International Journal Of Fertility and Sterility
Volume:5 Issue: 2, Jul-Sep 2011

Premature ovarian failure (POF) affects 1% of young women. This condition has significant psychological sequelae and major health implications. POF seriously interferes with fertility and family planning. Diverse etiologies are associated with POF. Literature review related to the causes and pathogenesis of POF, cited between the year 1900 and May 2010. POF may be either spontaneous or induced. The known causes include: - Genetic disorders, which could involve the X chromosome or autosomes. However, the growing body of literature demonstrates a list of newly discovered mutations that may be responsible for causing POF. Most of these mutations are extremely rare, and most cases of POF are still considered to be idiopathic. - Autoimmune causes; there is some evidence of an association of POF with lymphocytic oophoritis and other autoimmune disorders. Antiovarian antibodies are reported in POF, but their specificity and pathogenic role are obscure. - Iatrogenic causes; chemotherapy, radiotherapy and pelvic surgery can lead to POF. - Infectious Causes; some viral and microbial infections can be followed by POF. - Environmental toxins, such as cigarette smoking are reported as risk factors of spontaneous POF. - Idiopathic; in most cases, no identifiable etiology can be recognized after complete evaluation.

Infertility can be a major concern for couples trying to conceive, and occupational hazards may constitute a main cause of infertility in men. Studies conducted throughout the world indicate that physical and chemical hazards in the workplace can have a negative impact on male fertility. The main objective of this study was to determine the frequency of occupational categories of men who attended an infertility clinic, and to evaluate the differences in the semen quality parameters among occupational categories. This cross-sectional study was conducted on 1164 males who were referred to the Infertility Research Center in Tehran for treatment of infertility in order to evaluate the effects of certain occupations on infertility. The participants were divided into several categories according to their occupations and evaluated by means of a questionnaire for duration of infertility, BMI, sperm count, percentage of normal sperm morphology and percentages of sperm with class A and class B motilities. Descriptive statistics, analysis of variance, and correlations were conducted using SPSS 16.0 for Windows. There were no statistically significant differences in the mean sperm count or sperm morphology between occupational categories. Assessment of the differences in the frequency of sperm motility classes between occupational categories revealed a significant difference only in the frequency of sperm with class B motility. The lowest mean percentages of sperm with class B motility were seen in those involved in the transportation industry, a finding in agreement with a number of other researches. Our findings revealed an association between occupation and sperm motility. Since our study population was relatively small and in many cases exposures to work hazards were brief, a larger study group must be evaluated in order to support the preliminary results of this study.

This study examines the relationship between infertile women’s social skills and their perception of their own mothers’ acceptance or rejection, and the role this relationship plays in predicting self-reported depression. This was a correlational study. 60 infertile women aged 25 to 35 years participated in a self-evaluation. A Social Skills Inventory, Parental Acceptance and Rejection Questionnaire and Beck Depression Inventory were used to measure social skills, acceptance rejection and depression. Data was analyzed by SPSS software, using independent two-sample t test, logistic regression, and ANOVA. Findings showed that there are significant differences between depressed and not depressed infertile women in their perceptions of acceptance and rejection by their mothers. Further, women''s perceptions of rejection are a more significant predictor of depression among less socially skilled infertile women than among those who are more socially skilled. Less socially skilled women did not show symptoms of depression when they experienced their mothers as accepting. In general the results of this study revealed that poorer social skills were more predictive of depression while good social skills moderate the effect of infertile women’s perceptions of their mothers'' rejection. At the same time, the findings showed that infertile women''s perceptions of acceptance moderated the effects of poorer social skills in predicting depression. Results suggest that the perception of mothers’ rejection and poor social skills are the key factors that make infertile women prone to depression.

To clarify the relationship between the general attitude towards gestational surrogacy and risk perception about pregnancy and infertility treatment. This study analysed the data of nationally representative cross-sectional surveys from 2007 concerning assisted reproductive technologies. The participants represented the general Japanese population. We used this data to carry out multivariate analysis. The main outcome measures were adjusted odds ratios and 95% confidence intervals from logistic regression models for factors including the effect of pregnancy risk perception on the attitude toward gestational surrogacy. In this survey, 3412 participants responded (response rate of 68.2%). With regard to the attitude towards gestational surrogacy, 54.0% of the respondents approved of it, and 29.7% stated that they were undecided. The perception of a high level of risk concerning ectopic pregnancy, threatened miscarriage or premature birth, and pregnancy-induced hypertension influenced the participants’ attitudes towards gestational surrogacy. Moreover, this perception of risk also contributed to a disapproval of the technique. Our findings suggest that a person who understands the risks associated with pregnancy might clearly express their disapproval of gestational surrogacy.

We conducted this study to compare the outcome of assisted reproductive technology (ART) procedures and recovery from anesthesia in women who received opioid analgesia with remifentanil versus fentanyl. This double-blind, randomized clinical trial was carried out in the Yazd Research and Clinical Center for Infertility, Yazd, Iran. We studied 145 women who were participants in an ART program. During the first phase of the study, all patients underwent induction of anesthesia with thiopental and received analgesia with remifentanil or fentanyl. The primary endpoint was pregnancy rate per transfer. The numbers of oocytes collected, fertilized and cleaved were recorded, as was the number of oocytes transferred and recovery profile. In the second phase of the study, all patients were followed for outcome of ART cycle. This study suggested that in women undergoing transvaginal ultrasound-guided oocyte retrieval procedures, the likelihood of a successful pregnancy was higher with a remifentanil-based monitored anesthesia care (MAC) technique than with a fentanyl-based MAC technique. The recovery from anesthesia was significantly better in the remifentanil group versus fentanyl group. The results of this study suggest that remifentanil in clinical practice is superior to fentanyl (Registeration Number: IRCT201009283468N3).

Women with polycystic ovary syndrome (PCOS) are at increased risk for cardiovascular (CV) and metabolic disorders. There is a close relationship between elevated androgen plasma levels and the ultrasound findings of stromal hypertrophy. In randomized trials, the administration of metformin has been shown to be followed by an improvement in insulin sensitivity and decrease in androgen levels in most women. In the present study, we investigate the association between reduced ovarian volume in PCOS patients after administration of metformin with improvement in CV risk factors. This was a randomized clinical trial study. A total of 28 women diagnosed with PCOS who referred to the infertility clinic were selected. Anthropometric characteristics of the patients, mean ovarian volume and plasma levels of fasting blood sugar (FBS), lipid profile, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, testosterone, 17-α-OH progesterone (17OHP), dehydroepiandrosterone sulfate (DHEAS), C-reactive protein (CRP) and homocysteine (Hcy) were evaluated before and after treatment with 500 mg metformin, three times daily for three months. Statistics were calculated with the aid of SPSS 16.0 with student’s paired t- and Pearson’s correlation coefficient tests. Significance was set at p<0.05. There were significant reductions in mean ovarian volume and body mass index (BMI), in addition to CRP, Hcy, testosterone, FBS, HDL and LDL levels. There was a positive correlation between mean ovarian volume and waist-to-hip ratio (WHR).After treatment, there correlation noted with reduction in mean ovarian volume and decreased BMI, in addition to reductions in CRP, LDL, Hcy and testosterone levels. A positive correlation may exist between reduced mean ovarian volume and improvement in CV risk factors after administration of metformin (Registeration Number: IRCT138903244176N1).

In this study, we investigated the effects of treatment with chronic antihypertensive drugs (clonidine, methyldopa, amlodipine, ramipril and rilmenidine) on oxidant-antioxidant parameters and toxic effects on DNA in rat uterus tissue. In addition, uterus tissues were examined histopathologically. A total of 36 albino Wistar rats were divided into the following six groups: 0.075 mg/kg clonidine group; 100 mg/kg methyldopa group; 2 mg/kg amlodipine group; 2.5 mg/kg ramipril group; 0.5 mg/kg rilmenidine group; and the healthy group. Rats underwent chronic drug administration for 30 days and at the end, biochemical and histopathological examinations were performed. All data were subjected to one-way ANOVA test. We divided these drugs into the following three groups according to their effects on rat uteri: (I) mild negative effects (clonidine), (II) moderate negative effects (rilmenidine, methyldopa) and (III) drugs which had severe negative effects (amlodipine, ramipril). These data may help with selection of antihypertensive drugs, in order to determine which drugs have the lowest toxicity in pregnant and non-pregnant (pre-pregnancy) women.

Bone morphogenetic protein 4 (BMP4) has a significant role in primordial germ cells (PGCs) differentiation from mouse embryonic stem cell (mESC). The aim of this study is to determine the best concentration of BMP4 at a time of two days on differentiation PGCs from mESC. To differentiate PGCs, embryoid bodies (EBs) from mESCs were cultured in concentrations of 0, 5 and 10 ng/ml BMP4 for two days. Germ cell markers Oct4 (Pou5f1), Stella (Dppa3) and Mvh (Ddx4) were analyzed by flow cytometry, immunocytochemistry and reverse transcriptase polymerase chain reaction (RT-PCR). Flow cytometry data demonstrated most Mvh-positive cells were observed only in the treated groups. Immunocytochemistry of EBs in the treated groups identified cells positive for Mvh. PCR results showed expression of Oct4 in the control group and treated groups. Stella and Mvh were expressed only in the treated groups. Low concentrations of BMP4 during two days had an optimal effect on differentiation of PGCs from mESC.

Recent studies have demonstrated that morphology of the first polar body (1st PB) is related to oocyte viability, which can be used as a prognostic tool to predict oocyte performance and pregnancy outcomes in an intracytoplasmic sperm injection (ICSI) program. According to some studies, there is a correlation between oocyte performance and 1st PB morphology, while others have not reported any correlation. The objective of this study is to evaluate the role of 1st PB morphology on rates of fertilization and embryo development in ICSI cases. In this prospective study morphological characteristics of 470 metaphase II (MII) oocytes were assessed in 80 ICSI cycles. The women were ages 21-42 years (mean 32.6 ± 0.2). Their oocytes were retrieved after a hyperstimulation protocol. After denudation, all oocytes were evaluated for 1st PB morphology. The oocytes were divided into two groups of A (normal 1st PB) and B (abnormal fragmented 1st PB). In addition, other abnormalities, such as refractile bodies (RF), wide previtelline space (wPVS), central and general granulation, bull’s eye, vacuole, smooth endoplasmic reticulum cluster (SERc), debris in PVS, shape and dark oocyte were checked. For verifying of fertilization, about 18-19 hours post-ICSI, oocytes were checked for two-pronuclear. Assessments of embryo quality, development and embryo transfer were done at day two. Chi-square, Fisher’s exact and independent sample t tests were chosen for statistical analysis. Twenty-seven percent of oocytes had fragmented 1st PB, while the remainder was associated with other morphological abnormalities. A total of 46.1% and 26.9% of oocytes showed double and multiple defects, respectively. RF was the most common abnormality observed in group B. No significant differences in women’s’ ages between groups A and B were noted (p=0.3). A total of 179 and 107 oocytes (61.5% vs. 59.8%) were fertilized in groups A and B, respectively (p=0.7). The rates of good embryo formation for A and B groups were 66.5% and 55.6% (p=0.07), and cleavage rates were 77.7% and 68.5%, respectively (p=0.09). The data demonstrated that 1st PB morphology does not appear to be a prognostic factor for rates of fertilization and embryo development in ICSI cycles.

With recent improvements in maternal fetal medicine and neonatal intensive care, the survival rates of extremely low birth weight infants have been improved. In this report we describe the case of an extremely low birth weight infant due to preeclampsia, who was conceived by in vitro fertilization and is in complete physical and mental health after a one - year follow - up.

A 35 year-old woman referred to Royan Institute (Reproductive Biomedicine Research Center) for infertility treatment. She had an eleven-year history of primary infertility with a normal abdominal ultrasound. Hysterosalpingography (HSG) was obtained one month prior to referral in another center (Fig A). The HSG finding of an apparent unicorn uterus followed by a normal vaginal ultrasound led us to perform a three-dimensional vaginal ultrasound before resorting to hysteroscopy. Results of the three-dimensional vaginal ultrasound revealed a normal uterus (Fig B, C). Accurate characterization of congenital Mullerian anomalies (MDAs) such as an arcuate, unicornuate, didelphys, bicornuate or septate uterus is challenging. While HSG has been the standard test in the diagnosis of MDAs, some limitations may favor the use of three-dimensional ultrasound. The most difficult part of HSG is interpreting the two-dimensional radiographic image into a complex, three-dimensional living organ (1). A variety of technical problems may occur while performing HSG. In this case, only an oblique view could lead to a correct interpretation. It is advisable for the interpreter to perform the procedure rather than to inspect only the finished radiographic images (2). One of the most useful scan planes obtained on three-dimensional ultrasound is the coronal view of the uterus. This view is known to be a valuable problem-solving tool that assists in differentiating between various types of MDAs due to the high level of agreement between three-dimensional ultrasound and HSG (3, 4). Recently, three-dimensional ultrasound has become the sole mandatory step in the initial investigation of MDAs due to its superiority to other techniques that have been used for the same purpose (5).