Journal of Reproduction & Infertility
Volume:24 Issue: 1, Jan -Mar 2023

Assisted reproductive technology (ART) and third-party reproduction provide the opportunity for infertile couples to have children through different genetic links. This type of treatment has created many challenges for infertile couples. With this treatment, the infertile couple will have a child who is biologically related to the gamete/embryo donor. Accordingly, the transformation that occurs in the structure of traditional families and the concept of parenthood is one of the main consequences and challenges which requires in-depth research. In spite of the successful expansion of infertility treatment and third-party reproduction, there is still no proper social context for implementing third-party infertility treatments in Iran. Therefore, despite the need to use the technology, some couples refuse the treatment unless their confidentiality is preserved. Many couples follow the practice surreptitiously by keeping the donation treatment confidential, to get rid of the existing social stigma and protect their identity, the child and the donor’s identity. Commitment theory as a theoretical strategy is proposed to solve the problems of all parties involved in this type of "social and non-biological" parenting. Commitment theory in the context of third-party reproduction expresses the commitment to the contract accepted by the donor and the recipient of the gamete/embryo, based on which, the recipients consider the resulting child as their own, and are committed to all the related paternal-maternal rights and duties such as "alimony" and "inheritance". On the other hand, the donors undertake to waive all their paternal-maternal rights and duties by donating gamete/embryo.

Vascular endothelial growth factor receptors (VEGFRS) play an important role in embryo implantation. The aim of the present study was to examine the association of VEGFR1 circulating level and gene polymorphism with in vitro fertilization and embryo transfer (IVF-ET) outcome.

In this case–control study, 120 women who had unsuccessful IVF (IVF–) history and 120 women who had successful IVF outcome (IVF+) as controls were included. Genomic DNA was extracted from blood samples. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The serum levels of soluble VEGFR1 (sVEGFR1) were measured by ELISA. ANOVA test was used for statistical analysis.

The frequency of T and C alleles in IVF+ individuals were 87.5%, 12.5% and among IVF- were 75.5%, 24.5%, respectively (p=0.0006). The minor allele (C) was associated with an increased risk of IVF failure based on results from codominant (OR=3.86, 95%CI 1.19-12.47), dominant (OR=2.32, 95%CI 1.31-4.10), recessive (OR=3.22, 95%CI 1.00-10.29), and allele models (OR=2.28, 95%CI 1.40-3.69). We also showed that there is a significant decrease in serum sVEGFR1 levels in IVF as compared to IVF+ (p=0.006) groups. Moreover, TT genotype is significantly associated with increased serum sVEGFR1 concentration in IVF group (TT, CT, and CC serum levels were 106.55±11.04, 94.33±10.75, and 83.33±9.13 ng/ml, and in IVF+ group were 156.11±18.08, 120.66±16.51, and 84.66±20.31 ng/ml, respectively).

The results of this study indicate that VEGFR1 polymorphism and sVEGFR1 circulating levels are associated with IVF-ET outcome. Moreover, CC genotype is associated with decreased sVEGFR-1 serum concentration and IVF-ET failure.

Genetic factors are significantly have important role in the etiology of the polycystic ovary syndrome (PCOS). This study examined the possible relation of rs1484215 and rs6495096 polymorphisms of CYP11A1 gene in Iranian women with PCOS. 

The population of the case-control research included 100 women presenting with PCOS and 100 women as a control group who were referred to Infertility Center in Qom, Iran. The genotypes of rs1484215 and rs6495096 polymorphisms in CYP11A1 gene were detected with the tetra-ARMS PCR method. The independent segregation of alleles was tested for the Hardy–Weinberg equilibrium (HWE). Differences in quantitative traits were assessed between each group with a single PCOS feature and control group using Mann–Whitney U test for categorical variables and student’s t-test for continuous variables. Statistical analysis of allele and genotype frequencies between women with PCOS and control was performed using the chi-square test. Significance level was defined as p<0.05. 

There was a significant association of C with G alleles in rs6495096 polymorphism and susceptibility to PCOS (p=0.001), but no significant relation was found between C and T alleles in rs1484215 polymorphism and susceptibility to PCOS. Also, GG genotype of rs6495096 was significantly associated with the waist-to-hip ratio (WHR) and infertility duration compared to CG and CC (p0.01). However, rs1484215 showed no association with these variables. 

The results from the research indicated that rs6495096 polymorphism of CYP11A1 gene is related to the PCOS risk in Iranians women.

There is an association between inflammatory factors and polycystic ovary syndrome (PCOS) and most of women with PCOS experience the symptoms of hirsutism. The purpose of this study was to evaluate the role of obesity in PCOS occurrence, which is linked with inflammation and hirsutism.

This study was designed as a case-control research. It was performed on 102 women with PCOS and 102 healthy women as controls who were age-matched. Serum concentrations of testosterone, estradiol (E2), IL-1, IL-6, high-sensitivity c-reactive protein (hs-CRP), and aromatase activity were measured in blood samples. Statistical tests including unpaired t-tests, Mann-Whitney U test, Kruskal-Wallis, Spearman’s correlation, and Chi-square tests were used for data analysis. Statistical significance was set at p<0.05.

A significant difference was found between hs-CRP, IL-1, and IL-6 in PCOS patients and healthy individuals (p<0.001). Aromatase activity was markedly lower in PCOS cases. The serum level of IL-1 (p=0.392) and IL-6 (p=0.764) was not different between overweight and normal weight women. In both studied groups (case and control), hirsutism frequency was markedly higher in individuals with BMI ≥25 kg/m2 (p<0.05). Inflammatory factors significantly affected the PCOS group (p<0.05). However, logistic regression showed that hs-CRP increment is more effective on increasing the risk of PCOS (OR: 6.324, p<0.001).

In this study, hs-CRP, IL-1, and IL-6 levels increased in all PCOS women. Although the incidence of hirsutism in PCOS is associated with obesity, in PCOS pathogenesis, only IL-1 and IL-6 were independent of BMI.

As one of the most widespread sexually transmitted infections, Herpes Simplex Virus (HSVs) globally account for 60-95% of persistent infections in adults. This infection is prevalent in women of gestational age and is likely to be transmitted from the infected mother to her neonate. Additionally, it gives rise to devastating complications in neonates. This study was designed to estimate the molecular and serological prevalence of HSV-1 and 2 in pregnant women of Gorgan city, North East of Iran. 

Vaginal secretions and blood specimens of 315 pregnant women referred to an educational hospital in the North east of Iran were tested for HSV-1 and HSV-2 using multiplex PCR and ELISA assays. Chi-Square test was utilized to evaluate the association of qualitative variables and the level of significance was set at p≤0.05. Moreover, statistical analysis was performed using SPSS V.19.0. 

HSV-1 and HSV-2 DNA was detected in 5.7% and 8.3% of participants, respectively. Given the serological analyses of total HSV-1 and HSV-2 antibodies, 92.7% (239/315) of patients were IgG positive and 5.4% (17/315) were IgM positive. 

The rate of HSV-1 and 2 in the present study was lower than that reported by World Health Organization (WHO). This study emphasizes the conduction of further investigations on HSVs since these viruses are probably playing significant role in sexually transmitted infections.

Gestational trophoblastic neoplasia (GTN) is a group of tumors highly responsive to chemotherapy. It has been suggested that cancer therapies have detrimental effects on female fertility. Anti-Müllerian hormone (AMH) is considered fertility potential and ovarian reserves in women. The aim of this study was to compare serum AMH levels between the patients with GTN treated with chemotherapy and the patients with hydatidiform mole who underwent suction curettage without receiving any chemotherapy.

In 35 patients with GTN, serum AMH levels were measured before suction curettage and after the administration of chemotherapy and compared with serum AMH levels measured in 35 patients with hydatidiform mole, who did not receive any chemotherapy as a control. In controls, serum levels of AMH were measured before suction curettage and at the time when beta human chorionic gonadotrophin (ß-hCG) levels approached zero concentration.

The mean serum AMH levels in the GTN group were significantly lower than those measured in the control group after chemotherapy. In addition, serum AMH levels measured after intervention in each group significantly decreased compared to the basal levels (p=0.034). Serum AMH levels showed significant differences between the patients who received chemotherapy regimens with methotrexate (MTX) alone, actinomycin-D (Act-D) alone, or the combination of MTX and Act-D (p=0.001).

Our study showed that fertility preservation is of great importance in patients with GTN treated with chemotherapy. Furthermore, both MTX and Act-D could have potential adverse effects on ovarian reserve.

Premature ovarian insufficiency (POI) occurs in women before the age of 40. Although the outcomes of POI in women include its adverse effects on general health, sexual-reproductive health, and finally reduced quality of life. One of the first adverse consequences is a threat to female identity of the patients. The purpose of the present study was to investigate the perception and experience of women with POI about female identity.

In this qualitative study, interviews were conducted with 15 women having POI. Data included participants' recorded voices that were analyzed using conventional content analysis.

After content analysis of the interviews with a focus on the perception and experience of women with POI about female identity, four categories emerged; they included the failure in realization of motherhood dream, the importance of menstruation, construction of female identity, and attempts to normalize the situation.

After analyzing the emerged categories obtained by interviewing with POI women, it seems that physicians need to pay special attention to the distortion of the female identity of these patients and educate the medical team about the importance of the effect of treatment on improving their emotional health.

Fibroadenoma (FA) and infertility can share common risk factors and probably common underlying pathophysiology, but yet there is no study evaluating the prevalence of FA in infertile women. Therefore, the aim of in the present study, the purpose was evaluating the association of FA and infertility for the first time.

This short communication is a secondary analysis of a primary study that was performed in Arash Women’s Hospital, Tehran, Iran. Participants were selected among reproductive-aged women with a history of infertility as the case and women without infertility as the control group. The criteria for diagnosis of FA were histopathologic assessment for lumps 1 cm in size or larger, and a typical ultrasound image for smaller lumps. Assisted reproductive technology (ART) was defined as any previous history of undergoing ovulation stimulation, intrauterine insemination, intracytoplasmic sperm injection, or in vitro fertilization.

Overall, 155 cases with a mean age of 39.2±6.9, and 167 controls with a mean age of 43.08±8.3 were included (p=0.0001). Interestingly, the incidence of FA was lower in the case group (18.7% vs. 25.7%), however, the difference was not statistically significant (p=0.13). Also, logistic regression analysis showed that the chance for an infertile woman who undergoes ART to get FA is 1.7 times higher in comparison to non-ART group, although the difference was not significant (p=0.21).

Infertility and ART were not associated with increased risk of FA; however, larger prospective studies should be conducted in the future in order to achieve conclusive results.

One of the few remaining important issues in urological and gynaecological surgery relates to fistulas between the urinary tract and the vagina. Vesicovaginal fistula (VVF) and ureterovaginal fistulas (UVF) are defined as abnormal connections between the urinary tract, on the one side, and the female genital system, on the other.

This study is about an unreported and undescribed case of 24 year old female who presented with the complaints of continuous urinary incontinence for 18 months following total abdominal hysterectomy. Preoperative cystoscopy and vaginal/speculum findings revealed a papillary frond like mass protruding intravesically from VVF site which was free from the edges of fistulous opening all around. Also, left ureteric orifice was not visualized. On exploration, there was evidence of intravesical herniation of right tubal fimbria through the common opening of VVF and left UVF near left vaginal vault apex mimicking a bladder mass presenting with continuous incontinence for 18 months. Modified O' Conners VVF repair with left ureteric reimplantation was done. The postoperative period was uneventful with patient having no incontinence.

It seems that surgical resection of ovarian cyst with VVF and UVF repair is the definitive treatment and histopathological examination is essential to exclude malignant transformation.