International Journal Of Fertility and Sterility
Volume:18 Issue: 1, Jan -Mar 2024

Recent achievements in reproductive biomedicine have led to a revolution in infertility treatment. A comprehensive understandingof the current status of reproductive medicine is necessary for the development of a forward-looking plan byhealth policymakers, based on fundamental requirements. This study is a systematic review of the Scopus database toassess reproductive biomedicine publications within Iran and compared to the rest of the world from 1990 to 2020. Thedata were categorized by geographical distribution across five continents. National data were assessed in comparisonwith the world and with neighboring countries. Finally, prominent national research institutes in the field of reproductivebiomedicine in Iran were identified, and their contributions to the field highlighted. Of the five continents, the highestnumber of publications and citations is from Europe (36% publications and 41.5% citations). Corresponding numbers forthe other continents are 32 and 33% for America, and 26 and 18.4% for Asia respectively. The remaining publications andcitations were from Australia (3.8 and 4.1%) and Africa (2.6 and 3.1%). In a national analysis, the highest-ranking institutesin reproductive biomedicine are in Tehran province (50.9% of all Iranian publications), Shiraz (8.8%), Yazd (7.8%),Isfahan (7.1%), and Tabriz (6.9%). More specifically, Tehran University of Medical Science (15.9%), the Royan Institute(12.2%), Shahid Beheshti Medical University (10.1%), Shahid Sadoughi University of Medical Sciences (6.9%), andTarbiat Modares University (6.7%) account for more than 50% of all Iranian scientific publications. In recent decades,reproductive biomedical research has grown significantly in Iran. Reviewing publications in this field helps health policydecision makers to monitor the direction of research and adjust investment in the treatment of infertility. In addition, it isnecessary to expand and organize inter-organizational and international collaborations to improve the research, gain thebenefits of different experiences, and engage in international multicenter studies.

Recurrent miscarriage (RM) is a condition defined as having three or more consecutive pregnancy losses before the20 weeks of pregnancy. The present study was undertaken to investigate association of Interleukin-17A (IL-17A)rs2275913 polymorphism with RM. To this end, we searched the international databases (Web of Science, PubMed,Embase, and Scopus) and extracted studies investigating the association of IL-17A rs2275913 polymorphism withRM using the appropriate keywords. The collected data were analyzed with the random-effects model and STATA(version 14). A total of five studies met the eligibility criteria, and total sample size was 998 subjects. Mean ageof the cases and controls were 31.41 ± 4.16 and 30.56 ± 3.5 years, respectively. Our results disclosed a significantrelationship of the IL-17A rs2275913 AA genotype [odds ratio (OR)=1.68; 95% confidence interval (CI)=1.16-2.43; I2=19; P=0.294) with RM. There was no statistically significant correlation between IL-17A rs2275913 GGgenotype (OR=1.04; 95% CI=0.64-1.7; I2=59.5; P=0.042) and GA genotype (OR=0.85; 95% CI=0.65-1.12; I2=19.1;P=0.293) with RM. Our findings revealed that the IL-17A rs2275913 polymorphism is associated with RM, and theAA genotype of this polymorphism increased possibility of being involved in RM.

For patients who had testicular tissue cryopreserved before receiving gonadotoxic therapies, transplantation of testiculartissues and cells has been recommended as a potential therapeutic option. There are no studies that indicate thegeneration of sperm after human immature testicular tissue (ITT) or spermatogonial stem cells (SSCs) transplantation.The use of releasing scaffolds and localized drug delivery systems as well as the optimizing transplantation site canplay an effective role in increasing the efficiency and improving the quality of testicular tissue and cell transplantationin animal models. Current research is focused on optimizing ITT and cell transplantation, the use of releasingscaffolds, and the selection of the right transplantation site that might restore sperm production or male infertilitytreatment. By searching the PubMed and Google Scholar databases, original and review papers were collected. Searchterms were relevant for SSCs and tissue transplantation. In this review, we'll focus on the potential advantages of usingscaffolds and choosing the right transplantation site to improve transplantation outcomes.

This study aims to determine whether pre or post-processing semen parameters obtained during intrauterineinsemination (IUI) predict pregnancy when controlling for confounding effects. A prospective cohort study of 2231 semen analyses was conducted at McGill University ofIVF center. Any couples who underwent IUI with partner sperm, over a 2.5-year period, were included. Controlledovarian stimulation was done with Clomiphene Citrate, Letrozole, or Gonadotropins. Statistical analysis was performedusing t tests, two types of stepwise logistic regression, and stepwise discriminant analysis. A comparison ofpre and post-processing semen parameters was undertaken to determine the probability of pregnancy. There were significant differences between pregnant and non-pregnant women in post-processing concentration(P=0.043), post-processing total motile sperm count (TMSC) (P=0.049), and post-linearity (P=0.012). However,when variable out-of-the-equation logistic regression or discriminant analysis, which controls for confounding effectsbetween variables, were used, the findings were no longer significant. It was statistically proven that when a variablein the equation logistic regression was employed, post-processing concentration (P=0.005) and post-processingTMSC (P=0.009) remained reliable predictors of pregnancy. Two of three prediction models suggested that TMSC’s relationship with pregnancy is due to confoundingfactors. One model maintained the validity of the TMSC. While TMSC has always been studied as an importantpredictor of insemination pregnancies, this finding may be due to confounding effects between semen parameters andtherefore requires further investigation as to this relationship.

Phospholipase C zeta (PLC-ζ) deficiency in sperm can underlie oocyte activation failure after intracytoplasmicsperm injection (ICSI). The aim of this study was to determine PLC-ζ expression and location in individualspermatozoa in each host score so that a hypo-osmotic swelling test (HOST) may be used to help routine sperm selectionfor ICSI. In this experimental study, fresh semen samples were randomly obtained from 30 men whowere referred to the Andrology Unit of the Infertility Center. Samples were processed by density gradient centrifugation(DGC) and exposed to hypotonic conditions. Seven different tail patterns, classified from ‘a’ to ‘g’ can be detectedaccording to World Health Organization (WHO) criteria. Then, the PLC-ζ protein localization pattern was assessed byquantitative Immunofluorescence in individual sperm Host grades. Moreover, the sperm content of PLC-ζ protein wasevaluated by flow cytometry correlated with semen analysis parameters. In the present study, quantitive immunofluorescence analysis indicated that sperm from different host gradesexhibited seven localization patterns of PLC-ζ of acrosomal (A); equatorial (EQ), and postacrosomal (PA) patterns.A+EQ=acrosomal and equatorial, A+PA=acrosomal and post-acrosomal, EQ+PA=equatorial and post-crosomal, andA+EQ+PA.The sperm from HOST grade 'd' exhibited significantly higher PLC-ζ (A+PA) and (A+EQ+PA) staining compared to spermfrom other grades (P=0.006). The sperm from grade 'd' exhibited higher PLC-ζ (EQ+PA) compared with other grades(P=0.001). However, grade 'd' was not significantly different from 'c' (P=0.087). Analysis of the combined results confirmedthat there was a clear reduction in PLC-ζ immunofluorescence in Host grades 'a', 'f' and 'g' sperms. Our data suggest that HOST may represent a useful diagnostic tool for the selection of sperms exhibitinga higher level of PLC-ζ expression.

Men’s infertility and lack of production of healthy and active sperm are concerns of recent years in mostcountries. Studies on the preparation of extracellular matrix (ECM) from decellularization of testis tissue and spermatogenesiscould provide proper results to solve some of the men’s infertility problems. This study aims to decellularize calftestis by different methods to reach a suitable scaffold and introduce it in spermatogenesis studies.

In this experimental study, calf testis were decellularized by a freeze-de freeze, 1% sodiumdeoxycholate (SD), 0.1% sodium dodecyl sulfate (SDS), 0.1% SDS-vacuum, 1% SDS, 1% SDS-vacuum, and Triton-X100 methods. The content of DNA, collagen, and glycosaminoglycan (GAG) was analyzed using the kit and stainingwith Hematoxylin-Eosin, Masson’s trichrome, Alcian blue, and Orcein methods. The morphology of the scaffolds wasanalyzed with a scanning electron microscope (SEM).

Methods of 1% SDS, 1% SDS-vacuum, and 1% SD completely removed the cells. The preservation of collagenand GAG was confirmed using the staining kit and methods. The use of a vacuum showed greater porosity inthe SEM images. Toxicity and hemolysis were not observed in the scaffolds.

Testis decellularization with 1% SDS and 1% SD, in addition to cell removal, could maintain the ECMstructure to a large extent without having cytotoxic and hemolysis effects.

Induced endometrial injury is a technique described that have positive impact on implantation. The aim ofthis study was to investigate whether hysteroscopic endometrial fundal incision (EFI) in oocyte recipients before embryotransfer increases pregnancy and live birth rates or not. A prospective study was conducted between 2014 and 2019 at an in vitro fertilization (IVF) unitin Greece. As part of the protocol, hysteroscopy and EFI were offered to all the egg recipients and the outcomes comparedwith those from an older cohort from the same Unit not undergoing hysteroscopy. In total, 332 egg recipients participated in the study; 114 of them underwent EFI prior to embryo transfer. Bothgroups were similar in terms of age, years of infertility, duration of hormone replacement treatment (HRT) and numberof blastocysts transferred. In the EFI group, minor anomalies were detected and treated in 6.1% (n=7) of the participants.Moreover, pregnancy test was positive in 73.7% of the women in the hysteroscopy group compared to 57.8% in the nonhysteroscopygroup (P=0.004). Live birth rate was also higher (56.1 vs. 42.2%, P=0.016) in the EFI group compared tothe non-hysteroscopy one. Apart from the obvious benefit of recognizing obscured anomalies, requiring surgical correction, it appearsthat in oocyte recipients prior to embryo transfer, EFI might improve uterine receptivity and reproductive outcomes.

Although there are numerous animal models of polycystic ovary syndrome (PCOS), they often fail toaccurately replicate the reproductive and metabolic phenotypes associated with PCOS. The objective of this study isto assess oxidative status and inflammatory levels in a rat model of PCOS subjected to a new high-fat diet (HFD) incombination with letrozole. In this experimental study, mature, six-week-old female Sprague-Dawley rats (n=20) weredivided into four groups: control (standard diet); letrozole (letrozole plus a standard diet); HFD; and letrozole+HFD.After 16 weeks, the rats underwent vaginal smear analysis, measurement of hormonal and lipid profiles, and anoral glucose tolerance test (OGTT). Ovarian tissue morphology, oxidative parameters, and inflammatory status wereevaluated. The experimental groups exhibited anoestrus profiles in the vaginal smears and abnormal ovarian morphology,which was not observed in the control group. Steroid hormone levels were significantly higher in theletrozole+HFD group compared to the other groups (P=0.00). The experimental groups also showed abnormal glucoselevels and lipid metabolism. The relative expression levels of inflammatory genes were significantly elevated inthe experimental groups compared to the control group (P=0.00), and the letrozole+HFD group exhibited the highestexpression level (P=0.00). The HFD, letrozole, and letrozole+HFD groups demonstrated significantly increased levelsof malondialdehyde (MDA) and reactive oxygen species (ROS), while the levels of enzymatic antioxidants weresignificantly reduced compared to the control group (P=0.00). The combination of a new HFD and letrozole treatment induces inflammation and oxidative stress (OS)in a rat model of PCOS. This model accurately exhibits abnormal metabolic phenotypes and disruptions in hormonalprofiles associated with PCOS.

In individuals with coronavirus disease 2019 (COVID-19), male subjects have consistently beenlinked to poor severity and prognosis. Data on sex hormones in non-critical COVID-19-infected patients are scarce.The aim of this study was to assess the status of total testosterone (TT) and dehydroepiandrosterone sulfate (DHEAS)among noncritical patients with COVID-19 according to sex and their associations with clinical and biochemicalfeatures. This cross-sectional observational study was done in the COVID-19 unit of a Universityhospital during the period of September 2021 to February 2022 among 91 adults (18-65 years) with reverse transcriptase-polymerase chain reaction confirmed noncritical COVID-19 patients. Blood was drawn by venipuncturebefore receiving steroids between 07:00 to 09:00 a.m. in a fasting state to measure serum TT and DHEAS by chemiluminescentmicroparticle immunoassay. Diagnosis and classification of COVID-19 were done according to WorldHealth Organization’s interim guidance. Age- and sex-specific laboratory reference values were used to classify theTT and DHEAS status of the patients. Only three males (8.1%) had low TT and the rest had normal TT. On the other hand, 15 (27.8%) of the femaleshad high TT with normal levels in the rest. Similarly, 11 (29.7%) males had low DHEAS. Females had low, normal,and high DHEAS in four (7.4%), 48 (88.9%), and two (3.7%) cases respectively. Males with moderate severity ofCOVID-19 had significantly lower DHEAS (post hoc P=0.038) than the mild group. Both TT (P=0.008) and DHEAS(P=0.023) significantly correlated with neutrophils/lymphocytes ratio and only DHEAS with platelets/lymphocytesratio (P=0.044) in males. In females, TT significantly correlated with serum sodium (P=0.034). In noncritical COVID-19 patients, substantial gender variations in TT and DHEAS were detected andcorrelated with severity markers in males.

Women with uterine fibroids (UFs) experience many clinical manifestations that affect their quality oflife (QOL). The Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire is an Englishinstrument specifically designed to assess fibroid-related symptoms and their impact on QOL. This study aims toinvestigate the reliability and validity of the Persian version of the UFS-QOL questionnaire in Iranian women with UF. In this psychometric study, women with UFs who presented to Imam Hossein Hospital(Tehran, Iran) between August 2022 and January 2023 were enrolled in this study. A forward-backward approachwas applied to translate the UFS-QOL questionnaire into Persian. The reliability of the UFS-QOL questionnaire wasassessed by internal consistency and test-retest correlation. Confirmatory factor analysis (CFA) was used to assessconvergent validity between items and subscales of the UFS-QOL questionnaire. Pearson’s correlation coefficient wasused to assess convergence validity between subscales of the UFS-QOL and the World Health Organization Qualityof Life Brief Version 26 questionnaire (WHOQOL-BREF-26). Overall, we assessed 226 women with UFs. All subscales of the UFS-QOL questionnaire had acceptableinternal consistency (Cronbach’s alpha>0.7). Test-retest analysis indicated significant positive correlations betweentwo measurements of all subscales of the UFS-QOL questionnaire: symptom severity (P<0.001), concern (P<0.001),activities (P<0.001), energy/mood (P<0.001), control (P<0.001), self-consciousness (P=0.002), and sexual function(P<0.001). The Kaiser-Meyer-Olkin (KMO) measure value was 0.920, and the result of Bartlett’s test of sphericitywas significant (P<0.001). CFA identified six factors for the health-related QOL (HRQL) questionnaire, which explained73.827% of the total variation. Most subscales of the UFS-QOL questionnaire correlated with domains of theWHOQOL-BREF-26 questionnaire (P<0.05). The Persian version of the UFS-QOL questionnaire is a valid and reliable instrument to evaluate UFrelatedsymptoms and QOL among Iranian women.

Polycystic ovary syndrome (PCOS) is a common endocrinological disorder associated with abdominalobesity (AO) and some reproductive complications including low pregnancy rate. Embryo-endometrium cross-talkhas a key role in successful embryo implantation and subsequent normal pregnancy rate. The primary objective ofthis study is to evaluate the decidualization potential of endometrial stromal cells (ESCs) using the embryo conditionmedia (ECM) collected from PCOS patients with AO, compared to ECM of those patients without AO. In this experimental study, we measured the capacity of ECM collected from PCOS patientswith or without AO for decidualization induction in healthy ESCs after coculture. A total number of 53 embryos from40 couples belonging to PCOS with AO, PCOS without AO, nonPCOS with AO, and nonPCOS without AO patients,were included in our study. The embryosof four groups were single-cultured up to the blastocyst stage. Their ECM(45λ/well) were pooled and added to healthy ESCs monolayer culture media to investigate their effects on decidualizationpotential via gene (PRL, IGFBP1, IL1-β, HOXA10, IL-6 and TNF-α) and protein (PRL, IGFBP1, IL1-β)expression analysis and ESCs migration assay. The morphological analysis, migration assay (P≤0.0321), protein (P≤0.0139) and gene expression analysisshowed PCOS with AO accounted for the highest gene (PRL, IGFBP1, IL1-β, HOXA10, IL-6, TNF-α) and proteinmarkers (PRL, IGFBP1, IL1-β) (P≤0.05). NonPCOS individuals without AO had the lowest level of both gene andprotein decidualization markers (P≤0.05). Considering decidualization as an inflammatory process, a higher level of decidualization markers wasassociated with a higher inflammatory status created by AO and PCOS, separately. Inflammation may disrupt the processof inflammatory to anti-inflammatory phase required for prevention of pregnancy loss, this could explain the highrate of abortion in these cases.

In our experimental study, we explored the impact of maternal reduced heme oxygenase-1 (HO-1) gene (Hmox1)expression on the in vitro fertilization (IVF) rate through the use of heterozygous Hmox1 knockout mice models(HET/Hmox1+/ -). Also, we hypothesized a beneficial role of gametes exposure during fertilization to carbon monoxide(CO), one of HO-1 by-products, that might be relevant for the improvement of IVF rates. IVF technique wasperformed by using oocytes obtained from wild-type (WT) or Hmox1+/ - dams fertilized with WT, Hmox1+/ - orHmox1-/ - mice-derived sperm. The fertilization step occurred either in a conventional incubator (37°C, 5% CO2) or inan incubator implemented with CO (500 ppm). The superovulation yield of WT and Hmox1+/ - mice and the number offertilized oocytes was assessed using an optical microscope. The dams’ Hmox1 heterozygous knockout neither impactthe superovulation yield, nor did influence the fertilization success rate. Moreover, CO exposure during fertilizationcould not significantly improve the outcome. Our study showed that the maternal Hmox1+/ - condition is not affectingthe IVF rate in mice. Furthermore, we discovered that CO exposure cannot be exploited to ameliorate this critical stepof the IVF protocol.

In this study, in order to promote chromosome abnormality carriers eugenics, three patients with adverse pregnancyhistories were examined by cytogenetics and their pedigrees further analyzed. In this retrospective study, approximatelyanticoagulant peripheral venous blood from the patients was collected for peripheral blood cell culture andchromosome analysis. Karyotypes were analyzed in the BEIONMED karyotype analysis system. The karyotypes ofthe three probands were all whole-arm translocations (WATs): case 1 (DatabaseNo.3591): 46, XY, t (7; 13) (p10; p10)dn, two years of marriage in which the spouse did not have pregnancy, with azoospermia; case 2 (Database No.3809):46, XY, t(12; 17) (p10; q10), three spontaneous abortions within three years of marriage; case 3 (Database No.4914)46, XX, t(2;6) (p10; q10) mat, 21ps+pat, a year of marriage without pregnancy. When the parents are carriers ofWAT, the family should be considered to have a high reproductive risk, increasing the risk of producing offspring withchromosomal abnormalities. Three kinds of human chromosomal aberration karyotypes were reported for the first timeproviding an important basis for studying the occurrence and clinical consultation of chromosomal diseases.

Presacral or retrorectal tumors are rare, usually asymptomatic, and diagnosed accidentally during physical examinationor imaging. Symptomatic tumors may present with perianal pain, bowel dysfunction, and urinary symptoms dueto the mass compression or invasion of the surrounding tissues and organs. Surgical resection is the first choice fortreating presacral tumors. Clinicians should choose surgical procedures based on the location and size of the tumors.We presented a 43-year-old woman who suffered from pelvic pain and primary infertility from two years ago. A largemass between the posterior vaginal wall and the rectum was found on recto-vaginal examination. Magnetic resonanceimaging (MRI) revealed a large 120×115 mm benign multiloculated cystic mass. Eventually, the mass was removedthrough laparoscopic surgery. The pathology report indicated a carcinoid tumor (grade I) with no lymphovascularinvasion. Thus, presacral tumors are resectable through laparoscopy with lower complications than open surgery.

Although intrauterine devices (IUDs) are known for their low failure rate in pregnancy prevention, potential risksassociated with their use include uterine perforation and migration through the abdomen. In this particular case, thepatient experienced simultaneous IUD failure and perforation, with the device becoming embedded in an omentum. A28-year-old woman who was 39 weeks plus one day gestation presented for caesarean section. During the caesareansection, it was discovered that the IUD had entered the omentum through a hole in the posterior part of the uterus.The result of the birth was a live boy. IUD perforation is most commonly observed during the insertion procedure;however, it may rarely occur at a later stage. IUD perforations are frequently asymptomatic and remain undetecteduntil follow-up assessments are conducted or clinical manifestations become apparent. The presence of gastrointestinalsymptoms is commonly observed in cases with intraperitoneal migration of the IUD. Although the occurrence ofabdominal pain, diarrhoea, and fever with a missing IUD are indicative, they may not always be present. Nonspecificsigns and symptoms lead to misdiagnosis and the consequent delay in initiating appropriate treatment. In the presentcase, the co-occurrence of IUD embedded in the omentum and pregnancy posed a challenge due to the device’s rapidand imprecise shift, which complicated its accurate localisation. In such scenarios, ultrasonographic guidance canserve as a valuable tool to enhance accuracy and decrease adverse outcomes.