International Journal of Reproductive BioMedicine
Volume:6 Issue: 3, Feb 2008

One of the major and life-threatening side effects of Assisted Reproductive Technique (ART) is ovarian hyperstimulation syndrome (OHSS). The available data however, have been showed that both Cabergoline (anti VEGF) and coasting reduce the severity of OHSS.

We aimed to compare coasting and Cabergoline administration in prevention of severe OHSS.

A total of 60 IVF/ICSI cycles were selected. Patients at risk of developing OHSS were divided into two groups as patient''s convenience. For 30 patients in coasting group, exogenous gonadotropins were withheld to allow E2 to decrease while GnRH-a was maintained. Then 10,000 unit hCG was administrated and oocyte retrieval was performed 36 hours later. In Cabergoline group, 30 patients were administered with 0.5mg Cabergoline tablet on day of hCG injection, continued for 8 days.

The mean number of retrieved, good quality, mature oocytes and the mean number of embryos were significantly different in two groups (p<0.05). The clinical pregnancy rate was 13.3% in coasting and 26.7% in Cabergoline group that was not significantly different (p>0.05). The incidence of severe OHSS was similar in two groups.

The Cabergoline was as effective as coasting in the prevention of early severe OHSS in high risk patients, but yielded more retrieved oocytes.

Cytogenetic analysis, Y-chromosome microdeletion screening, FISH techniques and other genetic methods have helped in finding the causes of infertility in azoospermic or severe oligoazoospermic cases in the last decade.

In the present study, we characterized an abnormal Y-chromosome, detected as a mosaic in an azoospermic male ascertained for infertility.

Chromosome analysis, using G, Q and C banding techniques and FISH analyses with several different DNA probes specific for Y and X chromosome sequences [XY centromeric α-satellite, Y non-α-satellite III, LSI-probes of the Y chromosome, WCP of Chromosome Y, SRY gene, subtelomeric Xp and Yp, which cover the SHOX (short stature-homeobox containing) gene, and subtelomeric Xq and Yq probes] were performed. A total of 20 sequence tagged sites were analyzed using primer sets specific for the Y-chromosome microdeletion loci. The primers were chosen to cover AZFa, AZFb, and AZFc regions as well as the SRY gene.

Chromosome analysis revealed a gonosomal mosaicism of monosomy X (51%) and a pseudodicentric Y (49%) chromosome: mos 45, X/46,X psu dic (Y) (qter→p11.32: : p11.2→qter). Molecular genetic studies did not show deletions in the AZFabc regions, but a deletion was found in the short arms of the dicentric Y chromosome. One of the SRY genes was also missing.

The azoospermia in this patient could be explained by either the presence of an abnormal Y-chromosome that cannot form a sex vesicle (which appears to be necessary for the completion of meiosis process and the formation of sperm), or the presence of the 45, X cell line.

Reactive oxygen species (ROS) are a group of free radicals that in excessive amounts have negative influence on sperm quality and function.

To study the effect of varicocele and its severity on the level of ROS in infertile men with clinical varicocele.

In this controlled prospective study, 42 men with clinically diagnosed left varicocele and 30 fertile men were studied. Patients were asked about history of urogenital infection, using any antioxidant medication and smoking. Grade of varicocele was determined by physical examination. Levels of ROS in seminal plasma were measured in each group by a chemiluminiscence assay. The sperm parameters were also determined and compared in different groups.

The ROS levels were significantly higher in patients with varicocele than normal men (mean: 1575.42 RLU (Radio Luminescence Unit) vs. 53.79 RLU, p=0.005). In total 20 patients had grade I, 20 patients grade II and 2 patients had grade III varicocele. The mean ROS levels were 669.12 RLU, 2406.87 RLU and 2324 RLU in patients with grade I, II and III varicocele respectively (p=0.144). In case group, 15 patients were smoker and 27 were non-smokers. The mean ROS levels in patients with the history of smoking was 1367.71 RLU while in non-smokers it was 897.672 RLU (p=0.729).

Our study showed that increased levels of ROS production in the seminal fluid can be an important factor in the etiology of male infertility in patients with varicocele, and this effect is more prominent with higher grade of varicocele.

Ciprofloxacin is a commonly prescribed antibiotic in the treatment of genitourinary tract infection.

The aim of this study was to investigate the effects of ciprofloxacin on testis apoptosis and sperm parameters in rat.

Twenty male Wistar rats were selected and randomly divided into two groups; control (n=10) and experimental (n=10). The experimental group was orally received 12.5 mg/kg ciprofloxacin daily for 60 days and the control group just received water and food. Rats were then killed and sperm removed from cauda epididymis and analyzed for sperm motility, morphology, and viability. Testis tissues were also removed and prepared for TUNEL assay to detect apoptosis.

Results showed that ciprofloxacin significantly decreased the sperm concentration, motility (p<0.05) and viability (p<0.001). In addition, ciprofloxacin treatment resulted in a significant decrease in the number of spermatogenic cells (spermatogonia, spermatocyte, spermatid and sperm) in the seminiferous tubules when compared with the control group. The apoptotic germ cells per seminiferous tubular cross section was significantly increased in the experimental group (15.11±3.523) as compared with the control group (7.3±0.762) (p<0.05).

It is concluded that ciprofloxacin has the toxicological effects on reproductive system in male rats

Men are unavoidably exposed to ambient electromagnetic fields (EMF) generated from various electrical gadgets and from power transmission lines. Prostate gland plays an important role in secretion of semen as largest accessory gland of male reproductive system. It seems that protection of this gland against EMF is important in spermatogenesis process.

The goal of this study was to investigate the effect of non ionizing radiation on ultra structure of prostate gland.

In total 50 male and 50 female rats, aged 15 weeks, were mated in animal house of Tabriz University of Medical Sciences. Then among born rats, 20 randomly were chosen as control and 30 were randomly chosen for exposure to EMF. They were exposed to 50 Hz EMF (8 M.T.) during in utero development (approximately 3 weeks) and postnatal life (5 weeks). Samples of prostate gland were processed and observed under light and transmission electron microscope.

In the experimental group, the secretory epithelial cells were generally inactive and cuboidal and their nuclei were dense with more corpus amylace compared to the control. Smooth muscle fibers spread out in different directions with heterochromatic nuclei. Mitochondria seemed without cristae and electron opaque.

The results indicate that EMF had a deleterious effect on ultra structure of prostate gland in rat.

Misoprostol, a prostaglandin E1 analogue compared to prostaglandin E2, has the advantage of being inexpensive and stable at room temperature, with its proven efficacy and safety. However studies on the effect of pH on the efficacy of misoprostol have yielded conflicting results. Thus its use in the induction of labour in patients with premature rupture of membrane requires further investigation.

To evaluate the safety and efficacy of misoprostol in induction of labour in Nigerian women with prelabour rupture of membrane after 34 weeks of gestation.

Three hundred and forty six Nigerian women with prelabour rupture of membrane who consented to participate in the trial were randomised into two arms of misoprostol and oxytocin. Labour was managed with WHO partograph. The primary outcome was the caesarean section rate and induction vaginal delivery interval.

The mean induction to vaginal delivery interval was significantly shorter in the misoprostol arm (504 mins) compared to 627 mins in the oxytocin arm (t=3.97; p=0.005). The caesarean section rate of 18.1% among the misoprostol arm was also significantly lower than the 41.4% recorded in the oxytocin arm (p=0.002). Among patients with Bishop score greater than 6 there were no statistically significant differences between the two groups in the outcomes measured.

Misoprostol is not only effective but also safe when compared with titrated oxytocin in Nigerian parturients with prelabour rupture of membrane after 34 weeks

There is increasing evidence that psychological factors like anxiety and depression can affect IVF/ICSI treatment results.

This study aimed to clarify the role of women’s anxiety and depression on the outcome of ART cycles using Intra Cytoplasmic Sperm Injection (ICSI).

This was a prospective pilot study. One hundred six (106) consecutive women undergoing ICSI cycles were enrolled between January 2006 and 2007. Age, duration and cause of infertility, number and score of transferred embryos were recorded for each patient. Data regarding the state of anxiety and depression of each volunteer were collected using the translated and validated Iranian Cattle Anxiety and Beck Depression Inventories.

Among 106 women enrolled in the study, 25 cases (23.5%) of clinical pregnancies occurred. In univariate analysis, there was no significant difference regarding age and cause and duration of infertility between groups. Number of transferred embryos was significantly associated with higher pregnancy rates (3.4± 1.15 vs. 2.5±1.38 in pregnant and nonpregnant group respectively). Among the 106 participants, 73.58% had anxiety and 30.18% showed various degrees of depression. Out of 28 patients with no anxiety, 21(75%) and out of 74 patients with no depression, 24(32%) became pregnant. There was significant association between depression/anxiety and pregnancy rate (p=0.034 and p=0.00 respectively). Logistic regression model showed that anxiety/depression affect the outcome of ART significantly.

It is crucial to identify infertile patients at greater demand for psychological support before starting ART cycles.

Recent studies have showed conservative management in selective patients with borderline and malignant ovarian tumors is safe; therefore this management is considered in patients with ovarian tumor who desire to preserve fertility.

This study has been performed to evaluate the clinical outcome and fertility in patients with ovarian tumors who were treated conservatively.

All patients who were treated conservatively (preservation of uterus and at least one ovary) or were on follow-up and had recurrence were evaluated in Vali-e-Asr Hospital during 2000-2004.

Among 410 patients with ovarian tumors, 60 were treated conservatively. Age range was 13-34 years. Twenty-six of patients (43.3%) were desired pregnancy and 34 (56%) patients did not. Three (5%) patients had history of infertility. Histological types of tumors were as follows; 15(25%) borderline tumors, 10(16.7%) epithelial tumors, 26(43.3%) germ cell tumors, and 9(15%) sex cord tumors. Range of follow-up time was 12-48 months. Seven term pregnancies in 6 patients had been occurred, 1 in epithelial group, 2 in germ cell group, 1 in sex cord group and 3 in borderline group. Nine patients had recurrence and 2 patients expired, including one patient with serous cyst carcinoma (Stage IIIC).This patient had refused radical surgery and referred to our center with recurrence. Another patient had immature teratoma (Stage IIIC).

Conservative surgical management in young patients with stage I (grade 1, 2) of epithelial ovarian tumor and sex cord-stromal tumor and in patients with borderline and germ cell ovarian tumors could be performed in order to preserve fertility.

Many azoospermic patients with non obstructive azoospermia (NOA) are candidate for testicular sperm extraction (TESE) and in vitro fertilization. Because sperm might be present in some but not all parts of the testes of such men, multiple sampling of testicular tissue are usually necessary to increase the probability of sperm finding. Sperm finding can be done by two

1) classic histopathology and 2) wet smear.

Comparative study of pathology and wet smear methods for discovering sperm in testis biopsy of azoospermic men.

We prospectively studied 67 consecutive infertile men who referred to Fatemieh Hospital, Hamedan, Iran between April 2002 and September 2004. All patients were either azoospermic or severely oligozoospermic. They underwent intraoperative wet prep cytological examinations of testis biopsy material and then specimens were permanently fixed for pathologic examination too.

Among the 67 testes that underwent wet prep cytological examination, 44 (65.7%) were positive and 23 (34.3%) had no sperm in their wet smear. On the permanent pathologic sections, 19 (28.4%) were positive and 48 (71.6%) cases were with no sperm in their sections. Among all the individuals 18 (26.8%) were negative in both studies, while 14 (20.8%) had minimum 1 sperm in their smears in both examinations. The positive cases in wet prep cytological examination were significantly more than the cases in the permanent histopathologic sections (p-value=0.000).

It seems that wet prep cytological examination is more reliable than permanent histopathologic sections in detecting sperm in testis biopsy of azoospermic men.

Spontaneous ovarian hyperstimulation syndrome rarely occurs during pregnancy and is usually associated with high levels of human chorionic gonadotropin, in conditions such as molar or multifetal pregnancies.

Case report:

 Here we report spontaneous ovarian hyperstimulation in a patient presenting with missed abortion at 16th week of gestation, when serum ß-subunit human chorionic gonadotropin level detected to be 400 milliunit per milliliter. Evacuation and curettage was performed and the ovaries returned to about normal size two months later.

Spontaneous ovarian hyperstimulation syndrome can develop even in the presence of very low levels of hCG in missed abortion.