Journal of Reproduction & Infertility
Volume:8 Issue: 3, 2008

Progress and completion of spermatogenesis is related to simultaneous expression of various genes. Recent studies show that many genes are expressed in the sperm and several RNA copies are present in the mature spermatozoa. Identification of these genes and evaluation of their functions would improve our understanding of the molecular basis of fertilization, early embryo cleavage and the causes of many types of unexplained male infertility. In this study, we investigated the expression of DAZ, PRM1, PRM2, TSGA10, SYCP3 and AKAP4 genes in ejaculated human spermatozoa. Semen samples were collected from men referring to Avicenna Infertility Clinic. Normal semen samples (According to WHO criteria) were subjected to density-gradient centrifugation to specifically recover the pure fraction of motile spermatozoa with normal morphology. Total RNA was extracted from sperm pellets and cDNA was synthesized using RT-PCR. The presence of DAZ, TSGA10, PRM1 and PRM2 cDNAs were evaluated using appropriate primers. Expression of SYCP3 (Testis specific gene) was evaluated by nested RT-PCR. The cDNA synthesized from normal testis tissues was used as positive control. Study on cDNAs showed that DAZ, TSGA10, PRM1 and PRM2 transcripts were present in normal human testis and all of the evaluated mature spermatozoa samples but not AKAP4 or SYCP3 transcripts. According to our previous study, the expression of SYCP3 and AKAP4 genes is started from spermatocyte level in human testis during spermatogenesis process. However, we did not found any transcripts of these genes in mature spermatozoa. It is estimated that mRNAs of TSGA10, PRM1, PRM2 and DAZ and other testis specific genes in spermatozoa may participate in later sperm functions such as fertilization and early embryo cleavage. Therefore, further studies are needed to understand the role of these transcripts in the process of fertilization and early embryo development.

One of the causes of infertility is due to male factors (Sperm count, sperm motility and morphology). Male factor infertility may be due to disorders in the number of spermatozoa, sperm motility or sperm morphology. Intrauterine insemination (IUI) is routinely used to help couples with male factor infertility. The criteria used to evaluate semen quality include sperm concentration, sperm motility and the percentage of sperm with normal morpho-logy. Several studies have been done on motility and sperm concentration but few studies have been done on sperm morphology. In this study, we evaluated IUI success rates in normal sperm morphologies that were greater or fewer than 5% in the Northern part of Iran (Mazandaran). This analytical study was performed on patients referred to two inferti-lity centers in Babol after ovulation induction. After collecting sperm specimens from the cases, the samples were kept in sterile tubes and then they were washed and swum up before perform-ing IUIs. Sperm concentration, motility and morphology were evaluated according to NAFA and ESHRE-SIGA criteria (2002). Statistical analysis was done by SPSS software using logistic regression, paired t-tests and Fisher’s exact test. A p–value < 0.05 was considered significant. Out of 561 patients, IUIs were successful in 103 (20.2%) patients with normal sperm morphology greater than 5% and in 4 (7.7%) patients with normal sperm morphology fewer than 5%; the difference being statistically significant (p<0.05). In 504 cases with sperm concen-trations greater than 20 million/ml, IUI success rates in subjects with normal sperm morphology greater than 5 % were significantly higher than cases with normal sperm morphology fewer than 5% (21.4:5.6), (p<0.01). In 543 cases with sperm motility greater than 50%, IUI success rates were significantly higher in patients with normal sperm morphology greater than 5% compared to the cases with normal sperm morphology fewer than 5% (20.5:8.3), (p<0.05). It seems that normal sperm morphology >5% is an important and effective factor in IUI outcomes and normal sperm morphology, alongside sperm counts and normal motility, has an essential role in increasing pregnancy rates. Therefore, it is suggested that in addition to sperm counts and motility, evaluations of sperm morphology be included in the work up too.

One of the primary desirers of couples, especially in Asian countries, is to have a male offspring. This wish is generally higher in fertile than infertile couples. One of the tech-niques used in infertility centers for separating the spermatozoa containing Y or X chromosomes, is the Ericsson method that is simple, cheap and practical with application of no toxic material. The goal of this study was to evaluate the results of sex selection with sperm separation using albumin gradient technique in fertile and infertile couples under IUI treatment cycles. This was a descriptive-analytical study. A total of 32 couples (30 fertile and 2 infertile couples) were enrolled for sex selection techniques (31 asking for male and one for female offsprings) using Ericsson method. Following sperm evaluation, the sperm samples were prepared with Ericsson technique in less than 2 hours. Through a transfer catheter400-500μl of the fluid, containing more than 1×106 spermatozoa, was transferred into uterine cavity. All candidates had been super-ovulated for IUI cycles. The data were analyzed using χ2, t-test and Wilcoxon nonparametric tests. Out of 32 couples under study, 30 individuals already had one child. The rate of pregnancy after IUI plus albumin gradient was 34.4%. The pregnancies of 4 couples were aborted. The live birth rate was 21.8% and achieving the desirable offspring was 71.4% among the born babies. The findings also showed that two sperm parameters of fast and slow motilities and normal morphology, following sperm separation with albumin gradient, were significantly increased (p<0.001, p<0.05 and p<0.05, respectively). In addition, the rate of sperm progressive motility and normal morphology was higher in subjects who gave birth to male offsprings than other candidates. Only one couple had asked for a female offspring, but the process resulted in a normal male infant. The separation of spermatozoa by albumin gradient technique, which was introduced by Ericsson, is a suitable technique for sex selection of offsprings. However, the applicability of this technique for infertile couples needs further studies. The aforementioned technique is considered safe, since it neither requires toxic materials during sperm separation, nor involves embryo manipulation.

Pneumonia during pregnancy can induce serious consequences to the mother and the fetus, therefore its diagnosis and therapy is very important. There are few published articles on Legionella infection prevalence during pregnancy. In patients with Legionellosis, bacterial LPS and DNA are excreted into urine for extended periods, so combination of PCR and ELISA methods would be a good diagnostic tool. This research was done to determine the prevalence of L. pneumophila in pregnant women with respiratory infections. This is a cross-sectional study on 95 pregnant women with respiratory infection carried out during winter to summer 2006. Presence of Legionella infection was con-firmed by nested PCR-RFLP and antigen detection in urine specimens by ELISA method. The data were analyzed by SPSS, version 13, by using independent t tests, Fisher’s exact test, χ2, a logistic model and McNemar’s test, while considering p<0.05 as significant. The prevalence of infection using PCR was 22.1% (CI=14.1%-30.1%) and by ELISA it was 4.2% (CI=2%-8.2%); this difference was statistically significant (p<0.005). The most pre-valent clinical features were Cough (56.8%), headache (54.7%), abdominal pain (38.9%), chills (35.8%), fever (22.1%) and diarrhea (8.4%). There were significant statistical relationships bet-ween cases with a positive CRP and fever, chills and abdominal pain and previous liver or renal problems (p<0.05, p<0.001). There were significant relationships between fever and chills with ELISA results (p<0.05) but no relationships with other variables. There was a considerable prevalence of this infection in the studied population (22.1%). It seems that performing PCR & ELISA tests on urine sample is suitable in detecting Legionella species and it can provide results in a less than a day_ a great help in the diagnosis and treatment of pneumonia especially during pregnancy.

Luteal phase support is practiced routinely in some medical centers in patients undergoing ovulation induction (OI) and intrauterine insemination (IUI) cycles. The purpose of this study was to compare the effects of progesterone in oil with 17-α-hydroxy progesterone caproate (17- HPC) for luteal phase support. This prospective randomized clinical trial was done at Montaserieh Infertility Center in Mashad, Iran, from October 2005 to October 2006. In this study, 162 patients undergoing OI and IUI were randomly treated with either 17-HPC (250 mg/weekly, IM) or progesterone in oil (50mg/daily, IM) until serum β-hCG was evaluated.In patients with positive β-hCG results (Biochemical pregnancy), the treatment was continued until the 12th week of gestation. The data were analyzed using t-tests, Chi-squared and Fishers exact test. P-values <0.05 were considered as the level of significance. The outcomes of IUI in both study groups were compared. No differences were found in the outcome of pregnancies, considering parameters such as biochemical pregnancy (p=0.69), clinical pregnancy (p=0.3) or ongoing pregnancy up to the 20th week (p=0.831). Complications were significantly lower in 17-HPC group (p=0.002) and the patients satisfaction was signi-ficantly higher compared to the other group (p=0.003). The results of this study confirm that 17-HPC has the same effects as oily progesterone for luteal phase support in patients undergoing OI and IUI cycles and it could be used instead of progesterone in oil, although more studies are needed to support this replacement.

Iron deficiency anemia has a high prevalence in women of reproductive age, especially in pregnant women (50%), with serious consequences on the mother and the fetus. Anemia is responsible for about 10-15% of all maternal deaths worldwide. There are different and sometimes contradicting reports on the role of Helicobacter pylori in causing anemia. On the other hand, Helicobacter pylori infection and its well-known complications are of high prevalence in developing countries. Therefore, the present study was conducted to determine the relationship between Helicobacter pylori and anemia. This study was retrospectively conducted on 187 pregnant women who were at their third trimester and attended the Health Centers affiliated with Mashad University of Medical Sciences for prenatal care during 2006. Based on hemoglobin assessment done in the first trimester and kept in their health records, the participants were divided into two groups: anemic (94 women) and healthy (93 women) groups. Demographic information and nutrition questionnaires were completed. Tests for hemoglobin, ferritin, and Helicobacter pylori infection, using Elisa method for the detection of IgA and IgG, and antibody titration were conducted. The data from this study were analyzed by SPSS software, version 13, using descriptive (Mean, standard deviation and odds ratio) and inferential statistics (Independent t-test, chi-squared, Mann-Whitney test, analysis of variance and logistic regression). P-values less than 0.05 were considered significant. The subjects in the two groups did not have significant differences in terms of age, job, education, husband's education, husband's job, number of pregnancies and economic status. The rate of Helicobacter pylori infection showed a significant difference between the two anemic and non-anemic groups (p=0.01). It was also shown that hemoglobin concentration and ferritin, during the third trimester of pregnancy in Helicobacter pylori infected cases were lower compared to that of the healthy ones (p<0.001). On the other hand, the changes of hemoglobin during the first and the third trimesters of pregnancy in the two groups showed a significant difference (p<0.001). The amount of hemoglobin during the third trimester of pregnancy in the Helicobacter pylori infected group had no significant increases in comparison to theirs at the first trimester, despite iron supplementation. It seems that there is a relationship between Helicobacter pylori infection and anemia in pregnant women, therefore it is suggested that tests for Helicobacter pylori infection be included in preconceptional consultations, especially for women who have a history of anemia or persistent anemia, as this will be both wise and economic.

Modern technology and biotechnology have provided the possibility of gamete and embryo donations to infertile couples. Consequently, one of the important questions that have arisen is that “Is there a right to know one’s biological parents?” To provide and answer this question, it is necessary, first, to determine, what one means by expressing the concept of “right”. Four meanings have been identified for the concept. They are right-claim, right-liberty, right-power and right-immunity. Right-claim and right-liberty as the strong and weak claims are applicable to the problem at hand. To choose between the two meanings requires putting forth a well-established justificatory theory of rights. Rights are to protect the very humanity of human beings. This has been a basis for two basic values of human dignity and moral agency. Not knowing one’s biological roots does not put in danger one’s humanity or the two mentioned values. Therefore, we may only defend a right-liberty of knowing one’s biological parents; a right that does not require the state and society to be active in making individuals know their biological parents. Nevertheless, in exceptional cases where the lack of that knowledge of the biological roots does endanger one’s personhood and humanity, the weak claim can turn into a strong one.

Advances in molecular biology over the past decade have helped enhance understanding of the complex interplay between genetic, transcriptional and translational alterations in human cancers. These molecular changes are the basis for an evolving field of high-throughput cancer screening techniques using microscopic amounts of patient-based materials. LASER capture microdissection allows pure populations of cells to be isolated from both the tumor and stroma in order to identify subtle differences in RNA and protein expression. Comparative analysis of these alterations between normal, pre-invasive, and invasive tissues, using powerful bioinformatic programs, has allowed us to identify novel tumor markers, profile complex protein pathways, and develop new molecular-based therapies. Continued refinement of such high-throughput micro-technologies will enable us to rapidly query patient specimens to identify novel methods for early diagnosis, treatment, and follow-up of a wide array of human cancers.There has also been an explosion in the development of new tools to analyze proteomic data of blood cells and other bodily fluids and materials in recent years. Analysis of a proteome would enhance the possibility of identifying protein signa tures for cancer. Surface enhanced LASER desorption and ionization with time of flight diagnosis (SELDI-TOF) spectral analysis is linked with a high-order analytical bioinformatic approach to define optimal discriminatory signature proteomic patterns. This technology is now being widely used in laboratories around the world for biomarker discovery in the early stages of cancer in general and breast cancer and cancers involving the reproductive organs such as ovary, prostate, cervix and endometrium in particular.

Uterine cervical incompetence is one of the risk factors for preterm labor and it is characterized by painless cervical dilatation and prolapse of membranes into the vagina in the second or third trimester of pregnancy. The aim of this report is to discuss a term pregnancy following complete bed rest in cervical insufficiency.

A 24-year old woman with a history of uterine cervical incompetence was admitted to hospital with cervical dilatation and effacement at the 24th week of gestation. She had a successful term pregnancy with bed rest and expectant management at the 39th week of gestation.

Expectant management with bed rest in an appropriate position, along with anti-coagulant prophylaxis is an effective and safe method for the management of cervical incompe-tency in advanced stages of pregnancy.