International Journal Of Fertility and Sterility
Volume:6 Issue: 4, Jan-Mar 2013

Polycystic ovary syndrome (PCOS), the most common endocrine disorder affecting women of reproductive age, is characterized by hyperandrogenism and insulin resistance. Women with PCOS have a higher risk for cardiovascular diseases (CVDs) and endothelial dysfunction. The mechanisms underlying these risks are unclear. Human peripheral blood contains circulating endothelial progenitor cells (EPCs) derived from bone marrow that have the ability to proliferate and differentiate into mature endothelial cells, which may contribute to vessel homeostasis and repair. PCOS is associated with insulin resistance, hyperinsulinemia, and dyslipidemia, which may result in EPC dysfunction. In this review, we summarize the potential mechanisms of EPC dysfunction in PCOS, which possibly result in a higher genesis of CVDs in PCOS-affected subjects.

Male factor infertility or subfertility is responsible for up to 50% of infertility cases. A considerable body of recent studies indicates that lifestyle as well as environmental and psychological factors can negatively affect male fertility, more than previously thought. These negative effects have been shown in many cases to be reversible. This review aims to provide a rationale for early clinical attention to these factors and presents a non-exhaustive evidence-based collection of primary relevant conditions and recommendations, specifically with a view to making first line diagnostics and recommendations. The presently available evidence suggests that considering the high cost, success rates, and possible side effects of assisted reproduction techniques (ART), such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), early efforts to improve male fertility appear to be an attainable and worthwhile primary goal. A series of searches was conducted of Medline, Cochrane and related databases from November 14th, 2010 to January 26th, 2012 with the following keywords: male, fertility, infertility, sperm defects, IVF, ICSI, healthy habits, and lifestyle. Subsequent follow-up searches were performed for upcoming links. The total number of studies contemplated were 1265; of these, 296 studies were reviewed with criteria of relevance; the date of study or review; study sample size and study type; and publishing journal impact status. Data were abstracted based upon probable general clinical relevancy and use. Only a selection of the references has been reflected here because of space limitations. The main results obtained were evidence-supported indications as to the other causes of male infertility, their early detection, and treatment.

Women in particular suffer from psychological stress when diagnosed with infertility. Psychosocial interventions are known to not only prevent and lessen various mental problems, but also to play a positive role in physical health and pregnancy rates. The aim of this study is to determine the unique impact of spiritual psychotherapy on concerns about infertility and their perceived psychological stresses. This study was a randomized clinical trial. The study population included nearly 800 infertile couples who attended the Maternity and Gynecology Clinic of Jahrom University of Medical Sciences, Jahrom, Iran. We enrolled65 people who were randomly divided into two groups, experimental (n=33)and control (n=32). The experimental group received spiritual group psychotherapy counseling for 12 sessions, 2 hours per week for a 3 months period. The control group did not receive any intervention, but due to ethical considerations, we gave a presentation (one session) about infertility treatment for this group after the research process was completed. We used two questionnaires to obtain data, the Penn State Worry Questionnaire (PSWQ) and Perceived Stress Scale (PSS). Data analysis was done by descriptive and analytic statistics using SPSS 16 software. Psychological intervention in the treatment group significantly decreased the PSWQ (p=0.004). There were significant differences in the mean score of the PSWQ in both groups as determined by analysis of covariance (ANCOVA; p=0.009). Psychological intervention in the treatment group decreased the level of perceived stress, when compared with the control group. According to ANCOVA there were significant differences between the mean PSS scores of both groups (p=0.01). Logotherapy is related to stress reduction and can decrease psychiatric symptoms of worry and perceived stress. This approach tends to improve an infertile person's ability to deal with their problem of finding the meaning of life. Thus it can be concluded that logotherapy along with other treatment methods, is a useful approach for infertile couples (Registration Number:IRCT201108247407N2).

The aim of this study was to compare the effects of easy and difficult embryo transfers (ET) on implantation and pregnancy rates. In this prospective study, we analyzed the results of 706 ET procedures over a 12-month period. An easy ET was defined as a transfer that occurred without the use of force or other instrumentation. A difficult ET was defined as the use of force for catheter placement, and/or the use of additional instruments, and/or manipulation. Pregnancy rate was compared between patients with easy or difficult ETs. There was a significantly higher implantation rate in the easy group (21.7%) compared to the difficult group (12.1%, p<0.05).The easy group had a higher pregnancy rate (38.1%) compared to patients who had difficult ETs (21.4%; p<0.05). Any uterine manipulation during ET adversely affects in vitro fertilization (IVF). Precaution should be taken to identify possibly difficult ET cases in advance.

We aimed to compare human menopausal gonadotropin (hMG) and recombinant follicle-stimulating hormone (r FSH) with respect to clinical outcomes and the development of ovarian hyperstimulation syndrome (OHSS) for patients with polycystic ovary syndrome (PCOS) treated with in vitro fertilization (IVF). This prospective randomized controlled trial included a total of 80 women with PCOS. Of these, 38 were randomized to receive treatment with hMG and 42 with rFSH using a long gonadotropin releasing hormone (GnRH) analogue protocol. Outcome measures were cycle characteristics, pregnancy rates, the need for coasting, and OHSS rates. In the hMG group we observed a significantly lower peak estradiol (E2) level (p=0.02), fewer intermediate-sized follicles (p=0.001), lower number of oocytes retrieved (p=0.002) and metaphase II (MII) oocytes (p=0.003). However, there were no significant differences between the groups in the number of fertilized oocytes, fertilization rates, top quality embryo counts, and the number of transferred embryos. There was no difference in pregnancy rates between the groups. OHSS occurred in 11.9% of the rFSH group patients, whereas no OHSS developed in the hMG group. Coasting requirements were lower in the hMG group (19.2% vs. 48.9%, p=0.013). Ovarian stimulation with hMG and rFSH provides similar clinical pregnancy rates in PCOS patients treated with a long GnRH agonist protocol in IVF cycles. hMG stimulation appears to be associated with a lower rate of OHSS and decreased coasting requirements (Registration Number: NCT01365936).

Metabolic syndrome (MetS) is a clustering of factors known to increase the risk for cardiovascular disease (CVD) and diabetes mellitus. Polycystic ovary syndrome (PCOS), the most common endocrine disorder among reproductive-aged women, is also closely linked to MetS. Limited information is available pertaining to the prevalence of MetS in Iranian PCOS women; therefore this study assesses the frequency of MetS and its components among PCOS women from Tabriz, Iran. In this cross-sectional study, we evaluated a total of 200 women with PCOS who referred to the only specialty and subspecialty gynecological center in Northwestern Iran. PCOS was diagnosed according to Rotterdam criteria. This study defined clinical and biochemical parameters for MetS by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Statistical analyses were performed with descriptive-analytical methods using SPSS software version 16. MetS was identified in 39.5% of PCOS women. The frequencies of individual components of MetS among studied subjects were: high-density lipoprotein cholesterol level (HDL-C)<50 mg/ dL (99.5%), waist circumference(WC) ≥88cm (65%), triglycerides (TG) ≥150 mg/dL(98%), and blood pressure≥130/85 mmHg(34%).There were no fasting glucose concentrations≥110 mg/dL. The frequency of MetS increased with body mass index (BMI)as follows: normal (5.4%), overweight (41.5%) and obese (85.7%) women (p<0.0001). The PCOS women in this study had a high frequency of MetS and its individual components, particularly decreased HDL-C and increased triglyceride levels. These data can useful for lifestyle modification programs.

Formaldehyde (FA), one of the simplest organic molecules, is a flammable, pungent, irritating and colorless gas. This study aimed to investigate the effects of various concentrations of FA vapor on sperm parameters and testicular tissue. In this experimental study, we randomly assigned 36 adult male mice to one control and two experimental groups (n=12 for each group). The control group (C) did not receive FA. Group F1 (low concentration) was exposed to 10 ppm FA vapor and the F2 (high concentration) group was exposed to 20 ppm FA vapor. FA was administered for ten days, eight hours per day for both groups. At the end of the exposure period, half of the animals in each group were sacrificed 24 hours after exposure to detect any short-term effects; the rest of the mice were sacrificed 35 days later to assess for long-term effects. Sperm parameters were analyzed by Computer-assisted Sperm Analyzer (CASA) and histological changes determined. In addition, we studied changes in testosterone hormone. Data were analyzed by one-way ANOVA followed by the Scheffe test using SPSS software. Long-term effects of FA in the experimental groups included significant reductions in sperm cell numbers and sperm viability. A drastic reduction in progressive motility and increased abnormal sperm percentage (p<0.001) compared with the control group was also noted. Histological study of testes specimens in the experimental group revealed displacement of germinal cells, along with degeneration of Leydig cells and seminiferous tubules. Exposure to FA vapor can destroy testicular structure and decrease percentages of concentration, viability, normal morphology, and progressive motility, in addition to increasing the percentage of immotile sperm.

Spermatozoa are a group of cells that consume adenosine triphosphate (ATP) rapidly. Creatine kinase (CK), produced by creatine phosphate, is an energy reservoir for the rapid buffering and regeneration of ATP and can play an important role in sperm motility. Therefore, this study investigates the effects of cigarette smoking on human sperm CK activity in males who smoke. In this case - control study, we obtained semen samples from male smokers (n=64) and nonsmokers (n=83). Smokers were categorized as light, moderate, or heavy smokers according to the daily number of cigarettes smoked and the number of years they have smoked. Data were analyzed by the independent t test and Pearson’s analysis. This investigation showed significantly lower sperm CK activity and movement in male smokers compared to nonsmokers. In addition, it was demonstrated that cigarette smoking had a dose-dependent effect on these parameters. There was a positive relation, although not significant, between sperm CK activity and its motility in male smokers. Smoking, by diminishing sperm CK activity, may potentially impair sperm energy homeostasis and have an association with damage to sperm motility. This effect can be an important mechanism that may cause infertility in male smokers. However, further research is necessary to elucidate the underlying mechanism of sperm motility damage caused by cigarette smoking.

This study compares the microdose flare-up protocol to the ultrashort gonadotropinreleasing hormone (GnRH) agonist flare combined with the fixed multidose GnRH antagonist protocol in poor responders undergoing ovarian stimulation. In this randomized clinical trial, 120 women who were candidates for assisted reproductive techniques (ART) and had histories of one or more failed in vitro fertilization (IVF) cycles with three or fewer retrieved oocytes were prospectively randomized into two groups. Group I (60 patients) received the microdose flare-up regimen and group II (60 patients) received the ultrashort GnRH agonist combined with fixed GnRH antagonist. There were no significant differences between the groups in the number of used gonadotropin ampoules (p=0.591), duration of stimulation (p=0.610), number of retrieved oocytes (p=0.802), fertilization rate (p=0.456), and the number of transferred embryos (p=0.954). The clinical pregnancy rates were statistically similar in group I (10%) compared with group II (13.3%, p=0.389). According to our results, there is no significant difference between these protocols for improving the ART outcome in poor responders. Additional prospective, randomized studies with more patients is necessary to determine the best protocol (Registration Number: IRCT201105096420N1).

This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles. This prospective study performed in a private assisted fertilization center included 1016 follicles collected from 96 patients who underwent intra cytoplasmic sperm injection (ICSI). After follicular aspiration, oocytes were assigned to two groups according to the diameter of the derived follicle. The large follicle group (n=96) comprised oocytes derived from the leading follicle of the cohort and the small follicle group (n=920) consisted oocytes derived from the smaller follicles of the cohort. The fertilization and percentage of topquality embryos were compared between groups by Chi-square or Fisher’s exact test, where appropriate. The effect of the follicular diameter on oocyte dimorphism was assessed by binary logistic regression. A significantly higher percentage of oocytes derived from the leading follicle were in the metaphase II (MII) stage (100 vs. 70.0%, p<0.001). However we observed no significant differences regarding the percentage of degenerated oocytes between the large (6.25%) and small follicle (5.0%) groups (p=0.550). Regression analysis demonstrated a nearly two-fold increase in the incidence of vacuoles in oocytes derived from the largest follicle of the cohort (OR: 1.81, p=0.046). The fertilization rate (50.0 vs. 38.8%, p=0.038) and the percentage of top quality embryos (84.7 vs. 76.4%, p=0.040) were significantly higher for oocytes derived from the largest follicle. However, the percentage of abnormal fertilized oocytes was equally distributed between the large follicle (15.0%) and small follicle (12. 8%) groups (p=0.550). Our data suggest that intrafollicular mechanisms within the larger follicle of the cohort may allow for these follicles to amplify the responsiveness to exogenous gonadotropin, which leads to the formation of more competent oocytes with higher fertilization and developmental capacities.

The purpose of this study was to investigate the in vitro survival and developmental potential of oocytes obtained from vitrified mouse ovaries transplanted to a heterotopic site. In this experimental study, two-week-old mice were unilaterally ovariectomized after anesthesia. The ovaries were vitrified by cryotop. After two weeks, the ovaries were thawed and autotransplanted to the gluteus muscle tissue. Three weeks later the mice were killed, after which we removed and dissected the transplanted and opposite right ovaries. Cumulus oocyte complexes (COCs) and denuded oocytes were evaluated for in vitro maturation (IVM), in vitro fertilization (IVF) and in vitro development (IVD). The control group consisted of sevenweek- old age-matched mice ovaries. All vitrified-transplanted (Vit-trans) ovaries contained some oocytes that survived. Following IVM, IVF and IVD, there were 41.7% out of 12 cultured zygotes that reached the 8-cell stage. Our experiment supports the progressive role of long-term graft survival after wholeovarian cryopreservation by vitrification and subsequent heterotopic transplantation. It is possible to recover viable follicles and oocytes that have the ability to develop in vitro.

The aim of this descriptive study was to evaluate the level of marital violence among Turkish women and to determine whether infertility was a risk factor for marital violence. This descriptive study was conducted during January-July 2009 at a training hospital. The study groups comprised 204 fertile and 228 infertile women. We administered the Descriptive Information Questionnaire and Scale for Marital Violence against Women (SDVW) to obtain data. There was a statistically significant difference between infertile and fertile women for the total score of violence in marriage. The emotional, economic and sexual violence scores were higher in the infertile group. However, the verbal violence score was lower. We performed a detailed study aimed at uncovering the presence of any violence from the data collection stage to the end of treatment in infertile couples with the intent to include questions to this effect in the care plan.

This research studied the effect of ciprofloxacin (CPFX) on spermatogenesis. We aimed to estimate the effect of CPFX on serum levels of testosterone, LH and FSH. In this experimental study, a total of 24 mice were assigned to controlsham and test groups. We subdivided the test group into low (206 mg/kg) and high (412 mg/kg) dose CPFX groups. Control-sham animals received carboxymethyl cellulose (CMC). All animals were treated orally for 45 days. Cytoplasmic carbohydrate, lipid accumulation, cytoplasmic lipase and alkaline phosphatase (ALP) ratios were examined. Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone were measured in the control and test groups. The spermatogenesis cell series exhibited low numbers of cells with periodic acid Schiff (PAS)-positive cytoplasm and higher numbers of cells with lipid-positive foci. The tissue to ALP ratio and germinal epithelium (GE) lipase synthesis increased in CPFX-treated animals. In contrast to the CPFX groups, control animals showed normal cytoplasmic carbohydrate, lipid, lipase and ALP ratios in all cellular layers. In the CPFX-treated groups there was a significantly lower serum testosterone level compared with the control group. The serum levels of FSH and LH in high dosetreated animals decreased. Our results suggest that following long time CPFX administration major alterations occur in GE intracytoplasmic biochemistry, which may lead to loss of physiological function and ultimately result in fertility problems. CPFX is able to imbalance serum levels of gonadotropins and testosterone levels by affecting Leydig cells.

Kisspeptin and RFamide-related peptide-3 (RFRP-3) are known to affect GnRH/luteinizing hormone (LH) in several species, including the rat. It has been hypothesized that GnRH/LH changes during the rat estrous cycle may result from changes in the expression of KiSS1 and RFRP-3 genes. Therefore, the present study investigates KiSS1 and RFRP-3 gene expression at the transcriptional level in the rat hypothalamus during the estrous cycle. In the present experimental study, 36 adult female Sprague-Dawley rats (3-4 months old) were used to study the expression of KiSS1 and RFRP-3 mRNA in the hypothalamus during the estrous cycle. Four rats were ovariectomized, whereas the remainder were allotted to four different phases of the estrous cycle (n=8 per estrus phase). Rats were decapitated, and the hypothalami were immediately dissected and frozen in liquid nitrogen. Expressions of KiSS1 and RFRP-3 mRNAs were analyzed by real-time PCR. The expression of KiSS1 mRNA during estrus was lower than other phases of the cycle (p<0.01). Expression of KiSS1 mRNA during the metestrus phase was lower than the proestrus phase (p<0.01). The expression of RFRP-3 mRNA during proestrus was lower than the diestrus phase (p<0.01). Results of the present study showed the role of coordinated expression of KiSS1 and RFRP-3 mRNA in the hypothalamus in the control of the rat estrous cycle.