International Journal of Reproductive BioMedicine
Volume:3 Issue: 2, Nov 2005

Ovarian hyperstimulation syndrome (OHSS) is a unique iatrogenic complication of controlledovarian stimulation (COH)/in vitro fertilization (IVF) in reproductive endocrinology occurringduring the luteal phase or early pregnancy. It can have a serious impact on the patient’s health.With the expansion of the assisted reproductive techniques (ART) from 1978, the incidence ofOHSS is increasing worldwide.OHSS is characterized by gastrointestinal symptoms, ovarianenlargement, fluid shift to the third space, and hemoconcentration. Severe cases are associated withthromboembolic phenomena, respiratory distress, liver dysfunction and renal failure. OHSS is morecommon among woman who are young, thin and have PCOS or multiple allergies. Vascularendothelial growth factor (VEGF) and other cytokines are pivotal in the pathogenesis of OHSS.In the prevention of any disease, it should be emphasized that the possibility of primary preventiondepends on two main requirements, first, the etiology of the disease and predisposing factors; andsecond, it must be feasible to avoid or manipulate such factors as paint of a prevention strategy.This strategy for preventing OHSS and its severity have included prediction of women at risk; thefirst step in prevention is identification of patients at risk by the recognition of risk factors. As thisis not always possible, there are several ways of avoiding developing of the syndrome. Thestimulation phase has to be carefully monitored (regular ultrasound and estradiol measurements),and further interventions need to be implemented if signs of hyper-response are present. The aim ofthis systemic review of the literature is to answer this question: “can we prevent severe OHSS”.Canceling the cycle, modification of method to trigger ovulation administration ofmacromolecules, coasting approach, timed unilateral or bilateral aspiration of one or two ovariesperformed before or after hCG administration, In vitro maturation (IVM), elective cryopreservationof all embryos, and laser or electrocautery of one or both ovaries, have been showed to beassociated with a reduced risk of OHSS by some research groups. The effect of combined methodshould be assessed.Finally, apart from canceling, none of these approaches was totally efficient, although most ofthe above-mentioned methods decrease the incidence in patients at high risk of OHSS, but overall“prevention is the ideal treatment of OHSS”.

Retinoids have been suggested to play a role in oogenesis and oocyte survival.

In the present study the effects of retinol palmitate were investigated on differentialfollicular counts in response to superovulation as well as follicle quality after vitrification of ovaries.

Ten, 4 week old female BALB/c mice were randomly assigned to eitherparaffin (n=5) or retinol palmitate (n=5) administration. Vitamin A administered animals received(i.p.) 250 IU retinol palmitate, dissolved in 0.1 ml of paraffin oil on days one and ten followed bysuperovulation with 10 IU PMSG. Paraffin administered mice were only treated with 0.1 ml ofparaffin oil. The collected left ovaries from both paraffin and vitamin A administered groups wereconsidered as non-vitrified and the collected right ovaries from both treated groups underwentvitrification. Ovaries in the vitrified group were frozen sequentially by placing into two vitrificationsolutions {VS1: 10% ethylene glycol (EG), 10% DMSO in holding medium (TCM-199 + 20% FBS:HM) and VS2: 20% EG, 20% DMSO in HM}. After warming, recovered ovaries as well as nonvitrifiedovaries were serially sectioned and examined histopathologically.

The proportion of antral follicles in the non-vitrified ovaries from vitamin A administeredmice was statistically higher than the non-vitrified ovaries from paraffin administered group (29.4%vs. 15.6%, respectively; p<0.001). No difference due to retinol palmitate injection was observed forthe rate of small follicles between the two non-vitrified groups. The percentage of damaged folliclesdid not show any significant differences between the two vitrified groups (76% vs. 79%).

Our results demonstrate that administration of retinol palmitate may improve theresponse to superovulation through the shift of follicular growth towards antral follicle development.However, no positive effect of retinol palmitate in the quality of follicles is probable when ovariesare vitrified.

Polycystic ovary syndrome (PCOS) is related to obesity and to major metabolicalterations including both insulin resistance and beta-cell dysfunction. Ghrelin was identified as theendogenous ligand for the growth hormone secretagogue (GHS) receptor. The actions of ghrelin arecarried out through interaction with specific receptor, named GHS-R.

In a case-control study, we compared the expression of ghrelin and GHS-Rs mRNA byQuantitative Real-time PCR method in studied groups in order to determine the role of ghrelin andGHS-Rs in pathogenesis of PCOS.

Follicular fluid samples were obtained at oocyte collection from 22 patientsundergoing IVF-ET as control and 11 patients were diagnosed as having PCOS. Total RNA wasextracted from isolated follicular fluid cells and 2μg RNA was diluted and reverses transcribedusing random primers and Superscript II. Specific primers for the ghrelin, GHS-R1a and GHS-R1bwere designed. Samples were run in triplicate on an ABI Geneamp 5700 sequence detection system.They were subjected to 40 cycles of amplification under condition 92°C- 20s and 62°C-1min using3μl diluted cDNA (1:7), 10μl 2X SYBR green, 3μl diluted cDNA. β-actin mRNA was assayed andthen normalized to total RNA measurements for each sample.

Age, weight and resulting pregnancies did not vary between PCOS and non-PCOSpatients, whereas the BMI and serum testosterone level of PCOS were significantly higher thannon-PCOS patients. Quantitative real-time RT-PCR showed that mRNA for ghrelin and GHS-R 1bwere detectable in follicular fluid cells from all patients. We failed to find mRNA for GHS-R 1a inany of follicular fluid cells. There were no significant difference in ghrelin and GHS-R1b mRNAexpression levels between PCOS and non-PCOS groups.

Our findings indicate that ghrelin and ghrelin receptors may not be considered riskfactors for pathogenesis of PCOS.

In vitro maturation (IVM) of oocytes is a promising technique to reduce the costs andavert the side-effects of gonadotropin stimulation for in vitro fertilization (IVF). The pregnancyrates from oocytes matured in vitro are much lower than those of in vivo stimulation cycles,indicating that optimization of IVM remains a challenge.

In this study, we investigated the effect of cumulus cells on maturation and fertilizationrate of immature oocytes (Germinal vesicle).

Germinal vesicle (GV) oocytes were recovered from 6-8 weeks old BalbC female mice 48hr after injection of 10 IU pregnant mare serum gonadotropin (PMSG). Collectedoocytes were divided into two groups. Group A: GV oocytes without cumulus (denuded oocyte).Group B: GV oocytes with cumulus cells (cumulus-oocyte complex). The oocytes in both groupswere cultured in TCM-199 medium in a humidified atmosphere of 5% CO2 in air at 37ºC. Thematuration, fertilization and developmental rates were recorded after 24hr.

Maturation, fertilization and developmental rates in denuded oocytes (DO) were 65.1%,68.02%, 78.63% respectively, and in cumulus-oocyte complex (COC) were 78.20%, 85.57% and85.05%, respectively. The maturation, fertilization and developmental rates of COC weresignificantly higher than those of DO (p<0.05).

The results show that cumulus cells have beneficial effects on maturation, fertilizationand cleavage rates of mice oocytes.

In the field of mammalian embryo culture, the putative influence of autocrine/paracrine factor(s), produce by the embryos itself, is under investigation. A smaller medium dropcan prevent dilution of this factor(s).

The objective of this study was to examine the effect of culture medium volume on invitro development of mouse 2-cell embryos.

The embryos were obtained from female NMRI mice. To evaluate theeffect of medium volume, groups of 16-20 late 2-cell embryos were cultured in 2, 5, 10, 20, 50 and100 μl of drops of Ham’s F10 medium for 72 h.

Development to blastocyst stage in 50 and 100 μl of drop were significantly higher thanthis in any other volume (p<0.001). Almost a similar pattern was also observed for hatchedblastocyst formation. However, the total number of cells in blastocysts, developing in differentvolumes, were not significantly different.

These results indicate that the optimal volumes of Ham’s F10 medium for mouse earlyembryo development are 50 to 100 μl. However, volumes as small as 2 μl can successfully supportmouse 2-cell embryo development to blastocyst and hatching stages.

About 90% of the world’s contraceptive users are women. This gender-based usagehas occurred due to the emphasis of family planning programs and contraception research. Condom,vasectomy and withdrawal are the only male contraception devices available with less assurance formen. For new male contraceptive to have an impact, they must be acceptable to both men andwomen, as well as effective. A hormonal method will likely come to the market within the next fewyears. It is necessary to use biologically active botanical substances or fertility-regulating agents ofplant origin which are ecofriendly.

The epididymis is a site which can be exploited for male contraception without undueside effects. It was therefore of interest to investigate the effect of biologically active botanicalecofriendly plants such as Azadirchta Indica (neem) seed alcoholic extract as an efficient andcompetent male contraceptive on male mouse epididymis.

In this experimental case control study sixty adult healthy mice dividedinto two groups of 40 as the control and 20 as the treated group. The treated group was administeredby Iranian Botanical Azadirachta Indica seed alcoholic extract, cultivated at Dashteh Moghan(Ardabil province). The seeds was extracted with ethanol then administered first 50 mg/kg bodyweight /day then 100 mg/kg body weight/day orally for 15 days, following WHO guide lines (MB-50). The target organ, epididymis parameters viz. sperm motility, sperm count fertility rate,Scanning Electron Microscopic (SEM) morphology of spermatozoa and ATPase activity ofepididymis of the two groups were compared.

The 50 mg/kg body weight (BW)/day showed no significant change in epididymal spermmotility, as compare to the control. Therefore the dose was changed to 100 mg/kg BW/day for 15days. The body and organ weights (epididymis) of the treated animals were not significantlychanged as compare to control group (p>0.05). The treatment brought about a significant reductionin fertility rate when normal cycling female mice were mated with treated males (p<0.001). Declinein ATPase activity in caput and cauda epididymis was observed (p<0.001). SEM photographsshowed spermatozoa with abnormal head and bent mid-piece region.

Decrease in ATPase activity could be attributed to androgen dependent parameters.However, the fertility rate was also significantly reduced which can be due to the decrease in caudaepididymal sperm motility and their morphological abnormalities. Since the effect on epididymalsperm motility and morphology was manifested in short period of 15 days, it is evident that theextract has potential as an antifertility agent. As this extract do not cause change in the body andorgan weight, it is likely that no effect occurred on electrolyte balance.

Knowledge of infertile couples about assisted reproductive technology is afundamental parameter to optimize the infertility treatment and conduct it cooperatively.

To evaluate knowledge and attitude of infertile couples about assisted reproductivetechnology we designed a descriptive cross-sectional study.

400 infertile patients were investigated by a self- administered structuredquestionnaire about demographic data, infertility history, and several relevant variables in an outpatient infertility clinic of a university hospital.The main outcome measurements included scoring the answers in the questionnaire regardingknowledge, and grouping the answers regarding attitude. Resulted data were analyzed in relation topatient’s gender and treatment history, and educational, ethnic and religious groups.

Of 400 cases (251 women and 149 men) 167 patients (41.7%) were scaled to have goodknowledge and 223 patients (55.7%) had a poor knowledge about ART. 74.6% of patients withadvanced education and 30.3% of patients without advanced education were scaled to be good inknowledge. 45.6% of men, 43.4% of women and 64.8% of patients with a history of passingprevious ART cycles had a good knowledge. The source of information was mentioned to be theART centers in 73% of cases. 95% of patients disagreed to have sperm or ovum donation or toundergo surrogacy. 22% of all patients (27.5% of women versus 12.1% of men) agreed withembryo reduction. 94.5% of patients mentioned the ART expenses not to be affordable readily.

Less than half of patients presented to be knowledgeable about ART. Not a greatportion of the patients agreed with sperm donation. ART expense is mentioned to be burdensome bynearly all of the patients.

Recent studies of uterine contractility in IVF–embryo transfer led us to consider analternative, and possibly complementary, explanation for the high implantation rates of blastocysts.It has been demonstrated that myometrial contractile activity influences embryo implantation,possibly through mechanical displacement of embryos.

The aim of this study was to examine the effect of nitroglycerine (NTG) treatment forpriming the uterus on the pregnancy outcome of ICSI-ET programs.

This study was a prospective, randomized, double-blinded placebocontrolledclinical trial. One hundred consecutive cycles of ICSI-ET on infertile couples wererandomly divided into treatment and control groups. The treatment group (50 cycles) received anoral dose of 0.4 mg of NTG, and the control group (50 cycles) received a placebo, 15 minutesbefore fresh ET. An informed consent from was obtained form each patients. The main outcomeswere implantation rate (IR) and pregnancy rate (PR).

The mean age of females in the control group and in the treatment group were 30.1±5.1and 31±5.5 years respectively. Data showed that the mean duration of infertility was notsignificantly different between control and treatment groups (6.6±5.8 versus 7.8±5.1 years,respectively). The mean number of oocyte retrieval (metaphase II), 2pn, embryo cleaved, embryotransferred and PR weren''t different between two Groups (p>0.05).Overall PR was 36%, it was 38% in treatment group and 34% in control group but there wasn’tstatistically significant difference between two groups. (p>0.05)

NTG didn''t increase PR compared to placebo group. These results suggest that NTGtreatment before ET isn''t effective in the priming of a uterus.