International Journal of Reproductive BioMedicine
Volume:9 Issue: 2, Feb 2011

The use of antioxidants in the treatment of infertility has been suggested and recent studies have indicated that oral administration of Satureja Khuzestanica essential oil (SKEO) to rats induces significant antioxidative effects. This systematic review was conducted to evaluate the effectiveness of antioxidants in infertility and also to assess the effectiveness of Satureja Khuzestanica in infertility management. Pubmed, Scopus, and Cochrane Library were searched for relevant trials published from respective database inception dates to August 2010. Study selection, and data extraction were performed by authors. Fifteen trials on evaluation of antioxidants in infertility and seven studies on the effectiveness of Satureja Khuzestanica were identified. Only 4 of the 15 trials were with application of allocation concealment and three studies were done in in-vitro environment. Despite the methodological and clinical heterogeneity of the trials, 14 of the 15 (93.33%) trials showed an improvement in either sperm quality or pregnancy rate after antioxidant therapy. The human and animal studies of Satureja Khuzestanica showed a significant antioxidative potential of the plant and its effectiveness for infertility improvement. The use of oral antioxidants in infertility could improve sperm quality and pregnancy rates. Improved fertility observed by SKEO in rats might be due to its antioxidative effect. Further studies and clinical trials in humans are necessary to evaluate SKEO effectiveness in fertility disturbances.

Previous studies have shown that morphine consumption during pregnancy may delay embryo development or cause abnormal nervous system function. The present study focused on the effect of maternal morphine consumption on development of placenta and blood corticosteron concentration in addictive pregnant mothers. 24 female rats, 170-200g weight, were used. The experimental groups after pregnancy received an oral dose of 0.05 mg/ml of morphine by tap water while the control group received only tap water. On 10th and 14th day of pregnancy, rats were anesthetized and placenta removed surgically, 1ml blood was collected from each pregnant mother from retro-orbital sinus, the concentration of blood corticosteron was determined by corticosteron Elisa kit after centrifugation. The fixed tissue was processed, sectioned and stained with hematoxylin and eosin. Placenta was studied microscopically according to the thickness of layers, area of blood cisterns, and the number of cells. Comparing the plasma corticosteron concentration of the treatment and the control groups, not only a severe increase in the treatment group was detected, but also the thickness of maternal and embryonic portions of the placenta at day 10th and 14th of gestation was different significantly (p?0.05). Furthermore, an increase in number of cells in maternal and embryonic portion of placenta and a decrease in blood cistern area were demonstrated in both the experimental and the control groups. The effects of morphine, including an increase in blood concentration of corticosteron, in dependent pregnant mothers were seen. Development of placenta in the experimental group was delayed.

Family planning has been defined in the framework of mothers and children plan as one of Primary Healthcare (PHC) details. Besides quantity, the quality of services, particularly in terms of ethics, such as observing individuals’ privacy, is of great importance in offering family planning services. A preliminary study to gather information about the degree of medical ethics offered during family planning services at Tehran urban healthcare centers. A questionnaire was designed for study. In the first question regarding informed consent, 47 clients who were advised about various contraception methods were asked whether advantages and disadvantages of the contraceptive methods have been discussed by the service provider. Then a certain rank was measured for either client or method in 2007. Finally, average value of advantage and disadvantage for each method was measured. In questions about autonomy, justice and beneficence, yes/no answers have been expected and measured accordingly. Health care providers have stressed more on the advantages of pills and disadvantages of tubectomy and have paid less attention to advantages of injection ampoules and disadvantages of pills in first time clients. While they have stressed more on the advantages and disadvantages of tubectomy and less attention to advantages of condom and disadvantages of vasectomy in second time clients. Clients divulged their 100% satisfaction in terms of observing turns and free charges services. Observance degree of autonomy was 64.7% and 77.3% for first time and second- time clients respectively. Applying the consultant’s personal viewpoint for selecting a method will breach an informed consent for first and second time clients. System has good consideration to justice and no malfeasance.

Aloe vera (Aloe barbadensis miller) is an evergreen perennial plant widely used in modern herbal practice and is often available in proprietary herbal preparations. This study was designed to investigate the semen picture and spermatozoa morphology of West African Dwarf (WAD) bucks treated with Aloe vera extract. Twelve sexually matured WAD bucks, weighing between 11 and 15 kg, were used for the study. The bucks were first used as control (pre-treatment) and later as two groups of six animals each. The first six bucks received 10 mls of the 3% extract while the other six received 10 mls of the 4% of the extract for a 7 day period. Semen was collected from both the 3 and 4% extract treated bucks for the control (pre-treatment), on days eight (first week post-treatment) and fifteen (second week post-treatment) in each case using the electroejaculation method. The spermiogram of the bucks were investigated using standard procedures. Data obtained were analyzed using two way ANOVA and significance reported at p<0.05. The continuous administration of Aloe vera extract significantly (p<0.05) reduced sperm concentration, motility and percentage livability and resulted in increased sperm abnormalities in the WAD buck. Aloe vera adversely affected the spermiogram of bucks. The plant can reduce fertility in male animals and is therefore not recommended for medicinal purpose in male animals especially those used for breeding.

Successful rehabilitation of cardiac surgery patients should include consideration of their sexual activity, but there is paucity of data regarding this matter. This study determined the incidence and type of sexual dysfunction in our patients. Two hundred-seventy nine men with age under 70 years old who had coronary artery bypass graft (CABG), valvular, or other types of cardiac surgery from Dec. 2006 until Dec. 2007 were enrolled in this descriptive-analytical study. They were interviewed before and 12 weeks after the operation in regard to the impact of surgery on their sexuality. The statistical methods used included analysis of variance, Kappa test, and chi-square analysis. The mean age of the patients was 55.7 ± 10.66 (25-69) years. The incidence of sexual dysfunction was 20.1% before, and76.4%, 12 weeks after the operation. P-valueas tested by Kappa test was 0.0001, which means that cardiac surgery had adverse effect on sexual activity of the patients. Types of sexual dysfunction were impotence, premature ejaculation, and decreased or loss of libido in 6.5%, 4.3% and 9.3%, respectively before operation, and 34.8%, 21.5% and 20.1%, respectively 12 weeks after the operation. Concurrence of more than one dysfunction was not reported. Sexual dysfunction is common after cardiac surgery, and sexual counseling is still not being addressed adequately. The role and responsibility of the physician and the rehabilitation nurse becomes evident, together with the need for the patient’s partner to participate in counseling.

For infertile women aged over 35 years, failure of the ZP (zona pellucida) to rupture is believed to be associated with a decreased implantation rate in in vitro fertilization (IVF) or intra cytoplasmic sperm injection (ICSI). In this research, laser assisted hatching (LAH) was offered to patients with advanced maternal age to evaluate a possible benefit. Nine hundred thirty two cycles of IVF/ICSI in females were analyzed. Women included in this study were allocated in 4 groups. In group I and II, embryos were cultured and transferred with and without LAH in women aged? 35, whereas embryos of group III and IV were examined with and without LAH in women aged? 35. Laser manipulations were performed using a suturn – Tm3 system using 2-3 pulses of 0.8 millisecond with 400 voltage duration. The size of the hole made in the zona was measured to be 5-10 µm, depending on the zona thickness of each individual embryo. The performance of LAH significantly increased clinical pregnancy rates in all patients. In group I and II, the chemical (50.99% and 31.61% respectively), clinical (50% and 30.69% respectively) and multiple pregnancies (22.27% and 5.94% respectively) significantly differ between these groups. In the patients with advanced female age? 35 the performance of LAH significantly increased chemical (30.12%) and clinical pregnancy (27.71%) rates compared to whom without LAH (18.96% and 16.37% respectively). Our data demonstrate in the patients who were less than 35 years old, multiple pregnancy rates were significantly increased compared to other groups who aged over 35 years old. In addition benefit of LAH in improving pregnancy rates after IVF or ICSI in women of advanced age (? 35) was shown.

Infertility is a major psychosocial crisis as well as being a medical problem. The factors that predict psychosocial consequences of infertility may vary in different gender and different infertile populations. The primary purpose of this study was to investigate whether Turkish infertile couples had higher levels of depression and anxiety when compared to non-infertile couples. Our secondary aim was to evaluate the relationship between sociodemographic characteristics and levels of depression and anxiety in Turkish infertile couples. We designed a descriptive cross sectional study of 248 infertile women and 96 infertile men with no psychiatric disturbance and 51 women and 40 men who have children to evaluate the depression and anxiety levels between infertile couples and fertile couples. A gynecologist evaluated participants for demographic data and then they were visited by a psychologist to perform questionnaire scales which were The Beck Depression Inventory and the State-Trait Anxiety Inventory for the evaluation of the degree of psychopathology. The data were statistically analyzed, with p<0.05 as the level of statistical significance. We observed significant differences between the infertile couples and fertile couples with respect to state and trait anxiety(p<0.0001) while no difference was regarding with depression, both of women and men. Anxiety and depression were observed as independent from gender when infertile women and men were compared (p:0.213). We believed that the psychological management at infertile couples must be individualized with cultural, religious, and class related aspects.

The intracytoplasmic sperm injection procedure ending with total fertilization failure is very distressfull event for both the clinician and the patient. The aim of this study was to identify independent factors which could be used to identify total fertilization failure before the day of intracytoplasmic sperm injection. This was a retrospective study of 232 patients who were admitted to a tertiary-care hospital IVF Unit and showed total fertilization failure during intracytoplasmic sperm injection cycles. To sort out the interwined effects of female age, basal FSH, sperm quality, antral follicle count, starting dose of gonadotrophine, sperm extraction technique, cycle length, >14 mm follicle number, oocyte number after oocyte pick up, estradiol and progesterone level on the day of hCG and the MI, MII and GV oocyte number on the fertilization, multiple logistic regression analysis was used. The total fertilization failure rate was 6% and the recurrance rate was 23%. The original model illustrated that the presence of GV oocytes, total oocyte number less than six, <2000 pg/mL E2 concentration on the day of hCG and testicular sperm extraction increases the total fertilization failure risk. It is very difficult to predict total fertilization failure. Sometimes even with one good quality oocyte and sperm and in the case of globozoospermia fertilization can be achieved. Not only azoospermia but also low oocyte numbers increase the chance of total fertilization failure even after intracytoplasmic sperm injection.

The association between lipid peroxidation biomarkers and adipocytokines is hypothesized in preeclampsia but little is known about it. The present study was undertaken to determine the association of lipid peroxidation biomarkers measured by the levels of 8-isoprostane and malondialdehyde with adipocytokines leptin and adiponectin in maternal serum of preeclamptic women. A cross-sectional study was designed. The study population consisted of 30 preeclamptic patients and 30 healthy pregnant women. Serum levels of 8-Isoprostane, total leptin and total adiponectin were assessed using commercially available enzyme-linked immunosorbent assay methods. The amount of malondialdehyde was determined by the thiobarbituric acid assay. Mann-Whitney U test and Spearman’s correlation coefficient were used for statistical analysis. Both 8-Isoprostane and malondialdehyde were significantly higher in preeclamptic group than those in normal pregnant women. Serum levels of leptin were significantly increased in preeclamptic patients compared with normal group, while adiponectin levels were decreased. Serum levels of 8-Isoprostane and malondialdehyde did not show any significant correlation with leptin and adiponectin. In preeclamptic women, maternal serum levels of leptin and adiponectin were not correlated with lipid peroxidation.

Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment. The objective of this study was to compare the efficacy of three types of progesterone on biochemical, clinical and ongoing pregnancy rates and abortion and live birth rates. A prospective randomized study was performed at Royan Institute between March 2008 and March 2009 in women under 40 years old, who use GnRH analog down-regulation. One hundred eighty six patients in three groups were received progesterone in oil (100 mg, IM daily), intravaginal progesterone (400 mg, twice daily) and 17-? hydroxyprogestrone caproate (375mg, every three days), respectively. Final statistical analysis after withdrawal of some patients was performed in 50, 50 and 53 patients in group 1, 2 and 3 respectively. No differences between the groups were found in baseline characteristics. No statistical significance different was discovered for biochemical, clinical and ongoing pregnancies. Although the abortion rate was statistically higher in group 1 (p=0.025) the live birth rate was not statistically significant between the three groups. The effects of three types of progesterone were similar on pregnancies rate. We suggest the use of intravaginal progesterone during the luteal phase in patients undergoing an IVF-ET program because of the low numbers of abortions, and high ongoing pregnancy rates.

Recurrent spontaneous abortion impacts almost 1% of couples. The sera from women with unexplained recurrent spontaneous abortion (URSA) have toxic effects on embryos that grow in the uterus. Therefore, the abnormal condition of the uterus may also affect sperm qualities. The objectives of this study were to search if these sera could induce DNA denaturation in sperm nuclei and also it could reduce sperm motility. Sera of 20 women with URSA history and sera from 20 women with at least two healthy children were added to the sperms samples from 20 healthy men for 2 hours. The sperm motility was assessed after incubation with sera. The samples were stained with Tdt mediated dUTP nick end labeling (TUNEL) assay for DNA fragmentation. The samples were analyzed with flow cytometry and the percentage of the TUNEL positive sperms were calculated. The data were analyzed by t-test. The incubation of the sperm samples in sera with URSA lead to a decrease in the percentage of the motile sperm from 55% in control to 41% in the treated group, significantly (p=0.038). The percentage of the sperm with abnormal fragmented DNA increased after incubation with URSA (26.6%) compare to the control (21.2%); however, it was not significant. It seems that sera from URSA patients could not induce a significant increase in the percentage of the sperms with nuclei contain DNA fragmentation. However, the sera of women with URSA could affect the fertility rate by reduction of the sperm motility.

Leptin is a protein product of obesity gene and is synthesized mainly by adipose tissue. The aim of this study was to determine maternal and neonatal serum leptin levels in term preeclamptic and normal pregnancies. This cross sectional study was performed on 37 preeclamptic and 40 normotensive term pregnant women without other disease. Serum level of leptin was measured in all of pregnant mothers and after delivery, their neonates. This study was performed in Babol Yahyanejad Hospital from March 2006 to December 2006. Infants with preeclamptic mothers had significantly lower leptin level than control group (p=0.02). There was no significant difference in serum leptin levels between normal and preeclamptic women (p=0.749). According to the results, it would be concluded that leptin level in infants of preeclamptic mothers is lower than infants of normal mothers. This can only confirm the diagnosis of disease after birth but it cannot predict the preeclampsia.

Celiac sprue (gluten sensitive enteropathy) is an autoimmune disease which is hereditary and its pathology mainly bases on immunologic intolerance to gluten. It has a vast variety of signs and symptoms and its clinical features range from a silent disease to a typical gastrointestinal disorder. In this study we reviewed and summarized some other related issues about this disease and its relation with infertility. Case: The case is a 26 years old lady who had referred to a gynecologist because of infertility for 2 years and later it revealed that she has celiac sprue. Screening for its silent or subtle types especially among suspicious cases such as unexplained infertility seems to be a cost effective action. Meanwhile, in time administration of a gluten-free diet can lead to an almost complete cure.

While myoma is the most common pelvic mass of women, most women do not seek screening tests for uterine myoma and if they have any fibroid they are not volunteer for its surgical removal. Case: We present here a novel technique of vascular skeletonization to preserve uterus, making pregnancy possible for an infertile woman with a large uterine myoma, situated in the uterine lower segment. Vascular skeletonization to preserve vessels for a case of myomectomy helped preserve the patient''s ability to conceive.

To construct a semen bank, the collection of donated semen has to be done and an important concern is the safety of collected semen. The contamination is a big problem. Basically, the infectious pathogens can exist within donated semen, hence, a good donor screening is very important. Although viruses have an indirect role in sperm quality, but the evidence in banked semen is presently lack. This does not mean that there is no viral contamination but it might imply the inadequate concern on this issue. Contaminated semen usually means poor quality and hazardous to the recipient. The contamination of the virus in banked semen is a common problem in animal semen banking (1). The safety and transmission of each problematic virus is widely studied and well clarified in animal semen banking (2). However, this issue is not widely concerned in human semen banking. For sure, this case is an actual direct contamination and this cannot be detected if there is no specific screening in the banking process. The scenario of important new emerging viral infections will be specifically detailed in this report. West Nile virus is an emerging problematic viral infection that can cause a deadly clinical disorder. Basically, West Nile virus is classified as an arbovirus that is mainly transmitted by mosquito. However, the uncommon modes of transmissions such as transfusion related transmission are reported (3). The contamination of West Nile virus in semen is an important question in andrology. There is no evidence indicating for the presence of West Nile virus in the semen of the patients. However, American Society for Reproductive Medicine/Society for Assisted Reproductive Technology recommended that practitioners defer gamete donors who have confirmed or suspected West Nile virus infections (4). SARS is another deadly emerging viral infection. The new coronavirus infection is transmitted via respiratory route. The serious symptom due to this infection leads to death in almost all cases and brings a great concern to medical scientists around the world. The contamination of SARS in semen is an interesting topic. The possible transmission of SARS virus via germ line is an important question to be investigated in reproductive medicine (5). Luckily, till present, there is no evidence of SARS contamination in semen. Generally, influenza virus is a respiratory virus that causes respiratory tract infection. In the recent few years, an atypical influenza, avian flu, emerged. This infection brought a concern to the medical society. In early of this year, 2009, the newest emerging viral infection caused by a novel influenza virus, swine flu occurred and became pandemic. The topic on the new influenza virus becomes the present hot issue. Focusing on the contamination of classical influenza virus in semen, there are many evidences confirming the existence of virus in semen derived from the infected cases. It is also confirmed that the existence of the influenza virus in semen lead to decreased semen quality and pathological spermatozoa (6, 7). For the case of avian flu and swine flu, there is no report on the existence of virus in the semen of infected cases at present (8). However, a recent report on animal model indicated for the possibility of transmission of swine flu virus via reproductive tract insemination (9). It is suggested that new atypical influenza can result in poor semen quality and might lead to further infertility (8). However, there is no report on contamination of influenza virus in banked semen. A possible explanation might be the fact that although the influenza virus can contaminate in donated semen it leads to poor semen quality but no proof for possible further transmission to the other one. For the case of avian flu and swine flu.