International Journal Of Fertility and Sterility
Volume:3 Issue: 1, May-Jun 2009

s article provides an overview of international developments in the area of infertility counselling. It informs about the development of international organizations and relevant professional standards and describes the need to make counselling accessible to all patients, especially those who experience great distress or display previous vulnerability. Whereas in previous years counselling focused on psychopathology; research shows that on average, men and women experiencing infertility are as healthy as others. Therefore, the aim of counselling is to reduce the emotional burden of infertility, help couples to consider the implication of family building alternatives and provide therapeutic care where relevant. In some instances, counsellors also have the task to carry out psychological assessments. For the sake of transparency, it is important to clearly differentiate between these two interventions. Last but not least, this article argues that much of our current knowledge is based on research carried out in Western societies, therefore lacking understanding and appreciation for the meaning of infertility in other cultures. Therefore we need more international debate across cultures to further our understanding and to honor different cultural values.

Chromomycin A3 (CMA3) staining has been used to assess protamine deficiency. The aim of this study was to determine credibility of CMA3 along with semen parameters for assessment of fertility potential. Semen analysis and CMA3 staining were carried out on 234 fertile and 178 subfertile individuals. Semen analysis was assessed according to WHO criteria. Protamine deficiency was assessed by CMA3 staining. Means, range of variables, coefficients of correlation and receiver operating characteristic (ROC) analyses of semen parameters and protamine deficiency were determined. Mean values of three main sperm parameters and the percentage of sperm with negative CMA3 were significantly different between fertile and sub fertile groups. The results of CMA3 assessment showed significant correlation with sperm density, percentage of motility and normal morphology in the total population, while in the subfertile group the results of CMA3 showed significant correlation with sperm density and normal morphology. However in fertile men, the only significant correlation was observed between sperm with negative CMA3 and normal morphology. ROC analyses revealed that CMA3 staining has a higher potential to predict fertility status, compared to semen parameters. Assessment of protamine deficiency could be considered as one of the complementary tests along with semen analysis for assessment of fertility.

Imatinib mesylate, a small-molecular analog of adenosine triphosphate (ATP) that potently inhibits tyrosine kinase activities of Bcr–Abl, PDGFR-β, PDGFR-α, c-Fms, Arg and c-kit, is one of the novel molecularly targeted drugs being introduced into cancer therapy. We tested the effect of imatinib on the ovarian histological structure and the concentration of estrogen and progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) in the serum of female Wistar rats. Two groups of rats (180 ± 15 grams) were gavaged with doses of 50 and 100 mg/kg body weight imatinib dissolved in distilled water for 14 days. The control group received sterile water. On day 7, after termination of the treatment, blood serum concentration was measured with the radioimmunoassay (RIA) method. Also, sections (5 μm thick) of ovaries stained with hematoxylin and eosin (H&E) were investigated histologically. Progesterone concentration in the experimental groups was increased (p<0.001), estrogen and FSH concentrations were decreased (p<0.01), and the LH concentration decreased but was not statistically different in comparison with the control group. The weight of ovaries and number of atretic follicles in the experimental groups was increased compared with the control group (p<0.05). The diameter of corpus lutea were increased but the number of corpus lutea decreased in both experimental groups (p<0.01). These findings suggest that administration of imatinib may have profound effects on female fertility.

For patients undergoing in vitro fertilization, lower pregnancy rates are observed in the presence of uterine cavity anomalies and correction of these anomalies has been associated with improved pregnancy rates. Office hysteroscopy has been proven to have superior sensitivity and specificity in evaluation of the endometrial cavity. Diagnostic hysteroscopy can be performed in an office with minimal discomfort and at a much lower cost than in an operating room. Our study was done to evaluate the importance of office hysteroscopy in diagnosis of pathology in normal appearing infertility work up. This study was performed from September 1, 2006 till September 1, 2008 at Imam Khomayni hospital, Ahwaz, Iran. All infertile patients who had unexplained infertility or uterine factor infertility were enrolled in the study and underwent office hysteroscopy. The participants were divided into two groups. Group one was composed of 54 patients with unexplained infertility and group two was composed of 53 patients with abnormal vaginal sonography or hysterosalpangography. Of the 54 patients with unexplained infertility; 33 patients (61.2%) had normal and 21 patients (38.8%) had abnormal hysteroscopic findings. Among 53 patients in the uterine factor group, there were 7 women (13.3%) who had a normal hysteroscopy and abnormal sonography or hysterography. In group one (unexplained infertility), there was a 38.8% positive finding in office hysteroscopy in spite of normal hysterosalpingography and sonography results. Therefore, it seems that office hysteroscopy should be a part of a routine work up in infertile patients.

The aim of the present study was to investigate the role of progesterone on the developmental competence of cumulus-oocyte complexes (COCs) and cumulus-denuded oocytes (CDOs) at germinal vesicle (GV) stage. GV oocytes of pregnant mare''s serum gonadotropin (PMSG)-primed prepubertal mice were divided into two groups: CDOs and COCs. The oocytes were cultured in TCM199 with different concentrations of progesterone (10, 38, 50 and 100 μM) and without progesterone (controls). The number of oocytes at the GV, germinal vesicle breakdown (GVBD) and metaphase II (MII) stages were counted. In vitro fertilization (IVF) of MII oocytes and their development to the blastocyst stage were evaluated. Significantly different MII rates were observed between the COCs (85%) and CDOs (68%) control groups. The MII rates of 83%, 48%, 14% and 0% for COCs and 65%, 53%, 20% and 0% for CDOs were obtained in TCM199 that contained 10, 38, 50 and 100μM progesterone concentrations, respectively. These MII rates were lower (p<0.05) in both COCs and CDOs as compared to their respective control groups, except for 10 μM. The fertilization and blastocyst rates of COCs (83% and 35%, respectively) were higher (p <0.05) than those of the CDOs (51% and 5%, respectively) control groups. The fertilization and blastocyst rates in the presence of 10 μM (81% and 36%, respectively) and 38 μM (85% and 30%, respectively) progesterone in COCs and CDOs (52% and 4% for 10 μM; 56% and 4% for 38 μM) were similar to their respective control groups. Adding progesterone to the medium could not improve maturation of mouse GV oocytes and their development to the blastocyst stage.

Despite a high prevalence of endometriosis, there still exist many challenges in diagnosing the disease. This study aims to evaluate non-invasive and practical diagnostic methods by measuring serum and peritoneal fluid CA 125 levels in patients with endometriosis. A secondary aim is to determine the correlation between these markers with the stage of disease as well as the relationship of the two markers with each other. This is a cross-sectional study of 60 women who underwent laparoscopy for benign conditions. Based on laparoscopic findings and biopsy results, patients were divided to two groups; one group included patients with pelvic endometriosis (35 patients) and the second enrolled patients free from endometriosis (25 patients). Serum and peritoneal fluid specimens were provided at the time of laparoscopy and CA125 levels were then assessed by electrochemiluminescence immunoassay. Mean serum and peritoneal fluid CA125 levels were significantly higher in women with endometriosis as compared to the control group (26.42 ± 24.34 IU/ml versus 12.64 ± 6.87 IU/ml in serum and 2203.54 + 993.19 IU/ml versus 1583.42 ± 912.51 IU/ml in peritoneal fluid, p<0.05). CA 125 levels also varied proportionally with the stage of endometriosis; but showed a significant difference only in higher stages of the disease, both in serum and peritoneal fluid. We calculated the cut-off value suggesting a diagnosis of pelvic endometriosis as 14.70 IU/ml for serum and 1286.5 IU/ml for peritoneal fluid CA125. A linear correlation between CA 125 levels in serum and peritoneal fluid in patients with pelvic endometriosis has also been observed. Serum and peritoneal fluid CA 125 levels are simple and non-surgical tools for diagnosing and staging pelvic endometriosis. These markers are of greater diagnostic value in higher stages of the disease.

Coasting is the most common method used in the prevention of ovarian hyperstimulation syndrome (OHSS) acting through vascular endothelial growth factor (VEGF) reduction. However, the pregnancy rate is reported to fall with coasting when it takes more than three days. Recently lowdose cabergoline, a selective D2 dopamine receptor agonist has been proven to selectively reduce vascular permeability without affecting angiogenesis and seems to be able to decrease the rate of OHSS without affecting pregnancy rate. This clinical trial was performed on 60 women in assisted reproductive technologies (ART) cycles at risk of OHSS, having at least 20 follicles in their ovaries (mostly ≤14mm) and a serum estradiol level ≥3000pg/mL. Patients were divided into two equal groups. In group A, oral cabergoline 0.5 mg/day was given for seven days after hCG administration; while in group B gonadotropin administration was halted until serum estradiol levels reached less than 3000pg/mL before hCG administration. The main outcome measurements compared were rates of pregnancy and severity of OHSS. Total number of oocytes, metaphase II oocytes, fertilization and clinical pregnancy rates were higher in group A (p<0.05). Severe OHSS was not found in either group. Moderate OHSS was seen in one subject in the cabergoline group versus seven in the coasting group. Cabergoline seems to be a safe drug for prevention of moderate-severe OHSS.

The rate of multiple pregnancy has dramatically increased during the past decades, along with the diffusion of assisted reproduction technology (ART). Multiple pregnancy entail an increased risk of, at times life threatening, maternal complications i.e. pre-eclampsia, eclampsia or abruptio placenta, of serious neonatal hazards, i.e. extreme prematurity or growth retardation, as well as deleterious impact on family and social life. It raises the ethical debate of fetal reduction. The international federation of gynaecologists and obstetricians (FIGO) recommendations on iatrogenic multiple pregnancy emphasizes the need for the transfer of a limited number of embryos during ART in order to secure a singleton pregnancy.