [11.53% vs. 8.55% OR=1.37 (0.65-2.92)] in the GCSF group compared to the control. However, the results revealed no statistically significance (P>0.05).

Although it was not statistically significant, 300 μg Intrauterine GCSF administration simultaneously with hCG injection in standard IUI procedure might increase the pregnancy outcomes. Further studies are warranted (registration number: IRCT201212079281N2).

Impaired expression of genes which act on hormone signaling pathways is one of the factors affecting miscarriage. In this study, the expression levels of insulin receptor (INSR) and insulin receptor substrates-1 (IRS-1) genes in endometrial tissue of infertile women and fertile women with miscarriage in less than twenty weeks gestation for unknown reasons were evaluated.

In this case-control study, forty-two fertile women with children and 42 infertile women, who underwent in vitro fertilization (IVF), were selected. Both groups had abortions under twenty weeks gestation for unknown reasons. The endometrial tissue of all patients was prepared to evaluate the expression of INSR and IRS-1 genes by quantitative real-time polymerase chain reaction (PCR) method after RNA extraction.

There was a statistically significant relationship between the expressions of INSR and IRS-1 genes in the endometrial tissue of the infertile women compared with the fertile women (P=0.002 and P=0.008, respectively). The expression level of genes was decreased in both groups by age and increasing body mass index (BMI). Comparison of genes expression levels in healthy and diabetic participants in each group showed a significant difference (P<0.0001), but no meaningful difference was indicated between diabetic infertile and fertile groups in terms of gene expression. INSR gene expression levels showed an increase in the fertile group in the second 10 weeks and a decrease in IRS-1 gene expression. But in the infertile group, both genes showed a slight increase in expression.

It seems a decreased expression of insulin signaling pathway genes in the endometrial tissue of infertile women can be one of reasons for unspecified abortion. These genes may be strong molecular markers for infertility

This study evaluated association between glucose uptake by individually cultured oocyte and their maturation competence in mice with polycystic ovarian syndrome (PCOS).

In this experimental study, PCOS and non-PCOS cumulus-oocyte complexes (COCs), and cumulus-denuded oocytes (DOs) were cultured individually and categorized in four groups: i. PCOS DOs (n=83), ii. PCOS COCs (n=35), iii. Non-PCOS DOs (n=61) and iv. Non-PCOS COCs (n=62). After the culture period, 50 μl aliquots of the spent drops were used for glucose change analysis using high performance liquid chromatography. Polar NH2 column was used for the study of carbohydrates, acetonitrile with deionized water as the solvent phase and UV as detectors. Oocyte quality (growth differentiation factor 9: GDF-9), viability [bcl-2-like protein 4 (BAX) and B-cell lymphoma2 (BCL2)], in addition to fertilization and embryonic development rates were also evaluated in relation to glucose consumption rate of each oocyte.

Maturation rate was significantly higher in non-PCOS COCs and DOs compared to PCOS COCs (IV: 70.9% vs. II: 45.71%) and DOs (III: 67.2% vs. 1: 53.01%), respectively. There was a significant negative correlation between high glucose intake (38.17 ppm) and BCL2 gene expression (P=0.03) in PCOS COCs compared to non-PCOS COCs. There was a significant difference in the GDF-9 gene expression from PCOS DOs (0.66 ± 0.02, P=0.003) and COCs (0.37 ± 0.02, P=0.0001) compared to non-PCOS DOs and COCs, respectively. A negative correlation was also observed between quality of PCOS-DOs and -COCs with glucose intake. Non-PCOS COCs significantly showed higher rate of successful IVF and development compared to PCOS COCs (P=0.01).

Based on the importance of metabolic analysis, the glucose consumption by DOs and COCs in culture medium can be a suitable criterion for their quality assessment. So that, glucose consumption may reflect oocyte maturation competence.

The ovarian Ischemia/reperfusion is one of the gynecological emergency concerns that may lead to the ovary damage and folliculogenesis. The present research aimed to evaluate the impact of the Chrysin (CH) on the ischemia-reperfusion (I/R) injury in the rat model.

In this experimental research, 48 adult female rats, 8 weeks age and 180-200 g weight, have been categorized into 6 equal groups (n=8) including one sham and 5 ovarian torsion groups (OT+CH groups) that received different treatments. Each group has been treated 30 min before detorsion with gavage of CH or normal saline for 1 week and pregnant mare serum gonadotropin (PMSG) has been injected on the day 5 for initiating folliculogenesis. Finally, bio-chemical, molecular, histopathological, apoptotic and hormonal evaluations were performed.

The anti-oxidant enzyme, superoxide dismutase and glutathione peroxidase, ameliorated in the ovarian tissues of the OT+CH groups in comparison with the OT group (P<0.001). Moreover, the level of serum Luteinizing hormone considerably declined and estradiol level (P<0.001), partly enhanced in the rats treated with CH in comparison with the ones in the OT group (P<0.05). In addition, histopathological scores of the OT+CH groups ameliorated in comparison with the OT group scores (P<0.05). Furthermore, the expression Caspase-3 and Bax genes were significantly increased while the expression of Bcl-2 was notably decreased in the OT group in comparison with the sham group (P<0.05).

Here, it seems that CH is possibly beneficial for the protection of ovaries against reperfusion injury and ischemia.

Oligospermia is defined as a less than 15 million per milliliter sperm in each ejaculation of semen. Proper and complete spermatogenesis requires the expression of a large number of genes. As a result, stopping the expression of any of them may lead to disrupt the process of spermatogenesis. In order to understand the disorders of spermatogenesis, it is necessary to study expression of effective genes in the spermatogenesis process. Therefore, in the present study, USP7 and SET9 (SETD7) gene expression was examined in the healthy and oligospermic men.

In this case-control study, semen samples of individuals with normal sperm and oligospermia were collected from men who referred to the Roya Clinic (Qom, Iran) according to World Health Organization (WHO) parameters after obtaining consent. Then the expression of USP7 and SET9 genes in two groups was analyzed using quantitative polymerase chain reaction (qPCR).

There was no difference forage between the healthy and oligospermic individuals (P=0.889). The data showed that, USP7 gene expression in the patients was 3.99 times higher than the control group (P<0.001). The expression of SET9 gene in the patient was 1.28 times less than the control group, which was not significant (P=0.231). The results indicated that USP7 gene expression was increased in the 84% of oligospermic individuals.

The USP7 gene can be considered as one of the molecular markers in the development of oligospermia.

Infertility is a major clinical problem that affects people psychologically and medically. For the past 40 years, studies have linked nearly 50% of childlessness to male infertility. It is worth noting that unlike other factors contributing to infertility, diet is a tunable factor and can be applied in counseling infertile men. The goal of this study was to determine the relationship between plant diet index (PDI) and semen parameters in Iranian infertile men.

In this cross-sectional study, dietary intake was determined by a valid 168-item questionnaire (FFQ). In this study, four dependent semen parameters, including total sperm motility (TSM), sperm concentration (SC), normal sperm morphology (NSM), and semen volume (SV) were measured.

Results of this study stated that greater adherence to the healthful plant-based diet index (hPDI), can significantly increase sperm density and motility in men, as well as greater adherence to the PDI dietary pattern is related to a lower risk of sperm volume deficiency, and ultimately more adherence to the unhealthful plant-based diet index (uPDI), can reduce the risk of sperm motility.

In this study, for the first time, the relationship between PDI, hPDI, uPDI and male infertility was evaluated. Altogether, this study demonstrated that nutrition has an impact on semen quality and fertility of men.