International Journal Of Fertility and Sterility
Volume:1 Issue: 1, 2007

A qualitative diagnosis of infertility requires attention to female and male physical abnormalities, endocrine anomalies and genetic conditions that interfere with reproduction. Many genes are likely to be involved in the complex process of reproduction. Cystic fibrosis (CF) incidence varies in different White people populations (a higher incidence of CF is observed in northern–western European populations than in southern European populations), and therefore the incidence of congenital bilateral absence of the vas deferens (CBAVD) may also vary in different White people populations. As CF is mainly observed in White people, hardly any data are available of CBAVD in non-White people, but frequent polymorphisms such as 5T are observed in most populations. The spectrum and distribution of cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations differs between CBAVD and CF patients, and even compared with control individuals. Combinations of particular alleles at several polymorphic loci yield insufficient functional CFTR. The combination of the 5T allele in one copy of the CFTR gene with a cystic fibrosis mutation in the other copy is the most common cause of CBAVD in Iran. Because of techniques such as intracytoplasmic sperm injection (ICSI), CBAVD patients are now able to father children, however such couples have an increased risk of having a child with cystic fibrosis, and therefore genetic testing and counseling should be provided. Around 10% of obstructive azoospermia is congenital and is due to mutations the CF gene. This paper reviews the relationship of mutations in the CFTR gene with CBAVD.

The etiology of infertility has direct influence on the plan and outcome of its management. In this paper we showed the effect of history of tuberculosis (TB) on female infertility among infertile couples admitted to Royan infertility management center. This case control study was performed on cases that were diagnosed with female infertility (308 women). Controls were women whose husbands were infertile due to some male factor (314 women). Those who had both female and male infertility were excluded from the study. The observed variables were BMI>25 kg/m2, positive history of smoking, tuberculosis, sexually transmitted disease and pelvic inflammatory diseases. The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI: 1.31-29.56).The attributable risk in exposed group was about 1%. According to our study, positive history of tuberculosis may be responsible for female infertility.

The etiology of infertility has direct influence on the plan and outcome of its management. In this paper we showed the effect of history of tuberculosis (TB) on female infertility among infertile couples admitted to Royan infertility management center. This case control study was performed on cases that were diagnosed with female infertility (308 women). Controls were women whose husbands were infertile due to some male factor (314 women). Those who had both female and male infertility were excluded from the study. The observed variables were BMI>25 kg/m2, positive history of smoking, tuberculosis, sexually transmitted disease and pelvic inflammatory diseases. The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI: 1.31-29.56).The attributable risk in exposed group was about 1%. According to our study, positive history of tuberculosis may be responsible for female infertility.

C. trachomatis is one of the most important agents of sexually transmitted diseases (STD). Untreated cases of vaginal infection with this bacterium may end up with infertility, scaring and ectopic pregnancy. In most cases infection with C. trachomatis is silent (70-80%) but when overt infection occurs the symptoms include: cervicitis, urethritis, and endometritis. Since prevalence of C. trachomatis was not studied in our city, this project was performed to evaluate the role of this bacterial agent in vaginosis. Two hundred and two specimens from vaginal discharge of out-patients referring to gynecology ward of Ahvaz hospitals were collected and tested for C. trachomatis by PCR. Out of 202 specimens, 33 (16.3%) were positive for C. trachomatis. The findings of this study show a high prevalence of C. trachomatis which indicates that special attention must be paid to detection and management of this infection.

Infertility is defined as failure in pregnancy after one year of unprotected intercourse. Several centers have reported different causes of infertility. The most common causes of infertility are: male factor such as sperm disturbance, female factor such as ovulation dysfunction and tubal factor, both male and female factor, and unexplained infertility. The aim of this study was to survey the epidemiology of infertility in Royan institute. In this descriptive retrospective study, 2492 infertile couples were studied. These couples were selected by systematic sampling among couples referred to Royan institute between 1995 and 2001.All existing demographic data and diagnostic methods were recorded in questionnaires. Results were analyzed using SPSS version 11.5. In this study, the frequency of primary and secondary infertility was 90.1% and 9.9%, respectively. Among 2492 couples, 50.5% had male factor, 28.6% had female factor, 11.6% had both male and female factors and in 9.3% of couples, the cause of infertility was unknown. Results showed that 32.3% of men had normal spermogram, 23.6% of couples had azoospermia, and 40.3% had sperm disturbance including oligospermia, asthenospermia, oligoasthenospermia and teratospermia. 3.8% were not able to collect sample for semen analysis. Among women, different infertility factors included: ovarian factor (20.36%), tubal factor (12.64%), uterine factor (4.13%), endometriosis (1.28%) and recurrent abortion (0.68%). 50.48% of women were normal. Although male factor was the most common cause of infertility in Royan institute, we can not conclude that this factor is the most common cause of infertility in Iran since this center is considered referral especially for male infertility. We suggest performance of similar researches in other centers to evaluate the most common causes of infertility in Iran.

The objective of this study was to evaluate the relationship between protamine deficiency, and acrosomal integrity with fertilization and pregnancy rate in patients undergone in vitro fertilization (IVF). Semen samples from 70 infertile couples undergoing IVF at Isfahan Fertility and Infertility center were assessed in this study. Semen analysis was carried out according to WHO criteria. Protamine deficiency, Sperm morphology and acrosin activity were assessed by Chromomycin A3 (CMA3), Papanicolaou staining and Gelatinolysis tests, respectively. Coefficients of correlation and student t-test were carried out using the Statistical Package for the Social Studies (SPSS 11.5) and P-value lower than 0.05 was considered as significant. Fertilization rate, percentage of halo formation, mean halo diameter and abnormal morphology show a significant correlation with percentage of CMA3 positivity. CMA3 positivity, percentage of halo, mean halo and sperm morphology showed a significant correlation with fertilization rate. Among the aforementioned parameters percentage of halo had the highest correlation. In the present study patients were divided into two groups according to pregnancy status. None of the studied parameters were significantly different between pregnant and non-pregnant patients. However, percentage of halo formation showed a slightly significant difference (r=0.306; P=0.058). The results of this study revealed that, even though sperm morphology, sperm protamine content and acrosome formation are events related to spermiogenesis, sperm acrosomal integrity assessed by percentage of halo formation has more profound effect on fertilization rate and pregnancy outcome during IVF procedure.

Infertility with an incidence of about 15% has been considered one of the major burdens on the community and has even been a threat to the continuity of the family life. One of the most prevalent causes of women infertility is ovarian causes particularly PCOS. The objective of this study was to determine the outcome of IVF & ET in women with PCOS in comparison with tubal factor. This historical cohort retrospective study was performed from 2000 to 2002, in Royan Institute. Our cases consisted of 33 patients with PCOS (without any other causes of infertility) who failed standard ovulation induction treatment with clomiphen citrate (≥6 cycles) and had undergone 33 cycles of IVF & ET. Control group consisted of 76 patients with only tubal factor infertility. Our study was performed during the first cycle of IVF in two groups, using long protocol with Buserelin (GnRHa and HMG). IVF and ET cycle characteristics were compared using student’s t-test, χ2 and Fisher''s exact test. The results of this research showed that a statistically significant difference existed in mean age and incidence of OHSS between the two groups. But there were no statistically significant differences in duration of follicular phase, the duration of GnRHa use up to onset of HMG, cyst number after using GnRHa, the percentage of cyst aspiration, HMG ampule consumption, retrieved oocyte, number of embryo per person, embryo transfer per person, cycle cancellation and pregnancy rate per embryo transfer in two groups. The result of this study showed that IVF / ET can be a successful treatment in PCOS patients resistant to other usual treatments and the hormonal disturbance of PCOs patients had no significant effect on IVF/ET outcome in comparison to patients with tubal factor.

To evaluate the effect of metformin on ovulation and pregnancy rate in clomiphene citrate resistant women with polycystic ovary syndrome (PCOS). In this clinical trial each patient, regarding her previous resistance to Clomiphene, served as her own control. A total of 35 clomiphene citrate resistant PCOS patients, referring to Royan institute were studied. Clomiphene citrate resistance was defined as having failure of ovulation during at least three cycles using clomiphene citrate doses up to 200 mg/day on cycle days 3-7 after a withdrawal bleeding with progesterone. Metformin was used alone or in combination with clomiphene citrate. First, the patients received metformin up to 1500 mg/day for 8 weeks. During the next 2-3 cycle if the patients did not become pregnant, clomiphene was added with increments of 100 mg (up to 150 mg/day). Follicular development and ovulation were monitored by ultrasound scans and mid-luteal progesterone level. Menstrual pattern, ovulation, and pregnancy rate were evaluated during the two stages of treatment. After 8 weeks of meformin monotherapy, ovulation occurred in 23 cases (65.7%) and 7 patients (20%) became pregnant. Among other patients (28/35) who were treated with Clomiphene Citrate and metformin for 64 cycles, 19 patients (67.8%) had proper ovulation and five of them (17.8%) became pregnant. Totally, metformin induced ovulation in 31 of 35 patients (88.6%) and twelve (34.3%) of them achieved pregnancy. Metformin alone or in combination with clomiphene is a very effective treatment in inducing ovulation and pregnancy in clomiphene resistant women with PCOS.

Cystic lesions in midline of prostate are uncommon and considered as congenital disorders. Here we report a 33- year- old male who presented with either azoospermia or decreased ejaculate volume leading to infertility and for whom performing Transrectal ultrasonography had a critical role in diagnosis. The obtained images revealed a congenital cyst of the prostate gland just in middle portion of prostate. Transurethral resection (TUR) of the cyst subsequently resulted in normalization of the semen analysis and restitution of the patient''s fertility. Spontaneous pregnancy occurred 2 months after TUR. Transrectal ultrasonography currently is the most accurate, inexpensive and readily available noninvasive imaging technique used to diagnose obstruction of the ejaculatory ducts in the infertile patient with either azoospermia or low ejaculate volume.