International Journal of Reproductive BioMedicine
Volume:4 Issue: 2, Nov 2006

The main factors affecting pregnancy and implantation rates are uterine receptivity, embryo quality,and transfer efficiency. Embryo transfer (ET) is the last step of critically important procedure of in vitrofertilization (IVF) and probably the least successful step in Assisted Reproductive Technology (ART)treatment cascade; though simple in most of the cases, it may pose to be the most difficult in some.No matter how good the IVF laboratory culture environment is, the physician can ruin everything with acarelessly performed embryo transfer. The entire IVF cycle depends on delicate placement of the embryosat the proper location near the middle of the endometrial cavity.Pregnancy rates will be significantly increased with the following procedures:1. Trial transfer2. Avoiding the initiation of uterine contractility by using soft catheters, gentle manipulation and byavoiding touching the fundus.3. Removal of cervical mucus, wash and lavage of cervix with culture media.4. Ultrasound-guided ET with full bladder.5. Deposition of the embryo 2 cm below the uterine fundus.6. Examination of catheter following transfer for retained embryos, blood and mucus.Slow withdrawal of the embryo transfer catheter, the use of a fibrin sealant, bed rest after embryotransfer, sexual intercourse and routine administration of antibiotics following embryo transfer remainedto be studied by randomized clinical trials (RCTs).

The quality of intraoperative analgesia with paracervical block (PCB) during egg collectionin in-vitro fertilization (IVF) is still unclear.

This study performed to compare the pain levels during egg collection and the subsequentintra and postoperative side effects in patients receiving a conscious sedation with and withoutparacervical block.

In this prospective, double-blind, and placebo–controlled study, 60 patientsundergoing egg collection in their first IVF cycle were randomized to receive conscious sedation inconjunction with paracervical block with 10 ml lidocaine 1.5% (sedation + PCB patients or study group)or with 10 ml normal saline (sedation patients or placebo group).

Patients in study group experienced significantly less vaginal (10.40±8.40 mm vs 20.77±4.60mm respectively; p<0.0005) and abdominal pain (10.87±5.08 mm vs 35.33±4.27 mm respectively;p<0.0005) during egg collection, compared with those in placebo group. Propofol requirements was8.67±2.42 mg in PCB patients vs 25.60±5.29 mg in placebo group (p<0.0005). Incidence ofintraoperative (9.90% vs 50% respectively; p=0.002) and postoperative (3.33% vs 56.66% respectively;p<0.0005) side effects were significantly less in study patients compared with placebo group.

Conscious sedation with PCB appears to be an effective and safe method of providinganalgesia and anesthesia for transvaginal retrieval of oocyte.

Today there is a rise in the number of newborns conceived by artificial reproductivetechniques (ART). Numerous studies have been performed on the perinatal outcome of these pregnancies.However, there is limited data about the condition of health of these newborns in Iran.

Regarding the higher prevalence of probable complications and symptomatic congenitalanomalies, we aimed to determine the state of health of newborns born by ART.

A total of 109 newborn who were conceived through ART and 479 newborns ofspontaneous conception were enrolled into our study.The study was prospective, case-control study in Tehran, Iran, from March 2003 to March 2004. Bothcase and control groups were adjusted in regard to race, sex, type of delivery, chronic disease of mother,age of mother, and antenatal steroids administration. All newborns were examined by neonatologist afterbirth and their outcome were followed until hospital discharge or death.Data pertaining to clinical and laboratory findings of newborns and death were entered into aquestionnaire and subsequently analyzed by appropriate statistical tests. Confidence interval was 95%.

Prematurity, low birth weight (LBW), very low birth weight (VLBW), twins and triplets, smallfor gestational age (SGA), need for resuscitation at birth, respiratory distress syndrome (RDS) and NICUadmission were significantly higher among newborns born after ART than those born throughspontaneous conception (p<0.05). Regression logistic analysis showed that RDS and NICU admissionwere more strongly associated with weight at birth and gestational age than with method of conception.However, increased rate of SGA in the case group was associated with multiple pregnancy. Also, therewas no significant statistical relationship between the method of conception and the prevalence ofcongenital anomalies, large for gestational age (LGA), congenital pneumonia, necrotizing entrocolitis(NEC), respiratory air leakage syndromes (ALS), hydrops fetalis, hyperbilirubinemia sepsis, meconiumaspiration syndrome (MAS), isseminated intravascular coagulopathy (DIC), cardiac failure, lunghemorrhage, hypoglycemia, hypocalcemia, neutropenia, thrombocytopenia and hemolysis.

Newborns who were conceived by ART were more likely in need of resuscitation at birthregardless of other factors. Furthermore, newborns born after ART were at higher risk of developingprematur birth, LBW, and multiple birth.

Endometriosis is defined as the growth of endometrial tissues in ectopic places outside theuterus. This disease has an important effect on the health and fertility of affected women. It’s etiology isnot clearly known. For better understanding the pathophysiology of this disease, many researchers studyon several aspects of the disease on animals.

In this experimental study endometriosis was induced in female rats surgically and then itsside effects were investigated with special focus on adhesion formation that is a major problem in womenwith this disease.

In Protestrous phase, female rats were randomly divided into two groups. Inboth groups, under intra peritoneal anesthesia, laparotomy was done and left horn and associated fat wereremoved. In experimented group (A), the removed endometrium was cut to six square pieces (2mm each)and they were sutured to the peritoneum, near ovaries and subcutaneous. In sham group (B), the sameprocedure was done for the fat tissues around the removed horn and the pieces were sutured to the sameplaces. After 8 weeks, in Protestrous phase, clinical adhesion and size of implants were evaluated.

The total mean size of implants was calculated in each group, and this was significantly larger inexperimented group (25.4 mm versus 2 mm p=0.000). The mean diameter of implants that calculated foreach site of implantation in experimented group were significantly larger in left peritoneum (p=0.002),followed by right (p=0.000) and left (p=0.000) ovaries. The endometrial tissues grew in 100% of implantsin subcutaneous area. Clinical adhesions (Score ≥ 2) were detected in 7 out of 10 in experimented groupand in 2 out 10 in control group. The number of Esterous cycle were similar in both groups.

Our study showed that after inducing endometriosis by surgical approach, only endometrialimplants grew as a cystic structures and this is a unique aspect of endometrial cells. Our results showedthat endometriosis had a direct effect on adhesion formation, not surgery alone and induction of thisdisease didn''t have any adverse effect on ovarian function in female rats.

Spontaneous occurrences of multifetal pregnancies always have been a medical problem.The risks of perinatal morbidity and mortality and maternal morbidity increase with enhancement of thenumber of fetuses.In our prospective experimental study, the outcome of twin pregnancy after Assisted ReproductiveTechnologies (ART) with and without Multifetal Pregnancy Reduction (MFPR) is compared relating toperinatal and maternal complications.

The aim of this study was to compare the gestational age at delivery, birth weight, and othercomplications of surviving twins following MFPR to those in a control group of non-reduced twins.

In this prospective experimental study, from infertile couples who were referredto Isfahan Fertility- Infertility Center (IFIC) and were candidate for ART (Invitro Fertilization or IntraCytoplasmic Sperm Injection), 30 couples who have had twin (control group) and 35 couples with quadruplet orhigher order pregnancies (experimental group) were selected. In cases with experimental group MFPR was done,and pregnancy outcome-miscarriage, premature labor, Premature Preterm Rupture of Membranes (PPROM)and Pregnancy Induced Hypertension (PIH)-were compared between two groups.

Distribution of complications in experimental vs. control groups was as follows: miscarriage: 23.3vs. 16. 7%, premature labor: 15.7% vs. 13.3 %, pregnancy induced hypertension: 13.3% vs. 16.7%,abruption: 6.7% vs. 6.7%, and premature preterm rupture of membranes: 23.3% vs. 26.7 %. Mean neonatalweight at birth (2239 vs. 2240 gr) and mean gestational age at delivery (33.5 vs. 34.1 w) were similar. Thedifferences between two groups were not statistically significant (P>0.05).

MFPR during early pregnancy is a safe, effective and simple operative for the purpose ofreducing perinatal and maternal complications.

The experience of infertility can be extremely stressful and associated with a rangeof psychiatric problems in infertile women. Generally; some of the risk factors which may lead topsychiatric problem are repeated unsuccessful treatment of infertility, low socioeconomic status,lack of partner support, being female, life events, etc.

In this study, we have analyzed the psychiatric problems of infertile women by meansof primary health questionnaire (PHQ).

In a cross sectional study 100 infertile women were selected and advisedto fill up PHQ. After obtaining their consents psychiatric problems such as somatoform, panic,other anxiety disorder major depressive and other depressive disorders, were assessed, and theirresults were analyzed and compared with these results from 98 fertile women.

According to PHQ results major depression and anxiety disorders were significantly morefrequent in infertile women, but considering somatoform and panic disorder there was nosignificant difference between infertile and fertile women.

Infertility may be considered as one of the major casual factor in major depressiveand anxiety disorders in association with other social problems.

Recurrent abortion is a critical problem in which many factors play a crucial role such asanticordiolipin antibody and antiphospholipid antibody. This study was conducted to evaluate thefrequency of anticardiolipin antibody and antiphospholipid antibody in pregnancy failures in women withthe history of recurrent pregnancy loss. In 154 women with the history of two or more recurrentpregnancy losses, serum anticardiolipin and serum antiphospholipid were measured using ELISA method.The positive IgG anticardiolipin and IgG antiphospholipid were detected in 12. 34% (19 patients) and6.5% (10 patients) of patients respectively. Although 16 out of 19 patients with positive IgGanticardiolipin were negative for IgG antiphospholipid and 7 out of 10 patients with positive IgGantiphosphplipid were negative IgG anticardiolipin, but there was a significant correlation between IgGanticardiolipin and IgG antiphaspholipid (r = 0.222 p=0.000). Our data concluded that anticardiolipinantibody is found to be more important than anti phospholipid antibody in recurrent abortion.

Over recent decades a possible decrease in sperm quality and an increase in the incidenceof testicular cancer have been reported in many populations. Some recent findings, as cohort studies,showed an increased risk of testicular cancer in men with abnormal semen analysis.Case: A 30 years old man referred to our clinic with chief compliant of infertility for 3 years.Spermogram revealed azoospermia and right extratesticular intrascrotal mass was detected by ultrasoundexamination. Right inguinal surgical approach showed intact small sized atrophic right testis and anintrascrotal mass. In microscopic examination of the mass mixed germ cell tumor with teratoma, yolk sacand embryonal components were reported.

Extragonadal germ cell tumors, like their testicular counterparts are associated with primarygerm cell defects. The higher incidence of antecedent infertility suggests that either congenital or acquiredprimary germ cell defect contributes to defective spermatogenesis and therefore, there is higher risk ofcancer development in incompletely migrated germ cells. We recommend complete evaluation of cancerin patients with infertility and azoospermia.