International Journal Of Fertility and Sterility
Volume:7 Issue: 3, oct-dec 2013

For many years, the innate immunity was of less interest than the adaptive immunity because it was perceived to have secondary importance in the functionality of the immune system. During the past decades, with the advancement of knowledge about innate immune system, interest in innate immunity has grown dramatically and thus its function has been extensively studied. Innate immunity plays fundamental roles in the initiation and induction of adaptive immune responses. It consists of several cells and receptors including natural killer (NK) cells, macrophages (MQs), dendritic cells (DCs) and pattern recognition receptors (PRRs). Two decades ago, Toll like receptors (TLRs) family was known as one of the important PRRs with unique functions especially in protection against invading pathogens. Since the female reproductive tract has access to the outside environment and has a unique interaction with different pathogens whether invading microorganisms or normal flora, allogenic sperm and semi allogenic fetus, it has an essential need for effective immune responses. It has therefore been suggested that TLRs may play important roles in the immune regulation of the female reproductive tract. In addition, it has been demonstrated that immune disturbance may be responsible for some adverse pregnancy outcomes such as preeclampsia (PE), recurrent spontaneous abortion (RSA) and intrauterine growth restriction (IUGR). Our focus in this review is to show the importance of TLRs in pregnancy with emphasis on the expression of these receptors in different tissues related to pregnancy.

Destruction of the endometrium due to trauma to the basal layer of endometrium may cause intra uterine adhesions, known as Asherman’s syndrome (AS). There are various types of imaging method for diagnosis of the intra uterine adhesion such as hysterosalpingography, sonohysterography, ultrasonography, and hysteroscopy which is considered as the gold standard approach. Hysterosalpingogram may suggest the presence of intrauterine adhesions, and may reveal the extent of the scar formation. Knowing different images in each technique is helpful in detection of intra uterine adhesion.

This study was conducted to evaluate the potential protective effects of omega-3 poly unsaturated fatty acids (Ω-3 PUFAs) on bovine sperm quality in response to cooling and cryopreservation. In this experimental study included ejaculates from five proven fertile bulls, allocated to the control and the four experimental groups. For group 1, polyethylene glycol (PEG) as a solvent was added alone to the extender, while for groups 2, 3 and 4, different concentration of omega-3 PUFAs (1, 2.5 and 5%, respectively) in combination with PEG were added to the semen extender. Motility [using computer aided sperm analysis (CASA)], viability and morphology of bovine sperm were investigated after 24 and 48 hours in both cold liquid storage and frozen-thawed conditions. Our findings showed that PEG has some detrimental effects on sperm quality. Cooling as well as cryopreservation decreased significantly most of measured variables of sperm as compared to fresh semen, whereas the treatments did not improve sperm quality. Furthermore, levels of some variables were decreased significantly during treatments (p<0.05). Addition of Ω-3 PUFAs to semen extenders cannot be effectively introduced to conservation media as well as sperm membrane in order to protect spermatozoa in response to cooling and freezing. It can be suggested if Ω-3 PUFAs is supplemented to the diet of bulls in order to modify the fatty acid compositions of sperm, they might perform their preventive properties.

Antenatal educations provide information regarding pregnancy, birth, infant care and early parenthood. The purpose of this study was to determine effect of prenatal education on mother’s quality of life during first year after childbirth among Iranian women. This single-blind randomized control trial study was performed on 160 first-time pregnant women; with a singleton fetus; aged 18 to 35; without history of medical, psychological, and infertility diseases; as well as with at least eight prenatal visits during pregnancy. Participants were invited into two groups of intervention (n=80) and control (n=80). The antenatal education classes were consisted of eight sessions, and then, mother’s quality of life was evaluated during first year after childbirth. Data was analyzed using t test, chi-square, and Mann-Withney. The interventional group demonstrated higher scores of quality of life domains than the control group (p<0.05). The interventional group (at one year postpartum) demonstrated significantly higher scores for quality of life in the physical health, psychological health, and environmental health domains compared to the control group. In addition, the interventional group showed a significant increase in the mean scores for the domains of physical, psychological, and environmental health from 6-8 weeks to 1 year postpartum. The study showed that women receiving prenatal education had higher level of happiness and satisfaction in their overall quality of life and health, respectively (Registration Number: IRCT201101115571N2).

The aim of this study was to evaluate the reproductive outcome of women with history of infertility or recurrent miscarriage following hysteroscopic septum resection. This was a retrospective descriptive study performed on 263 patients, among whom 248 patients were infertile (79% with primary infertility and 21% with secondary infertility) and 15 patients presented with histories of recurrent miscarriage (three or more miscarriages) between 2005 and 2009. All participants underwent hysteroscopic septum resection using monopolar knife electrode. The main outcome measure was reproductive outcome after hysteroscopic metroplasty. The septum was completely removed during the first hysteroscopy in 242 (92%) patients. A residual septum was seen in 21 (8%) patients who required a second sitting of surgery. Three cases were complicated by minor perforations which required no further interventions. One operation complicated with bleeding which was controlled by a Foley catheter. There were no cases of postoperative Asherman’s syndrome. Postoperatively, out of 263 patients, outcomes of 203 individuals were analyzed. According to the results, the miscarriage rate reduced significantly from 20.2 to 4.9%. Postoperative ectopic pregnancy rate and preterm labor were lower than prior to septum resection. Term deliveries increased significantly from 2.5 to 33.5%. Hysteroscopic septum resection is a safe and effective method for patients with history of infertility or recurrent miscarriage.

The aim of this study was to investigate follicular growth and steroid production in neonatal mouse ovary during in vitro culture. In this experimental study, 7-day-old mouse whole ovaries were cultured in α-MEM (medium supplemented with 100 mIU/ml recombinant follicle stimulating hormone, 1% insulin, transferrin and selenium (ITS), 5% fetal bovine serum (FBS), 100 IU/ml penicillin and 50 μg/ml streptomycin for 7 days. The size of whole ovary was determined as mean area during culture. The survival rates of isolated preantral follicles after culture were assessed using trypan blue staining after being mechanically isolated. Histological evaluation of whole ovary was done by hematoxylin and eosin staining. 17-β estradiol, progesterone and dehydroepiandrosterone concentrations in the medium were measured during culture. The mean area of ovary increased after culture (1.47 vs. 0.21 mm2). The survival rate of isolated follicles in ovary after culture was 99.2%. There was a significant decline in the percentage of primordial follicles after seven days of culture (91.8 ± 0.2% vs. 65.1 ± 1.1%), whereas the rate of preantral follicles increased significantly (4.6 ± 0.4% vs. 29.2 ± 0.5%). The levels of estradiol, progesterone and dehydroepiandrosterone also increased significantly after culture (p<0.001). These results show that the growth and development of primordial follicles in contrast with hormonal production decreased during in vitro culture ofneonatal mouse ovaries.

To establish the reference range of the angle between ascending aorta and main pulmonary artery of fetus in the second and third trimester using spatiotemporal image correlation (STIC), and to investigate the value of this angle in prenatal screening of conotruncal defects (CTDs). Volume images of 311 normal fetuses along with 20 fetuses with congenital heart diseases were recruited in this cross-sectional study. An offline analysis of acquired volume datasets was carried out with multiplanar mode. The angle between aorta and pulmonary artery was measured by navigating the pivot point and rotating axes and the reference range was established. The images of ascending aorta and main pulmonary artery in fetuses with congenital heart diseases were observed by rotating the axes within the normal angle reference range. The angle between ascending aorta and main pulmonary artery of the normal fetus (range: 59.1˚~97.0˚, mean ± SD: 78.0˚ ± 9.7˚) was negatively correlated with gestational age (r = -0.52; p<0.01). By rotating the normal angle range corresponding to gestational age, the fetuses with CTD could not display views of their left ventricular long axis and main pulmonary trunk correctly. The left ventricular long axis and main pulmonary trunk views can be displayed using STIC so that the echocardiographic protocol of the cardiovascular joint could be standardized. The reference range of the angle between ascending aorta and main pulmonary artery is clinically useful in prenatal screening of CTD and provides a reliable quantitative standard to estimate the spatial relationship of the large arteries of fetus.

Sperm membrane integrity is not only important as a barrier between intraand extra-cellular spaces, but also it can be considered as a sign of DNA integrity. Hypoosmotic swelling test reflects membrane integrity and has been used to evaluate sperm quality. Intracytoplasmic sperm injection (ICSI) in adjunct with hypo-osmotic swelling test (HOST) has been used for treatment of males with asthenozoospermia. Therefore, this study aims to evaluate correlation of different pattern of HOST with sperm parameters, protamine deficiency and apoptosis. In this case-control study, sixteen semen samples were randomly collected from infertile normozospermic men. Semen samples were divided into two portions as follows: one portion was assessed for sperm parameters according toWorld Health Organization (WHO)-2010, while the other portion, after applying HOST procedure, was used for assessment of sperm morphology, protamine deficiency and late or early apoptosis. Statistical analysis was carried out using the Statistical Package for the Social Studies (SPSS 11.5). Our results showed that, the lowest odds ratio (OR) of abnormal sperm head morphology and abnormal acrosome was in d-sperm as compared to a-pattern or nonviable spermatozoa (p=0.00, p=0.01). In addition, a significant correlation was observed between d-sperm with sperm concentration and percentage of DNA damage (p=0.03 and p=0.04, respectively). A significant correlation was observed between percentage of sperm motility and DNA fragmentation (r=-0.56; p=0.01). Furthermore, significant correlations were observed between percentages of early apoptotic sperm with protamine deficiency and sperm concentration (p=0.009 and p=0.01, respectively). Significant correlations exist between d-pattern and sperm DNA integrity. Semen samples with low sperm concentration have low percentage of d-sperm which aremature and intact sperms.

ackground: Infertility has been described as creating a form of stress leading to a variety f ychological problems. Both psychotherapy and pharmacotherapy are effective treatments for nfertility tress. The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy long with luoxetine for improvement infertility stress in infertile women. In a andomized ontrolled clinical trial, 89 infertile women with mild to moderate depression (Beck scores 0-47) were ecruited into the following three groups: i. cognitive behavior therapy (CBT), ii. ntidepressant therapy, nd iii. control group. Twenty-nine participants in the CBT method received radual relaxation training, estructuring, and eliminating of negative automatic thoughts and ysfunctional attitudes to infertility for 0 sessions. Thirty participants in the pharmacotherapy group ook 20 mg fluoxetine daily for 90 days. hirty individuals in control group did not receive any ntervention. All participants completed fertility roblem inventory (FPI) and the Beck Depression nventory (BDI) at the beginning and end of the study. e applied Chi-square paired t test, ANOVA and Turkey’s test to analyze the data. The mean f the infertility stress scores in CBT, fluoxetine, and control groups at the beginning and end of the tudy were as follows, respectively: 3.5 ± 0.62 vs.2.7 ± 0.62 (p<0.05), 3.5 ± 0.53 vs.3.2 ± 4.4 (p. 05), and 3.4 ± 0.55 vs. 3.5 ± 0.48. In CBT group, the mean scores of social concern, sexual concern, arital concern, rejection of child-free lifestyle, and need for parenthood decreased meaningfully ompared to those before starting the therapy. But in fluoxetine group, mean score of women sexual oncern out of those five main problems of infertility reduced significantly. Also, fluoxetine and CBT reduced depression compared to the control group. CBT improved the social concerns, sexual concerns, marital concerns, rejection of child-free lifestyle, and need for parenthood more than floxitine group. Thus, CBT was not only a reliable alternative to pharmacotherapy, but also superior to fluoxetine in resolving and reducing of infertility stress (Registration Number: IRCT2012061710048N1).

To evaluate the impact of the association of endometrioma with or without deep infiltrating endometriosis (DIE) after a first intra cytoplasmic sperm injection- in vitro fertilization (ICSI-IVF) cycle on pregnancy rate. In this retrospective study, women with endometrioma who underwent a first ICSI-IVF cycle from January 2007 to June 2010 were reviewed for pregnancy rate. The main outcome measure was the clinical pregnancy rate. A multiple logistic regression (MLR) was performed; including all variables that were correlated to the conception rate. Only independent factors of pregnancy rate were included in a Recursive Partitioning (RP) model. The study population consisted of 104 patients (37 without DIE and 67 patients with associated DIE). Using multivariable analysis, a lower pregnancy rate was associated with the presence of DIE (OR=0.24 (95% CI: 0.085-0.7); p=0.009) and the use of ICSI (OR=0.23 (95% CI: 0.07-0.8); p=0.02). A higher pregnancy rate was associated with an anti-mullerian hormone (AMH) serum level over 1 ng/ml (OR=4.3 (95% CI: 1.1-19); p=0.049). A RP was built to predict pregnancy rate with good calibration [ROC AUC (95% CI) of 0.70 (0.65-0.75)]. Our data support that DIE associated with endometrioma in infertile patients has a negative impact on pregnancy rate after first ICSI-IVF cycle. Furthermore, our predictive model gives couples better information about the likelihood of conceiving.

In many countries, 1 to 3% of newborn infants are conceived by assisted reproductive techniques (ART). Despite the success of ART, there is concern about the risk of congenital malformations among these infants. We report our experience to determine whether use of ART is associated with an increase in major congenital malformations or adverse pregnancy outcomes. Historical cohort study of major congenital malformations (MCM) was performed in 978 births from January 2008 to December 2010. The data for this analysis were derived from a Tehran’s ART linked data file by simple sampling method. In our study, the risk of congenital malformations was compared in 326 ART infants and 652 naturally conceived (NC) infants. We also performed multiple logistic regression analyses to calculate the odds ratio (OR) and 95% confidence intervals (CI) for the independent association of ART on each outcome. We found 56 infants with major congenital malformations, these included 29 NC infants (4.4%) and 27 ART infants (8.3%). In comparison with NC infants, ART infants had a significant 1.94-fold increased risk of MCM.After adjustment for maternal age, infant’s sex stillbirth, abortion and type of delivery, we found a relatively small difference in risk (OR=2.04). In this study the majority (94.3%) of all infants were normal but 5.7% of infants had at least one MCM. The prevalence rate for the intracytoplasmic sperm injection (ICSI) was 6.5% for the In vitro fertilisation (IVF) group was 15.9% or 2.73-fold higher than ICSI group (P=0.018). Also we ignore the possible role of genotype and other unknown factors in causing more malformations in ART infants. Other studies have shown a slightly increased risk of major congenital malformations in pregnancies resulting from ART. Likewise, this study reports a greater risk of MCMs in ART infants than in naturally conceived infants. We also found evidence of a difference in risk of MCMs between IVF and ICSI. Musculoskeletal and urogenital malformations were the most reported MCMs in ART infants according to organs and systems classification.

Metronidazole (MTZ) is commonly used as an antibacterial and antiprotozoal drug. Various doses of MTZ have been reported to inhibit spermatogenic activity and sperm indices. In this experimental study, dose-dependent effects of MTZ on the structural and functional integrity of the testis and accessory reproductive organs have been investigated. Adult male mice of Swiss strain were administered orally with MTZ at the doses of 250 mg/kgBW/day and 500 mg/kgBW/day for 28 consecutive days to study the changes in the testis, epididymis, seminal vesicle, sperm indices and fertility. Reversal effects of the drug were also studied on the same mice, 42 days after cessation of the treatment. Therapeutic dose of MTZ (250 mg/kgBW/day) neither altered the weights of the testis, epididymis and seminal vesicle nor their histoarchitecture and sperm indices. The drug at the high dose (500 mg/kg BW/day) caused significant reductions in the weights of the testis and epididymis. Histoarchitecture of the testis and epididymis at the high dose revealed marked regressive changes while that of seminal vesicle remained unaffected. Significant reductions were noticed in the motility, viability and count of epididymal spermatozoa while the concentrations of epididymal sialic acid and seminal vesicular fructose remained unaltered after the treatment. No significant changes were noticed in the mating ability as well as in the level of serum testosterone in the treated mice. Fertility of the male mice treated with high dose of MTZ declined markedly leading to an increase in pre- and postimplantation loss while a significant decrease was noticed in the number of live blastocysts in females impregnated with such males. MTZinduced changes in the male reproductive organs and fertility were reinstated 42 days after cessation of the treatment. High dose of MTZ induced reversible deleterious effects on the male reproduction and fertility.

Uterine rupture is a life threatening condition for both the mother and her fetus. It may be seen in the second trimester usually after induction for pregnancy termination in a scarred uterus. Spontaneous rupture in the second trimester before labor is a very rare condition. Here, we report a case of uterine rupture at 23-week pregnancy due to elevated uterine pressure with a history of laparoscopic myomectomy one year before admission. She was symptomatic for diffuse abdominal pain and the ultrasonographic image was interpreted as amniotic band. Four days later, because of deterioration of the patient and fetal bradycardia urgent laparotomy was performed. Fundal rupture with fibrotic borders suggested that a chronic event was seen. Laparoscopic myomectomy has advantages over laparatomy but the possibility of uterine rupture in following pregnancies should not be underestimated. Therefore, repair of the myometrium should be carefully assessed.