International Journal Of Fertility and Sterility
Volume:2 Issue: 4, Feb-Mar 2009

Reactive oxygen species (ROS) are involved in physiological functions and act as mediators in various signaling processes. Elevated or sustained generation of free radicals and non radical species derived from free radicals can lead to an imbalance in the intracellular redox homeostasis. Normally, any excess levels of reactive radical and nonradical species generated are intercepted by antioxidants. An excess of the free radicals however, can precipitate pathologies in the female reproductive tract. Oxidative stress (OS) is involved in various pathological conditions such as abortions, preeclampsia, hydatidiform mole, fetal teratogenecity, preterm labor and intrauterine growth retardation, all of which lead to an immense burden of maternal and fetal, morbidity and mortality. In addition evidence suggests that oxidative stress plays a role in the proinflammatory changes seen with polycystic ovarian disease and also in the pathogenesis of endometriosis and tubal factor infertility. Our review captures the role of OS in assisted reproduction specifically in in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) and in vitro maturation of oocytes (IVM). We also examine the role antioxidants play in modifying the fertility outcomes with assisted reproductive techniques. Finally in vivo and in vitro strategies to modulate the influence of ROS and establish an optimal redox state are also discussed.

To compare a flexible, multi-dose GnRH antagonist protocol with a long GnRH agonist protocol in poor responders. A randomized clinical trial of 70 poor responder patients (35 patients in GnRH antagonist protocol and 35 patients in long GnRH agonist protocol) was performed at Royan Institute, Tehran, Iran. Both groups were given a fixed dose of human menopausal gonadotropin (HMG) for stimulation and oral contraceptive pre-treatment. Data analyzed by student’s group t-test or Chi square test. Stimulation duration, total gonadotrophins consumption, mean numbers of oocytes retrieved, formed embryos, cycle cancellation rate, and clinical pregnancy rate were similar between both groups. Although the miscarriage rate was higher in the agonist protocol group, the rate of miscarriage was not statistically significant between both groups. A flexible, multi-dose GnRH antagonist protocol appears as effective as the long GnRH agonist protocol in poor responders. More (larger) randomized controlled trials for better statistical analysis are recommended.

Implantation failure is the most important cause of recurrent in vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) failure. Several reports suggest that intercourse during the peritransfer period might improve pregnancy rates. This study is designed to determine whether intercourse during the peritransfer period will improve pregnancy and implantation rates in patients undergoing IVF or ICSI. In a randomized control trial study, 390 women with at least five years infertility were evaluated. In the study group, 195 patients had intercourse at least once 12 hours after embryo transfer. Implantation and clinical pregnancy rates were compared with 195 patients in the control group who had no intercourse for the entire assisted reproductive technology (ART) cycle. Implantation rate in the study group was 6.5% in comparison with 5.5% for the control group. Clinical pregnancy rates were not significantly higher in study patients when compared to the control group (14.2% and 11.7% respectively). The results showed that intercourse during the peritransfer period can not increase pregnancy outcome.

In vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI) are recognized as established and increasingly successful forms of treatment for infertility, yet significant numbers of couples discontinue treatment without achieving a live birth. This study aims to identify major factors that influence the decision to discontinue IVF/ICSI treatments.

We studied the data of 338 couples who discontinued their infertility treatments after three cycles; based on medical records and phone contact. The main measure was the reason for stopping their treatments.

Economical problems were cited by 212 couples (62.7%), as their mean income was significantly less than other couples (p<0.0001). Lack of success was reported as a reason by 229 (67.8%), from whom 165 (72%) also had economical problems. Achieving independent-ART pregnancy was the reason for discontinuation in 20 (5.9%) couples. Psychological stress, depression and anxiety were reported as other cessation factors by 169 (50%), 148 (43.8%) and 182 (53.8%) couples, respectively.

This survey suggests that the most common reasons for assisted reproductive technique (ART) discontinuation after three cycles are: prior unsuccessful cycles, economical and psychological problems. Therefore, the substantial proportion of couples could benefit from psychological intervention, increasing awareness of ART outcomes and health funding to cope more adequately with failed treatments.

The purpose was to investigate the effect of the duration of gamete incubation on fertilization rate, embryo cleavage, and embryo quality before and after freezing in mice. Ovulated oocytes collected from superovulated mice after ip injection of PMSG and hCG were divided randomly into control and experimental groups. Oocytes from the control group were inseminated for six hours and the experimental group were inseminated for one hour, respectively. The differences in fertilization rates, embryo cleavage and percent of good quality embryos in four grades (A, B, C, D) were analyzed. Finally, two cell embryos were frozen; and after thawing, the quality of embryos from the two groups were compared. There was no difference between the two groups in regards to fertilization and cleavage rates. However, the proportion of grade A embryos was significantly higher among the experimental group (41.7%) when compared to the control group (19%). Also the proportion of grade D embryos was significantly (p=0.04) lower in the experimental group (8.3%) as compared to the control group (23.8%). In addition, percentage of good quality embryos in the experimental group did not decrease after freezing (p=0.3), however the percentage of good quality embryos were significantly decreased after freezing in the control group (p=0.01). Insemination of oocytes for a short period produced embryos of superior quality than insemination for a longer period in the experimental group. Also, the effect of freezing on embryos produced from short insemination was less than the long insemination period. After freezing, a higher percentage of good quality embryos survived post thawing in mice.

Infertility may have many emotional and psychological implications on infertile couples. So far, different methods for reducing anxiety in infertile couples have been evaluated. The goal of this study is to evaluate the effect of provision of information regarding infertility treatment to infertile couples on their anxiety levels. This study was conducted as a before and after clinical trial. Forty-two individuals were considered as cases and 40 as controls. In order to evaluate anxiety and depression in participants, the Hamilton Anxiety and Depression Scale (HADS) questionnaire was used. The intervention group received information about infertility treatment through a two hour face-to-face meeting and was provided with a brochure. Anxiety level was assessed at the time of admission, immediately after the session and two weeks later. Assessment was performed twice for the control group; once at the time of admission and secondly, two weeks later. Our results show that receiving information about infertility treatment significantly decreases anxiety among infertile couples two weeks post-training. This decline does not have a significant correlation with age, sex, education level of the couple, and neither with the duration nor the cause of infertility. Providing information does not have any significant effect on the rate of depression among couples. It is recommended that provision of information regarding infertility treatment methods should be considered as a means of decreasing anxiety among infertile couples who refer to infertility treatment centers.

Infertility is one of the most common and important subjects in today’s obstetrics and gynecology. Immunological factors such as the presence of antisperm antibodies (ASA) are challenging etiologies for infertility. This study was performed to determine the correlation between the type of sexual practices (oral‚ anal and vaginal during menstruation) and the ASA levels in semen and in the sexual partners’ serum.

In this analytic cross sectional study which was performed in Royan Institute between 2005-2007‚ the type of sexual behaviours was determined in 51 couples with primary or secondary infertility. The ASA level was determined in both sexual partners’ blood serum and in the semen‚ using the Sperm Mar Test kit.

Using statistical analyses‚ there was no significant difference between the types of sexual practices (anal‚ oral‚ vaginal during menstruation) and the prevalence and level of ASA.

Based on the results of this study, the prevalence and level of ASA has no significant correlation with the types of sexual behaviours (anal‚ oral‚ vaginal during menstruation).

Chlamydia trachomatis infections are the most prevalent sexually transmitted bacterial infections (STI) in the world that lead to a cause of tubal factor infertility in women. The aim of this study is to determine the presence of C.trachomatis by polymerase chain reaction (PCR) and ELISA.

Endocervical swabs were collected from 80 women; 22 of them were asymptomatic and 58 symptomatic. Samples were examined by PCR designed to detect Chlamydial plasmid using specific KL1 and KL2 primers. Serum IgG and IgA antibodies to C.trachomatis were detected by ELISA. Since elevated CRP levels are a marker for inflammation, the presence of C- Reactive protein (CRP) has also been evaluated in all samples.

The rate of C.trachomatis infection by PCR was revealed to be 27.2% and 18.9% in asymptomatic and symptomatic women, respectively The χ2 test shows no significant difference (p value= 0.22). Serological screening was done on all samples. The high level of IgG and IgA to C.trachomatis infection was 29.4% and 17.6%, respectively. The presence of high levels of CRP, as a serological marker of persistence infection, was 31.8% and 34.4% in asymptomatic and symptomatic women, respectively. The high rate of CRP level in the samples indicates acute infections in both groups.

Genital C.trachomatis infection is the leading cause of tubal factor infertility. The present study shows that C.trachomatis infection could be present in symptomatic as well as asymptomatic women. Therefore, a screening test for C.trachomatis infection is recommended for all women who refer to gynecologic outpatient departments in Isfahan and other parts of Iran.