Journal of Reproduction & Infertility
Volume:11 Issue: 4, 2010

Infertility is believed to be part of the various medical problems that has increased up to 50% since 1955 in the world and 10-15% of couples are already suffering from it.Development of industrialization and urbanization in human societies have dramatically changed the human life style and led gradually to the increase of various environmental risk factors. Humans are exposed to polluted air, containing harmful elements such as lead, drinking water which is frequently contaminated by different noxious materials like arsenic, chromium, benzene, agricultural water and soil containing pesticides and chemical fertilizers – which subsequently will produce contaminated crops – use of hormones and drugs in animal husbandries and presence of their residues such as steroidal hormones in meat and dairy products, the ever-growing use of synthetics and preservatives in food industry. Furthermore, poor dietary habits and malnutrition, consumption of diets deficient in antioxidants, zinc, selenium and copper, adverse effects of some pharmaceutical products and chemical agents such as ketoconazole and dioxin, daily exposure to harmful radiations such cosmic, ultraviolet and X rays, electromagnetic waves emitted from telecommunication transmitters and cell-phones, physical and psychological stresses in living and working environments, smoking, stationary life-style, obesity, and the increasing age of marriage all are the factors which can directly and indirectly affect human fertility. Although measuring environmental hazards and studying their effect on fertility reduction is difficult due to their multifactorial and diverse nature, the problem still remains indeterminate and more studies are required to draw a strong conclusion. The purpose of this review was to study the effects of environmental risk factors, especially emerging risk factors, on decreasing human fertility.

Cyclophosphamide (CP) is a mustard alkylating agent used in the treatment of some neoplastic diseases such as leukemia, breast and pulmonary cancers. CP administration induces oxidative stress and has cytotoxic effects on normal cells, especially in the reproductive organs. A major side-effect of CP is the alteration of male reproductive function which may result in oligospermia or azoospermia. The aim of the present study was to evaluate the protective effects of vitamin E and ginseng extract on the reproductive system of male rats during cyclophosphamide administration. Fifty-six adult male Wistar rats (220±30 g) were randomly divided into seven groups of eight. To eliminate the stress induced by gavage, the animals in the first group were considered as the control group and only received water and food. The second group received the placebo for CP via gavage. The third group received CP, 6.1 mg/kg/day, through intraperitoneal administration. The fourth and fifth groups, respectively, received Ginseng, 500 mg/kg/day, and vitamin E 100 mg/kg/day via gavage. The eighth group received both antioxidants by intubation 1 h prior to CP administration for 50 days. The animals were sacrificed one day after the last injection. The testes, body weight, sperm parameters and fertility status of animals were evaluated at the end of the experiments. For the evaluation of fertility index, the male rats were mated with untreated female rats on the 40th day of the treatment period. Cyclophosphamide decreased sperm count, lowered fertility rate and decreased testis weight while it increased the number of dead and abnormal sperms (p < 0.01). In addition, the number of pregnant animals and viable offspring were reduced too; while antioxidant use diminished the adverse effects of CP. The results of the study showed that antioxidative agents vitamin E and Ginseng could diminish the adverse effects of cyclophosphamide in the reproductive system of male rats during cyclophosphamide administration.

Etiologically, oxidative stress can be considered as one of the reasons for defective embryonic development which leads to developmental arrest due to necrosis or apoptosis. Under in vivo conditions, multiple mechanisms act to protect the embryo against reactive oxygen species (ROS), but under in vitro conditions most of these mechanisms are absent leading to higher levels of ROS in the culture medium. The objective of this study was to compare the antioxidant effects of Tempol, 4-hydroxy-2, 2, 6, 6-tetramethylpiperidine-1-oxyl, a permeable synthetic antioxidant, on mouse pre-implantation embryonic development in vitro conditions in the presence or absence of oxidative stress. Mature oocytes from mouse were retrieved following ovarian stimulation by the administration of Pregnant Mare Serum Gonadotropin (PMSG) and hCG. Upon in vitro fertilization, the zygotes were cultured in different groups in HTF medium containing 4 mg/ml BSA. To study the effects of oxidative stress on embryo development, the zygotes were cultured for an hour in a medium containing different concentrations of H2O2. After washing, the zygotes were transferred to the culture plate. The zygotes were later placed in the media containing different concentrations of Tempol following their culture in 10 µM H2O2 for one hour to study the effects of different concentrations of the substance in the absence of other oxidative stresses. The data were later compared and statistically analyzed. The pre-implantation embryonic development decreased significantly in the case group, compared to the control group after a short exposure to H2O2, – the effect being more noticeable in higher concentrations. Tempol reduced the impairments resulting from the oxidative stress to some extent. Under in vitro conditions and a concentration of 0.5 µM, Tempol improved embryonic development quality, quantitatively and morphologically. Tempol increased the percentage of two-cell embryos from 91.78% in the control group to 96.99% (p < 0.05), blastocysts from 67.80% in the controls to 81.33% (p < 0.05) in the cases, and significantly decreased embryonic arrest from 32.19% in the controls to 18.67% in the cases (p < 0.05). ROS has a major role in embryonic arrest, witnessed in embryo cultures in vitro conditions. The present study showed that supplementation of embryo cultures with Tempol improved the embryonic development. It seems that addition of permeable synthetic antioxidants, such as Tempol, to embryo cultures could protect embryos from oxidative damage and improve embryonic development.

Laptop computers are known sources of electromagnetic field and as the name implies a number of people use these computers frequently on their laps. To date, there seems to be only reports on the thermal effects of these devices on spermatogenesis in a laptop position. This study aimed to investigate the bioeffects of electromagnetic fields induced by laptop computers on rat spermatogenesis after blocking its thermal effects. Thirty inbred Wistar rats (200–250 g) were randomly divided into a control and three experiment groups. The magnetic field strength of the lap-side of a computer was measured (in an upside down position) at different areas by using a TES 1390 EMF tester and marked it with an appropriate marker. The maximum magnetic field strength was 1.15 µT. Animals in the test groups (21) were kept on the marked area on a thermal shield 7 hours a day for one week. The controls (9) were kept on a switched-off laptop for the same period. Subsequently, the animals were sacrificed and sperm parameters such as count, motility and morphology were analyzed. Non-parametric tests such as Mann Whitney U and Kruskal-Wallis tests were used to compare the results between the experimental groups and the controls. A significant and correlated decrease was seen in sperm motility parallel to the increase in the magnetic field. Sperm motility was divided into four groups (A to D), A exhibiting the highest and D the lowest motility. The relative frequency of group D sperms (immotile sperms) exposed to background, moderate, high and very high magnetic fields were 17%, 31%, 29%, and 68% and the relative frequency of sperm in class C sperms (non-progressive sperms) exposed to background, moderate, high and very high magnetic fields were 52%, 43%, 51% and 16%, respectively. After merging sperms in classes C and D, the relative frequencies of sperms in animals exposed to the background, moderate, high and very high magnetic fields were 69%, 74%, 80% and 84%, respectively. Although, the lowest sperm count was observed in animals exposed to the highest magnetic field but this difference was not significant. There seems that sperm count and motility decrease as the magnetic field strength increases. In this light, magnetic fields induced by laptop computers may decrease sperm count and sperm motility, ultimately affecting male reproductive capabilities. It is advisable to limit the time these devices are used in a laptop position.

Male factors account for nearly 50% of infertilities, among which genetic defects constitute some of the major ones. Microdeletion of the long arm of Y chromosome has been seen in about 7% of infertile men. The importance of these microdeletions lies in the possibility of their occurrence in the off-springs in ART and their de novo appearance. This cross-sectional descriptive-analytical study was performed on 47 individuals with azoospermia or severe oligozoospermia. The cases were recruited when they attended Imam Reza Hospital in Mashad during 2006–2008. Hormone profile, including FSH, was measured and karyotyping, testicular biopsy and Y chromosome microdeletion detection, using 11 pairs of sequence-tagged site (STS method) sets which were specific for AZF and SRY loci, were performed. Three out of four patients with azoospermia had Y chromosome microdeletion (8.5%). Klinefelter's syndrome and deletion of SRY region were each seen in two patients (4.3%). Multiple AZF region deletions were seen in 75% of Y chromosome microdeletions and deletions in AZFa, AZFb and AZFc regions were seen in 25%, 75% and 100% of the cases, respectively. The prevalence of AZF deletion in patients with and without FSH abnormality were 17.6% and 3.3%, respectively, however, the differences were not statistically significant (p = 0.125). In patients with azoospermia and severe oligozoospermia, AZF deletion were 11.1% and 5%, respectively (p = 0.628). In addition, there were no significant differences in AZF deletion between patients suffering from varicocele or other related disease (p = 1.0). Family history had no significant effect on AZF deletion (p = 0.239). Testicular biopsy showed Sertoli-cell-only syndrome in three out of four patients with AZF microdeletions. Male factor infertility is associated with a high incidence of Y chromosome microdeletions and transmission of these defects to the off-springs in ART, aside from their de novo occurrence, seems probable. Therefore, it would be wise to look for microdeletions in cases with severe oligozoospermia or cases with non-obstructive azoospermia. There seems to be a correlation between the prevalence of AZF regional deletions and the degree of spermatogenesis disruption but this finding needs further scientific evidence.

Aplasia of the uterus and upper two-thirds of the vagina due to Mayer–Rokitansky–Kuster–Hauser syndrome prevents normal coitus which may lead to anxiety and other psychiatric problems in these women. Vaginal reconstruction improves the patients’ quality of life. This study intends to compare sexual function in normal women and women having undergone vaginoplasty for Mayer–Rokitansky–Kuster–Hauser syndrome. This descriptive and analytical study was carried out in the gynecologic clinic of Imam Khomeini Hospital in 2004 to 2008. Nineteen female patients with Mayer–Rokitansky–Kuster–Hauser syndrome and a history of vaginoplasty were compared to 30 women without any anatomical malformations in their genitalia. The female sexual function index (FSFI) was used to evaluate the problem in the two groups. The calculated scores of the two groups were compared and statistically analyzed. The mean age of the patients was 29.57 (SD = 6.11) years. The mean score for sexual desire in individuals with a history of vaginoplasty was 22.84 (SD = 2.5) compared to 24.63 (SD = 2.94) in the healthy women (p = 0.033) and the mean score for sexual arousal in women having undergone vaginoplasty was 13.89 (SD = 2.47) compared to 15.27 (SD = 3.41) in the healthy individuals. Sexual arousal, orgasm and pain were not different between the two groups. Sexual arousal and satisfaction were not different in women having undergone vaginoplasty and women with normal sexual function. It seems that the surgery offers a better quality of life and is acceptable to women with Mayer–Rokitansky–Kuster–Hauser syndrome.

Bioethics consists of human conducts that directly and particularly relate to the application of technology in his natural life. Technologies of this kind are distinguished under the title of biotechnology. Biotechnology has indirectly changed the human life through changes made in animal and vegetable lives, while directly affecting his own life too. Therefore, the moral evaluation of biotechnology is very important since the moral perspective is fundamental in light of which other perspectives, such as religious and legal ones, could be interpreted or determined. All aspects of human life – before birth, during his life and after death – fall within the scope of bioethics. These aspects include subject matters such as “infertility treatment”, “abortion”, “organ transplantation”, “human cloning”, “research on human beings”, “vegetable genetic modification”, “animal genetic manipulation”, “concept and criteria of death” and “euthanasia”. In this paper we deal with the scope of bioethics by introducing and analyzing the problems that dominate this field, present and evaluate contending viewpoints in this field, and put forth solutions for a precise approach for the analysis of the problems. Approach to bioethical problems needs to be both free of dogmatism and holistic. Moreover, it is proposed that moral judgements in this field, be presented within a justifiable moral theory whose bases are established at the meta-ethical level, in a clear, sufficient and consistent way.

Reproduction is a natural inclination in human beings. Having a child has become more important for human beings, as they see their eternity and survival in child bearing. However, one may temporarily or permanently remove his natural ability to reproduce. Despite the indirect intervention of governments to enforce family planning policies through taking specific measures, there are many cases in which individuals wish to make themselves infertile due to medical, psychological, cultural, economic or social reasons. Voluntarily reducing or removing fertility potential may be done through various methods. It could be done through a mutually legal consent in a contract with a physician or an unnamed contract between couples or stated as in implied conditions included in marriage or employment contracts. A number of questions may be raised in this regard: Can human beings make themselves infertile and destroy this divine ability, or could this right be regulated? Or how can we integrate autonomy in reproduction and family planning policies? In fact, no one is legally allowed to completely remove one’s freedom to reproduction. However, a partial / a conditional permission for removal is legally possible. After all, it is necessary to clarify and distinguish between general and partial willful removal of one’s reproduction capability, according to the criteria of age and duration of removal. Finally, the aforesaid clarification and distinctions are not always an easy task to make.

Gestational surrogacy is a recent revolutionary subject in assisted repro-ductive technology (ART) with profound effects on religious, legal, ethical and societal matters. Since enacting the law in this matter could efficiently handle challenges and prevent subjective inclinations, the authors of this study wished to suggest the adoption of a particular Iranian law on the subject, regarding the different legal systems worldwide. In this article, effort has been made to conduct a comparison between the Gestational Surrogacy Law of Illinois, USA and some other similar resources with those of Iranian laws and regulations. Surrogacy laws in some countries like India and Australia have been drafted but only in the Illinois, USA it has been signed into law. Drawing a crude comparison between the limited existing laws and regulations on surrogacy reveals small structural differences but a bulk of similarities among them. Despite its novelty and regardless of any specific law, surrogacy practices have been made possible in Iran due to the utilization of common rules and observation of Fatwa issued by clerics in this regard. Aside from religious rules, surrogacy laws meet a rational basis and they have been evolved to address societal needs and seem justifiable enough to be applicable for a general Iranian law preparation.

Infertility bears a painful psychological distress and affected couples’ reaction to it is commonly seen in the form of anxiety, depression, somatization or social dysfunction. The goal of this study was to evaluate the mental health status of the infertile couples referred the Avicenna Infertility Clinic by the General Health Questionnaire-28 (GHQ-28).

In this qualitative study, 400 couples were randomly selected among couples referred to Avicenna Infertility Clinic for infertility work-up and treatment. After signing an informed consent form, each individual filled a questionnaire on demo-graphic characteristics and one for mental health status assessment, the GHQ- 28.

The mean age of the couples (21 to 63 years) was 34  6 years. The prelimin-ary diagnosis of infertility related to gender included 21.9% female, 65.5% male, 7.1% both and 5.4% unexplained causes of infertility. By regarding a cut-off point of 24 for the GHQ-24 questionnaire, 4% of the individuals showed an abnormal score. The abnormal scores were in domains of social dysfunction (43.5%), anxiety (10.9%), somatization (9.5%) and depression (3.3%). Significant statistical difference were seen between male and female participants in total GHQ-28 scores, as well as somatization and depression, (p < 0.05), where the female participants showed worse psychological health states (p < 0.05).

About 4% of the infertile patients attending Avicenna Infertility Clinic seem to be at risk of psychological disorders and provision of psychological health care alongside the medical treatment is advisable.