International Journal of Reproductive BioMedicine
Volume:11 Issue: 12, Dec 2013

Preterm birth (PTB) is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations. Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. This retrospective cohort study included all preterm (26-37 weeks) infants (n=1612) born alive in Shahid Akbar-abadi university hospital, during one year period (April 2010-2011). These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights (LBW) and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age (GA) of 30 weeks and the youngest infants was a 970 gram female with GA of 25weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation (CPR), need to neonatal intensive care unit (NICU) admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight (VLBW) and extremely low birth weight (ELBW), were risk factors for mortality in preterm neonates. Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant

Recent publications about differentiation of stem cells to germ cells have motivated researchers to make new approaches to infertility. In vitro production of germ cells improves understanding differentiation process of male and female germ cells. Due to the problem of using embryonic stem cells (ESC), it’s necessary the mentioned cells be replaced with some adult multi-potent stem cells in laboratories. The aim of this study was to obtain germ cells from appropriate source beyond ESC and compare differential potentials of adipocytes derived stem cells (ADMSCs) with bone marrow derived stem cells (BMMSCs). To find multi-potential entity, after providing purified ADMSCs and BMMSCs, differentiation to osteoblast and adipocyte was confirmed by using appropriate culture medium. To confirm mesenchymal lineage production superficial markers (expression of CD90 and CD44 and non-expression of CD45 and CD31) were investigated by flowcytometry. Then the cells were differentiated to germ cells in inductive medium containing retinoic acid for 7days. To evaluate germ cells characteristic markers [Dazl (Deleted in azoospermia-like), Mvh (Mouse vasa homolog gene), Stra8 (Stimulated by retinoic acid) and Scp3 (Synaptonemal complex protein 3)] flowcytometry, imunoflorescence and real time PCR were used. Both types of cells were able to differentiate into osteoblast and adipocyte cells and presentation of stem cell superficial markers (CD90, CD44) and absence of endothelial and blood cell markers (CD31, CD45) were confirmative The flowcytometry, imunoflorescence and real time PCR results showed remarkable expression of germ cells characteristic markers (Mvh, Dazl, Stra8, and Scp3). It was found that although ADMSCs were attained easier and also cultured and differentiated rapidly, germ cell markers were expressed in BMMSCs significantly more than ADMSCs.

Assessment of uterine abnormalities is a core part in infertility evaluation. The aim of this study was to evaluate the sensitivity and specificity of three-dimensional hysterosonography (3-DHS) in the diagnosis of uterine abnormalities in infertile women. The infertile women who visited Royan Institute and referred to 3-DHS consecutively, prior to in vitro fertilization, from 2010-2011 included in this cross-sectional study. For patients who underwent hysteroscopy in addition to 3-DHS (214/977), the verification bias adjusted sensitivity and specificity of 3-DHS which were calculated by global sensitivity analysis method. Hysteroscopy was used as the gold standard for diagnosis of uterine abnormalities. Histological diagnosis of resected endometrial tissues by hysteroscopy was assessed and the adjusted sensitivity and specificity of 3-DHS and hysteroscopy in detection of polyp or hyperplasia were determined. Histopathologic results were considered as the gold standard for diagnosis of polyp or hyperplasia. The overall sensitivity and specificity for 3-DHS in diagnosis of uterine anomalies considering hysteroscopy as the gold standard were 68.4% and 96.3% respectively. Sensitivity and specificity of hysteroscopy in diagnose of polyp or hyperplasia was calculated at 91.3% and 81.4% respectively. Sensitivity and specificity of 3-DHS in diagnosis polyps or hyperplasia was calculated at 91.4% and 80.2 % respectively. The results of present study proved that, compared to hysteroscopy; 3-DHS has a reliable specificity for diagnosis of uterine abnormalities. Sensitivity and specificity of 3-DHS and hysteroscopy in detecting polyp or hyperplasia regarding histopathology as the gold standard was the same.

HOXA11 and HOXA10 are expressed in endometrium throughout the menstrual cycle and show a dramatic increase during the mid-luteal phase at the time of implantation. The expression of these genes is decreased in women with myomas. To determine whether myomectomy would reverse HOXA11 and HOXA10 expression, we evaluated the transcript levels of these genes in the endometria of patients before and after myomectomy. Expression of HOXA11 and HOXA10 were examined prospectively during the midluteal phase in endometrium obtained from infertile women (n=12) with myoma before and three months after myomectomy. Endometrial HOXA11 and HOXA10 expression were evaluated using quantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Endometrial HOXA11 and HOXA10 mRNAs expression levels (normalized to 18SrRNA) were increased insignificantly in endometrium of patients after myomectomy (p=0.7 and p=0.15 respectively). The results suggest that the alteration in expression pattern of these genes could not account for some aspects of fertility after myomectomy.

CatSper genes are a novel family of four sperm-specific calcium channels, which indicate testis-specific expression patterns. Despite the crucial role of CatSper genes in the male reproduction, very little is known about the factors that regulate their expression. The objective of this study was to investigate the effects of vitamin E treatment on the expression of CatSper 1 and CatSper 2 genes as well as sperm quality in the aged male mice. Twenty four 11-12 months old aged male mice and twenty four 2-3-months old young male mice were randomly divided into four groups. Control groups received no injection. The experimental groups of male mice were received intraperitoneal injection of 106 mg/kg vitamin E daily for 35 days. Left testis and cauda epididymides from each mouse were collected on the days 21, 28 and 35 following vitamin E treatment and were used for Real-Time PCR and immunohistochemistry. Also, sperm analysis was performed according to the WHO guidelines given for human sperm examination. Data were analyzed using SPSS software. Administration of vitamin E improved sperm parameters in the aged as well as young adult male mice. In addition, the expression of CatSper genes increased following vitamin E treatment. Also, intensity of signal for CatSper1 and CatSper2 increased in the head and middle piece of sperm in experimental group as compared to those of control ones. The vitamin E treatment significantly improved the sperm quality, especially in terms of sperm motility, count and morphology rate. Furthermore, CatSper genes expression could be up-regulated by the vitamin E treatment.

Group B streptococcus (GBS) colonizes the gastrointestinal and genitourinary tract of 10-40% of pregnant women and it is a major cause of neonatal morbidity and mortality. This study was to evaluate whether vaginal GBS culture results alter after digital vaginal examination or not. Antibiotic resistance pattern of this specie has been also assessed. A total of 186 pregnant women with gestational age of 37 weeks were enrolled to the study. Two vaginal swaps were taken before and immediately after digital vaginal examination, then third swap was taken after 48 hours of examination. The cultures were evaluated for bacterial growth and the isolated bacteria were assessed for antimicrobial drugs sensitivity. Positive culture of GBS was seen in 16.1%. Initially negative GBS result was found not to change immediately after examination. But positive cultures were negative in 1.6% of women after digital vaginal examination. After 48 hours 2.7% of initially negative GBS was positive and no one with initially positive GBS had negative culture. Sensitivity to penicillin and vancomycin was 100%, erythromycin 74%, ampicillin 65%, cefazolin 62.8%, cefotaxime 54.2% and ceftizoxime was 40%. The present investigation showed that the vaginal GBS culture result is minimally affected by digital vaginal examination. Drug of choice for GBS eradication is penicillin; vancomycin could be the choice in the case of penicillin hypersensitivity.

Fat-rich diet may alter oocyte development and maturation andembryonic development by inducing oxidative stress (OS) in follicular environment. To investigate the relationship between fat intake and oxidative stress with oocyte competence and embryo quality. In observational study follicular fluid was collected from 236 women undergoing assisted reproduction program. Malon-di-aldehyde (MDA) levels and total antioxidant capacity (TAC) levels of follicular fluid were assessed as oxidative stress biomarkers. In assisted reproduction treatment cycle fat consumption and its component were assessed. A percentage of metaphase ΙΙ stage oocytes, fertilization rate were considered as markers of oocyte competence and non-fragmented embryo rate, mean of blastomer and good cleavage (embryos with more than 5 cells on 3 days post insemination) rate were considered as markers of embryo quality. The MDA level in follicular fluid was positively related to polyunsaturated fatty acids intake level (p=0.02) and negatively associated with good cleavage rate (p=0.045). Also good cleavage rate (p=0.005) and mean of blastomer (p=0.006) was negatively associated with polyunsaturated fatty acids intake levels. The percentage of metaphase ΙΙ stage oocyte was positively related to the TAC levels in follicular fluid (p=0.046). The relationship between the OS biomarkers in FF and the fertilization rate was not significant. These findings revealed that fat rich diet may induce the OS in oocyte environment and negatively influence embryonic development. This effect can partially be accounted by polyunsaturated fatty acids uptake while oocyte maturation is related to TAC and oocytes with low total antioxidant capacity have lower chance for fertilization and further development.

The global prevalence of diabetes mellitus is on rise. Diabetes-induced oxidative stress has been known to affect liver, pancreas, kidney and reproductive organs pathologically. Honey is a natural product of bee with antioxidant properties. Current study aimed to analyze the protective effects of Metformin (MF) alone and MF+ natural honey co-administration on diabetes-induced histological derangements in testis of rats. Thirty six, mature male Wistar rats were randomly divided into six groups including; control, honey-dosed non-diabetic, diabetes-induced (65 mg/kg, single dose), honey-administrated diabetic (1.0 g/kg/day), Metformin-received diabetic (100 mg/kg/day), Metformin and honey-co-treated diabetic which were followed 40 days. The animals were anesthetized by diethyl ether and the blood samples were collected. The serum levels of testosterone, Insulin, LH and FSH analyzed using antibody enzyme immunoassay method. The testicular tissues were dissected out and underwent to histological analyses. The biochemical analyses revealed that the diabetes resulted in significantly reduced testosterone (p<0.01), LH and FSH (P<0.01, 0.001) levels in serum. Light microscopic analyses showed remarkable (p<0.01) reduction in seminiferous tubules diameter (STD), spermiogenesis index (SPI) and thickness of the epithelium in the diabetic group versus control and co-treated groups. Simultaneous administration of the honey with MF could fairly up-regulate testosterone, LH and FSH levels. The animals in metformin and honey-treated group exhibited with improved tubules atrophy, elevated spermiogenesis index and germinal epithelium thickness. Our data indicated that co-administration of Metformin and honey could inhibit the diabetes-induced damages in testicular tissue. Moreover, the simultaneous administration of metformin and honey up-regulated the diabetes-reduced insulin, LH, FSH and testosterone levels.

Routine use of assisted hatching (AH) following ICSI is a controversial issue in the literature. There are rare studies regarding the effect of laser assisted hatching (LAH) on live birth rate. Our main goal was to evaluate the effect of LAH on delivery rate as well as congenital anomaly in patients undergoing their first ICSI cycle. A total of 182 patients subjected to ICSI were randomly aliquot into two groups of experiment and control. In experiment group, the embryos were subjected to LAH to open a hole in ZP (about 10-12 μm) while in control group, the transferred embryos were intact with no AH. The patients were followed for clinical pregnancy and delivery rate as well as congenital anomaly. All the patients were infertile due to male factor infertility and LAH and embryo transfer were done on day 2. Laboratory and clinical characteristics of two groups of experiment and control were the same. There were insignificant differences between two groups of experiment and control for clinical pregnancy rate (20% vs. 23.9%, respectively, p=0.3) and live birth rate (11.11% vs. 8.6%, respectively, p=0.6). Also no significant differences were observed between two groups of experiment and control for multiple pregnancy as well as congenital anomaly. Routine use of LAH in first ICSI cycle for male factor patients may have no beneficial effects on clinical pregnancy and live birth rate.

Ectopic pregnancy is one of the main problems in women in reproductive age that needs special attention and appropriate strategy should be managed. In some cases expectant management seems good strategy without any medicine or surgery and their possible side effects. But are the outcomes always the same? Which outcomes should we expect?Case: We have reported 2 patients whose ectopic pregnancy had been managed conservatively and they had sustained pain for several months which needed surgery to resolve. In the case of ectopic pregnancy, it is important for the clinician to select the patient meticulously and be aware of common and rare consequences of her treatment.

One of the most common endocrine disorders in women of reproductive age is polycystic ovary syndrome (PCOS) which its prevalence is reported around 6.5-8% (1). Some clinical trials assessed association between PCOS and other autoimmune related endocrinopathies such as impaired glucose tolerance (IGT), type 2 diabetes mellitus and thyroid dysfunction with controversial results (2). Some investigators showed increase level of serum antiovarian antibodies in the half of affected women (3, 4). However, the exact mechanism of autoimmune processes in PCOS pathogenesis is remained to be fully elucidated. Autoimmune thyroid disorder including hashimoto’s thyroiditis also has been shown to have correlation with PCOS (5). According to Janssen’s et al study the prevalence of autoimmune thyroiditis (AIT) was three times higher in patients with PCOS compared with control group (6). The cause of this high incidence is open to speculation. Genetic defect was assumed to predispose persons to AIT as well as PCOS. Both disorders seem to have an oligo-genetic background (5, 7). To date, a common genetic background has not been found. Gleicher et al hypothesized that development of PCOS could be attributed to functional autoantibodies including thyroid autoantibodies [anti-thyroid peroxidase antibodies (anti-TPO), and thyroglobulin antibodies (TG-Ab)] (8). Ott et al reported a poor treatment response in infertile PCOS women with elevated anti-TPO levels (9).In a cross-sectional study at Infertility and Reproductive Health Center (IRHRC), we evaluated serum level of thyroid function tests (TFT) including autoantibodies and to assess their relation with other characteristic and hormonal parameters of PCOS. A total of seventy five women with average age of 26 years who fulfilled the 2003 Rotterdam Criteria underwent gynecologic evaluation and blood sampling between January 2009 and December 2011. The mean±SD of serum anti-TPO in Ott et al, Ganie et al, Kachuei et al, Janssen et al and our study were 52.2±98.5, 321.4±189.6, 216±428, 123±328, and 41.06±91.18 IU/ml respectively (5, 6, 9, 10). The wide range of reported values could be attributed to different type of laboratory assessment, value of cut point and heterogeneity of selected patients. About fifteen percent of our patients were anti-TPO positive; the reported range of positive anti-TPO percentage was 15 to 30 in different studies (5, 6, 9, 10 and present study). In fact, the observed ratio in our research is lower than Kachuei’s study which held in a same country (5). In that research, authors did not find difference in rate of positivity between PCOS and control group. Percentage of anti-TPO positivity in Ganie et al and Janssen et al in normal women were zero and eight percent respectively (6, 10). In our study, presence or absence of anti-TPO did not have a major influence on the characteristics and hormonal values of the PCOS patients; only hip circumference and estradiol level were significantly higher in anti-TPO positive cases. In another study this difference was observed for hypoechoic ultrasound pattern, patient’s age and LH to-FSH-ratio. Ott et al suggested that anti-TPO could be a good predictive marker for treatment response in infertile women with PCOS (9). They reported a higher anti-TPO level in patients who were resistant to clomiphene citrate treatment. TSH level in our PCOS patients was 3.16±3.55 mU/l; other investigators report its value between 2 and 3 mU/l. We did not find any difference in biochemical and hormonal serum values of patients between euthyroid and hypothyroid ones. TSH level in PCOS patients and control subjects did not differ significantly in Ganie et al, Kachuei et al researches which is in contrast to the results of Janssen and colleagues (5, 10).High prevalence of thyroid autoimmunity in PCOS women of reproductive age brings this question in our mind that is it necessary to screen these patients for hypothyroidism? Due to increased risk of morbidity in hypothyroid mother and her newborn, it seems logical to assess thyroid function test in suspicious patients. To have a proper answer for this question, however, several prospective researches should be conducted with more number of participants in a longer follow up period. Based on our data, it is more likely to see a disturbance in serum values of thyroid function test and autoantibodies in women with PCOS. We recommend evaluation of these parameters by longitudinal cohort studies with more number of cases and a longer follow up period.

Some studies propose that changes in leptin concentrations (above or under the normal range) result in infertility. Therefore, we investigated serum and follicular fluid leptin concentrations in infertile women with polycystic ovary syndrome (PCOS). To study serum and follicular fluid leptin concentrations in infertile women with PCOS. We conducted a case-control study. The case group consisted of 30 infertile women with PCOS who were admitted to the Infertility Department of Imam Khomainy Hospital in Ahvaz, Iran. The control group consisted of 30 healthy fertile women adjusted for age and body mass index (BMI) with the case group. On day 14 of the menstrual cycle, 5 ml of blood was obtained from subjects in both groups. Serum and follicular fluid leptin concentrations were determined by the enzyme linked immunosorbent assay (ELISA). A Biovendor kit was used for the measurement of leptin concentrations. All data were analyzed using statistical package for the social sciences (SPSS) software (version 17.0, Nie, Bent & Hull, USA). There was a significant correlation between BMI and serum leptin concentrations in both the control (p=0.005, r=0.516) and case groups (p=0.006, r=0.547). In the case group, serum leptin concentrations were consistent with follicular fluid leptin concentrations (p<0.001, r=0.839). Comparison of serum leptin concentrations between the case and control groups revealed no significant difference (p=0.56). Infertility among women with PCOS was not a consequence of changes in leptin concentrations.