international journal of fertility and sterility Int J Fertil Steril | Royan Institute (original) (raw)

Papers by international journal of fertility and sterility Int J Fertil Steril

Volume 18, Issue 4, October , 2024

Background: Threatened abortion (TA) is associated with adverse pregnancy outcomes. Despite the a... more Background: Threatened abortion (TA) is associated with adverse pregnancy outcomes. Despite the attention paid to the adverse outcomes of obstetrics, only a few studies have been conducted on the psychological status of women with threatened abortion. This study aimed to compare the symptoms of depression and anxiety in women with TA and those without threatened abortion. Materials and Methods: In a case-control study, 136 women with TA (the case group) and 136 women without TA (the control group), were matched with the case group in terms of gestational age, education level, age, and number of pregnancies, were examined from Obstetric clinics of Babol University of Medical Sciences. Demographic information and pregnancy history were obtained from all participants. Additionally, the women filled out the BSI-18 questionnaire. Statistical analysis was performed using SPSS version 22 software. Results: The results showed that in women with threatened abortion, the likelihood of experiencing depression symptoms was 1.9 times higher [odds ratio (OR)=1.91, 95% confidence interval (CI)=1.13-3.23, P=0.015], anxiety symptoms were 1.8 times higher (OR=1.83, 95% CI=1.08-3.10, P=0.024), and somatization was 2.6 times higher (OR=2.65, 95% CI=1.61-4.37, P<0.001) compared to pregnant women without threatened abortion. Additionally, in women with threatened abortion, the risk of psychological distress was 3.3 times higher (OR=3.30, 95% CI=1.96-5.56, P<0.001) than in women without threatened abortion. Conclusion: This study suggests that gynecologists, midwives, and healthcare providers, in addition to providing medical care for women threatened with abortion, should identify women at risk of experiencing symptoms of depression and anxiety. Providing appropriate psychological support should be prioritized in the management of women with threatened abortion.

Volume 18, Issue 4, October , 2024

Background: Sperm DNA fragmentation is an important factor that affects male fertility. This stud... more Background: Sperm DNA fragmentation is an important factor that affects male fertility. This study intends to evaluate the impact of sperm DNA damage [single-strand breaks (SSB) and double-strand breaks (DSB)] on fertilisation and embryonic euploidy after intracytoplasmic sperm injection (ICSI). Of the different sperm selection techniques, the novel microfluidic sperm sorting (MSS) ZyMōt™ ICSI device reduces both SSB and DSB in semen samples. The second objective is to study the impact of this MSS device on fertilisation and embryonic euploidy. Materials and Methods: This retrospective study included data from 167 ICSI treatments. The alkaline and neutral Comet assays were used to analyse SSB and DSB, respectively. Analysis of fertilisation and embryo euploidy rates was performed in four groups of patients with normal/altered SSB or DSB values. Density gradient centrifugation (DGC) and the ZyMōt™ ICSI MSS device were used for semen preparation. Results: Fertilisation rates in 167 ICSI cycles were higher when using sperm from patients with normal SSB values (70.84%) and patients with abnormal SSB whose samples were processed using the MSS device (69.71%) compared to patients with abnormal SSB values using DGC (58.49%). Preimplantation genetic testing for aneuploidies (PGT-A) revealed a higher embryo euploidy rate in patients with normal DSB values (60.00%) and patients with abnormal DSB whose samples were processed using the MSS device (44.59%) compared to patients with abnormal DSB values using DGC (36.84%). When female age was considered, there were fewer euploid embryos in women ≥35 years of age compared to younger women, independently of SSB and DSB. The number of euploid embryos increased when the MSS device was used. Conclusion: High SSB and DSB values in semen samples decreased fertilisation rates and embryonic euploidy, respectively. The ZyMōt™ ICSI device for semen preparation increased both rates, especially in couples that included women <35 years old.

Volume 18, Issue 4, October , 2024

Background: Testicular torsion is a surgical emergency leads to severe acute ischemia injuries, a... more Background: Testicular torsion is a surgical emergency leads to severe acute ischemia injuries, and may eventually cause male infertility. The nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domaincontaining 3 (NLRP3) inflammasome is involved in testicular torsion pathophysiology. The aim of this study was to evaluate the effects of nanocurcumin (nCur) on testicular tissue and the NLRP3 inflammasome components. Materials and Methods: In this experimental study, male Wistar rats (n=36) were randomly divided into six equal groups: controls, ischemia-reperfusion (I/R), I/R+nCur (50 or 100 mg/kg thirty minutes before reperfusion), and I/ R+nCur (50 or 100 mg/kg thirty minutes before reperfusion and continued for seven days). The left testis was rotated 720 (2×360) degrees counterclockwise to induce testicular torsion. After two hours of ischemia, detorsion was performed. At the end of treatment, an orchiectomy was carried out. The testis histopathology and the mRNA levels of NLRP3, apoptosis-associated speck-like protein (ASC), and Caspase-1 were evaluated. Results: Our results revealed that, testicular I/R had a detrimental effect on testis histology such as the number of spermatogonia (14.5 ± 0.57, P<0.001) and the seminiferous tubules epithelium thickness (28.5 ± 11.7, P=0.007). It also significantly increased the expression of the NLRP3 inflammasome components (P<0.001). Treatment with nCur (in both doses) improved testicular damage and significantly reduced the expression of NLRP3 (P=0.007), ASC (P=0.003), and Caspase-1 (P<0.001). Conclusion: These results imply that nCur might be a useful therapeutic strategy in the field of reproductive medicine to diminish the side effects of testicular I/R via its anti-inflammatory properties and may be employed as adjuvant therapy to lessen testicular torsion complications.

Volume 18, Issue 4, October , 2024

Background: The objective of this study was to investigate the correlation between the expression... more Background: The objective of this study was to investigate the correlation between the expression levels of sperm microRNA-149b and 34c and sperm quality in men diagnosed with oligoasthenoteratozoospermia. Materials and Methods: In the experimental study, we recruited 30 infertile men with oligoasthenoteratozoospermia and 30 control samples. In this study, miR-149b and miR 34c expression using reverse transcription polymerase chain reaction (RT-PCR) were evaluated. Semen samples were collected and subjected to initial analysis, including semen parameters, following the protocol provided by the World Health Organization (WHO). The levels of total antioxidant capacity (TAC) and malondialdehyde (MDA) were measured using an ELISA kit. Results: The expression levels of miR-149b and miR-34c were significantly downregulated in men with oligoasthenoteratozoospermia compared to age-matched normozoospermic men, as determined by RT-qPCR (P=0.001, and P=0.003 respectively). Correlation analysis revealed a positive correlation between the expression levels of miR-149b and miR-34c and various sperm parameters, including sperm count, motility, morphology, viability, sperm mitochondrial membrane potential, sperm capacity, and TAC. Additionally, an inverse correlation was observed between the expression levels of miR-149b, miR-34c, DNA fragmentation, and MDA levels. Conclusion: The findings of this study indicate that the decreased expression of miR-149b and miR-34c is associated with oligoasthenoteratozoospermia, potentially affecting fundamental semen parameters. These results provide a basis for future research aimed at exploring potential therapeutic interventions for male infertility.

Volume 18, Issue 4, October , 2024

Background: This study aims to investigate the effects of carob (Ceratonia siliqua L.) pod extrac... more Background: This study aims to investigate the effects of carob (Ceratonia siliqua L.) pod extract (CPE) on the viability of human endometrial mesenchymal stromal/stem cells (EnMSCs) and its impact on mRNA and protein expressions of DNA methyltransferases (DNMT1, DNMT3A, and DNMT3B), histone deacetylase 1 (HDAC1), matrix metalloproteinase-2 (MMP2), and cyclooxygenase-2 (COX-2) in endometriotic patients. Materials and Methods: In this experimental study, EnMSCs were derived from endometrium of patients with ovarian endometrioma (OMA-EnMSCs group) and deep infiltrative endometriosis (DIE) samples of 10 endometriosisassociated infertility (EAI) women (E-EnMSCs group) and compared to EnMSCs derived from the endometrium of an endometriosis-free, normal woman as the control group (C-EnMSCs). The metabolic activity of the control and case groups were evaluated by treating them with different concentrations of CPE. Cell viability was analysed by MTT. Real-time reverse transcription-polymerase chain reaction (RT-PCR) and Western blot were used to evaluate the expression of specific genes at the mRNA and protein levels, respectively. Results: Treatment with 0.8 and 2 μg/mL of CPE downregulated COX-2 and HDAC1 in the E-EnMSC group compared to the C-EnMSCs group. Treatment with 0.8 μg/mL of CPE also decreased MMP2 and DNMT3B gene expressions. The COX-2 and DNMT3A genes were significantly upregulated after treatment with 2 μg/mL of CPE. Expressions of the COX-2, HDAC1, DNMT1, DNMT3A, and DNMT3B peptides decreased in the all three groups

Volume 18, Issue 4, October , 2024

Background: Endometriosis is an idiopathic gynecological condition affecting women with pelvic pa... more Background: Endometriosis is an idiopathic gynecological condition affecting women with pelvic pain and infertility in reproductive ages. Due to preventive and therapeutic effects of soy isoflavones (SI) and broccoli extract (BE) on tumor angiogenesis, inflammation and oxidative stress and since endometriosis is accompanied by chronic inflammation, in this study, we aim to evaluate the potential role of these compounds on the pathological scores of endometriosis and also consider the expression level of the gene markers of autophagy, apoptosis, and oxidative stress in an endometriosis rat model. Materials and Methods: In the present experimental study, 45 mature female Sprague-Dawley rats weighing 220 ± 20 g at the age of eight weeks with surgically induced endometriosis was divided into five groups and treated for six weeks with normal saline (control group), BE, SI, BE+SI by oral gavage, and also Diphereline intramuscularly. The histopathological scores of the endometrial implants (0, 1, 2, 3: no, poorly, moderately and well-preserved epithelial layers, respectively) and the mRNA expression level of Bcl-2, Bax, Caspase-3, Beclin-1, Lc3, and Sod within peritoneal tissue were compared among the groups. Results: Pathologic scores of the implants in the Diphereline (1.2 ± 0.27) and BE+SI (1.2 ± 0.41) groups were declined significantly in comparison with the control group (2.08 ± 0.44) (P≤0.001). In the endometriotic structures, the mRNA expression levels of our target genes were improved significantly (P≤0.01) in comparison with the control group. Conclusion: The findings of the current study demonstrated that the simultaneous consumption of a certain amount of broccoli extract and SI can be considered as a promising therapeutic strategy for treatment of endometriosis.

Volume 18, Issue 4, October , 2024

Background: In recent times, various algorithms have been developed to assist in the selection of... more Background: In recent times, various algorithms have been developed to assist in the selection of embryos for transfer based on artificial intelligence (AI). Nevertheless, the majority of AI models employed in this context were characterized by a lack of transparency. To address these concerns, we aim to design an interpretable tool to automate human embryo evaluation by combining artificial neural networks (ANNs) and genetic algorithms (GA). Materials and Methods: This retrospective cohort study included 223 human blastocyst time-lapse (TL) images taken at 110 hours post-injection. All the images were evaluated by five embryologists from different clinics in terms of blastocyst expansion (BE), quality of the inner cell mass (ICM), and trophectoderm (TE). The embryo database was used to develop an AI system (70% training, 15% validation, and 15% test) for automate blastocyst assessment. The entire set of images underwent a standardization process, followed by processing and segmentation using Matlab software. The resulting quantified variables were utilized in AI techniques (ANN and GA). Finally, the accuracy and performance of the automation tool was assessed with the area under the receiver operating characteristic (ROC) curve (AUC). Then, the level of agreement among embryologists and between embryologists and the AI system was compared with Kappa Index. Results: The overall agreement among embryologists was low (Kappa: 0.4 for BE; and 0.3 for TE and ICM). The AI tool achieved higher consistency (Kappa 0.7 for BE and ICM; and 0.4 for TE). The AI exhibited high accuracy in classifying BE (test 81.5%), ICM (test 78.8%), and TE (test 78.3%) and better performance for BE (AUC 0.888-0.956) than for ICM (AUC 0.605-0.854) and TE (AUC 0.726-0.769) assessment. Conclusion: Our AI tool highlighted the superior consistency of AI compared to human operators in grading blastocyst morphology. This research represents an important step towards fully automating objective embryo evaluation.

Volume 18, Issue 4, October , 2024

Background: Circulating microRNAs (miRNAs or miRs) are key regulators of a wide array of biologic... more Background: Circulating microRNAs (miRNAs or miRs) are key regulators of a wide array of biological processes that aberrantly express under physiological as well as pathological conditions. This study aims to determine whether altered expression of circulating miR-223-3p in plasma is associated with an increased risk of idiopathic recurrent pregnancy loss (iRPL), and if it could be a novel non-invasive biomarker for diagnosis of iRPL. Materials and Methods: In this case and control study, Plasma samples were obtained from 60 women with a history of ≥ 2 consecutive miscarriages and 60 women with at least one full-term pregnancy and no history of miscarriage. The samples were used to assess the expression of circulating miR-223-3p by quantitative real-time polymerase chain reaction (qPCR) and determine the correlation between patient clinico-demographic parameters and miR-223-3p expression levels. We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic accuracy of miR-223-3p for the diagnosis of iRPL. Results: There was significant up-regulation in miR-223-3p expression in patients with iRPL compared with healthy controls (P=0.002). No significant correlation was found between the expression level of miR-223-3p and the number of miscarriages in iRPL patients (P=0.344). ROC curve analysis revealed that the area under the curve (AUC) value for miR-223-3p was 0.658 [95% confidence interval (95% CI): 0.5590.757, P=0.002). Conclusion: These results suggest that a higher expression level of circulating miR-223-3p may be closely related with the increased risk of iRPL and possibly serve as a promising non-invasive diagnostic biomarker for iRPL.

Volume 18, Issue 4, October , 2024

Background: While the effects of polycystic ovary syndrome (PCOS) and infertility on women's heal... more Background: While the effects of polycystic ovary syndrome (PCOS) and infertility on women's health have often been discussed, not many studies have assessed the other complications of infertility. One of these complications is female sexual dysfunction (FSD), a range of psychosexual disorders. The aim of this study is to investigate the prevalence of FSD in PCOS and its comparison with other causes of infertility. Materials and Methods: In this cross-sectional study, two questionnaires were filled out by two groups (60 people each) of infertile patients, due to PCOS and other causes, referred to Arash Women's Hospital from December 2018 to 2019. The data was analyzed in SPSS software to evaluate the frequency of FSD in the whole study population and each group separately as well as its relationship with age, history of pregnancy, the literacy level of the patient or spouse, body mass index (BMI), infertility duration, hirsutism, and acne. Results: The frequency of FSD in the study group had a significant inverse relationship with the women's level of education (P=0.044), although no such correlation was found with age, pregnancy history, spouse's literacy level, BMI, duration of infertility, acne, and hirsutism. In the comparison group, there was a significant relationship between the duration of infertility and FSD (P=0.002). The prevalence of FSD in the study and comparison groups was 43.1 and 52%, respectively. The prevalence of FSD sub-domains in all categories, except for pain, was higher in the study group. PCOS, compared to other groups, presented at a relatively younger age. Conclusion: In the PCOS group, patients with lower education levels were more likely to suffer from FSD. This suggests the effect of education and awareness on the sexual performance of these people. No significant difference in FSD experience was found between PCOS and other groups.

Volume 18, Issue 4, October , 2024

Background: Endometriosis, is a prevalent condition among women of childbearing age, characterize... more Background: Endometriosis, is a prevalent condition among women of childbearing age, characterized by the presence of ectopic endometrial glands. It is associated with pelvic pain and infertility. Unfortunately, the diagnosis of endometriosis is often delayed in many patients. While laparoscopic investigation is required for a definitive diagnosis, physical examination combined with ultrasonography can provide reasonably accurate detection. Machine learning (ML) techniques have shown promise tools in medical imaging and diagnostics. However, there is a lack of sufficient ML studies focusing on Iranian endometriosis female patients. In this study, we aimed to compare the diagnostic accuracy of different ML algorithms for endometriosis detection. Materials and Methods: In this retrospective study, our objective was to assess the diagnostic accuracy of different ML algorithms in classifying suspicious cases of endometriosis using ultrasonographic signs. Our data set consisted of 505 patients, among which 149 were confirmed cases of endometriosis. We divided the data set into training and test sets to train and evaluate the performance of the ML models. To ensure robust evaluation, we employed stratified 5-fold cross-validation and calculated the area under the receiver operating characteristic curve (AUC) as a measure of model performance. Results: In the test set, a total of 37 out of 127 patients (29.1%) were diagnosed with endometriosis, while in the training set, 112 out of 378 patients (29.6%) were confirmed to have the condition. Sensitivities ranged from 59.5 to 75.7%, and specificities ranged from 71.7 to 83.3%. Notably, the SVM, Random Forest, Extra-Trees, and Gradient Boosting models exhibited the highest performance, with AUCs of 0.76. Conclusion: Our study supports the use of ML models for the screening and diagnosis of endometriosis. The superior performance of the SVM, Random Forest, Extra-Trees, and Gradient Boosting models, as indicated by their high AUCs, suggests their potential as valuable tools in improving the accuracy of endometriosis detection.

Volume 18, Issue 4, October , 2024

Background: Frozen embryo transfer (FET) has been increasingly used due to advancements in cryopr... more Background: Frozen embryo transfer (FET) has been increasingly used due to advancements in cryopreservation techniques and the safety advantages. This study aims to determine various factors influencing the successful FET. Materials and Methods: Retrospective cohort analysis included 1112 women who underwent programmed FET between January 2012 and October 2022, at King Chulalongkorn Memorial Hospital, Thailand. Patient characteristics, embryo characteristics, endometrial preparation protocol, endometrial characteristics (thickness, pattern), embryo transfer procedure (tip and flow during transfer, embryo placement location, the difficulty of the procedure, presence of blood and mucous at catheter), and operator factor were analyzed. Multiple logistic regression analysis was used to assess the relationship between collected variables and successful embryo transfer which is defined by clinical pregnancy. Results: The overall clinical pregnancy rate was 34.2%. Women aged 35-40 years and >40 years were less likely to have a clinical pregnancy compared to those aged <35 years [adjusted odds ratio (aOR): 0.523; 95% confidence intervals (CI): 0.360-0.757, P<0.001 and aOR: 0.260; 95% CI: 0.152-0.434, P<0.001, respectively]. Obese women with body mass index (BMI) ≥25 kg/m 2 were significantly associated with decreased clinical pregnancy (aOR: 0.632; 95% CI: 0.403-0.978, P=0.042) compared to those with normal BMI. Day-3 and day-4 embryo transfer showed a significant decrease in clinical pregnancy compared to blastocyst transfer (aOR: 0.294; 95% CI: 0.173-0.485, P<0.001 and aOR: 0.497; 95% CI: 0.265-0.900, P=0.024). Double embryo transfer (DET) was 1.78 times more likely to have a clinical pregnancy than women with single embryo transfer (SET) (aOR: 1.779; 95% CI: 1.293-2.458, P<0.001). The cycles with endometrial thickness <8 mm were associated with a decrease in clinical pregnancy compared with those with a thickness ≥8 mm (aOR: 0.443; 95% CI: 0.225-0.823, P=0.013). Conclusion: Older age, obesity, non-blastocyst transfer, single embryo transfer, and endometrial thickness of <8 mm were significantly associated with a decreased clinical pregnancy in programmed FET.

Volume 18, Issue 4, October , 2024

Background: This study aimed to determine the alteration of endometrial expression levels of HOXA... more Background: This study aimed to determine the alteration of endometrial expression levels of HOXA9/HOXA10/ HOXA11/HOXD10 genes and HOX transcript antisense intergenic RNA (HOTAIR) in mid-luteal phase endometrium in patients with hydrosalpinx before and after salpingectomy. Materials and Methods: In this prospective study, 14 infertile women with unilateral hydrosalpinx who were scheduled for laparoscopic salpingectomy were evaluated. The presence of hydrosalpinx was confirmed by hysterosalpingography or transvaginal 2D-ultrasonography. All patients had normal hormonal profiles, body mass index, and regular menstrual cycles identified by mid-luteal serum progesterone. Fourteen healthy fertile age-matched women with a successful pregnancy history were considered the control group. Mid-luteal-phase endometrial biopsies were performed at the time of surgery and during the mid-luteal phase of the fourth treatment cycle by Pipelle. After tissue collection, RNA extraction and cDNA synthesis were performed. Real-time polymerase chain reaction (PCR) technique was used for quantitative gene expression of HOXA9/HOXA10/ HOXA11/ HOXD10 and lnc HOTAIR. Results: The endometrial expression of HOXA9 (P<0.001), HOXA10 (P=0.001), HOXA11 (P=0.003), and HOXD10 (P=0.004) were significantly lower in the patients with hydrosalpinx compared to the controls. After salpingectomy, we observed a significant increase in the endometrial HOXA9 (P=0.006) and HOXA10 (P=0.023) mRNA expression levels compared to before salpingectomy samples. Similarly, a significant upregulation in endometrial HOXA11 (P= 0.013) and HOXA10 mRNA expression levels (P=0.012) were detected in postoperative samples compared to preoperative tissue. Moreover, the lnc HOTAIR was significantly higher in the endometrium-induced hydrosalpinx fluid than in controls (P=0.020), which had a 2.89-fold decrease following salpingectomy (P=0.010). Conclusion: Elevated endometrial lncRNA HOTAIR may disrupt the expression of endometrial receptivity HOX genes in women with hydrosalpinx. However, our results failed to show a significant inverse correlation between HO-TAIR and HOX genes due to limited sample size. Further studies with larger sample sizes are required to investigate HOTAIR inverse co-expression with HOX genes in these subjects.

Volume 18, Issue 4, October , 2024

Background: The role of laparoscopy and hysteroscopy in managing unexplained infertility (UI) is ... more Background: The role of laparoscopy and hysteroscopy in managing unexplained infertility (UI) is debatable because of the improved success rate of assisted reproductive technologies (ART). This study aims to assess the findings of laparoscopy and hysteroscopy in selected women diagnosed with UI to determine the frequency of such pathological conditions in order to manage them properly. Materials and Methods: The current cross-sectional study was conducted on 96 women who attended an infertility clinic at the educational hospitals of Isfahan University of Medical Sciences from March 2018 to February 2020. The participants had one or more of the following conditions: had failed to conceive after 2-3 cycles of ovulation induction with clomiphene citrate and intrauterine insemination (IUI), had a history of pelvic infection, pelvic surgery, or ectopic pregnancy (EP). Laparoscopy and hysteroscopic findings were recorded for all participants. Results: Fifty-nine (61.4%) women had primary infertility, while 37 (38.6%) suffered from secondary infertility. In patients with primary and secondary infertility, 42.3 and 43.2% had laparoscopic abnormalities, respectively. Additionally, 33.8 and 21.6% of the participants had hysteroscopic abnormalities in the primary and secondary groups, respectively. The most common findings in the two groups of infertility who had done laparoscopy were endometriosis (21.8%, P=0.201) followed by tubal pathology (13.5%, P=0.952). Also, the most common intrauterine pathology found in both groups were uterine septum (7.2%, P=0.753) and endometritis (6.2%, P=0.241). Conclusion: Based on the findings of this study, laparoscopy is recommended in UI after three failed IUI and ovarian stimulation, a history of pelvic pain, pelvic surgery, or pelvic infection; however, it seems that further investigation is required to recommend universal hysteroscopy to all women with UI. Nonetheless, it is still emphasized that regional practice in one's local settings may also be effective concerning the prevalence of these pathologies.

Volume 18, Issue 4, October , 2024

Semen quality is considered as an alternative measure for men's fertility. Several studies have e... more Semen quality is considered as an alternative measure for men's fertility. Several studies have examined the association between the hepatitis B virus (HBV) infection and semen quality, but the findings have been inconclusive. This study investigated the effects of HBV on semen quality. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020, as well as Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guideline. In this study, international electronic databases including PubMed (National Library of Medicine), Web of Science, Scopus and Cochrane Library and also Persian databases including Scientific Information Database (SID) and Magiran were searched without a time limit until June 2023. All cohort and case-control studies examining the effects of HBV infection on the semen parameters of infertile men were included in the study. Animal studies, letters to the editor and case reports were excluded. The Newcastle-Ottawa scale was used to evaluate the quality of the included articles. Data analysis was done with Stata software. Of the 913 studies, 13 observational studies comprised a total of 10156 patients were included in this review, nine of which were included in the meta-analysis. The results showed that HBV infection has a negative effect on semen volume (95% confidence interval (CI):

Volume 18, Issue 4, October , 2024

Preeclampsia (PE) remains a significant cause of maternal and neonatal morbidity and mortality, p... more Preeclampsia (PE) remains a significant cause of maternal and neonatal morbidity and mortality, particularly in high-risk pregnancies. The present study aims to assess the efficacy of L-arginine supplementation in preventing PE and improving maternal and neonatal outcomes in high-risk pregnancies. We searched international databases (ISI, PubMed, Scopus, and Embase) and extracted studies that evaluated the efficacy of L-arginine for preventing PE and improving maternal and neonatal outcomes in high-risk pregnancies. The data collected were analysed utilising the random-effects model in Stata (version 15). Out of the collected studies, 10 met the eligibility criteria, comprising a total sample size of 1165 subjects (586 cases and 584 controls). The mean age of the cases was 28 ± 5.05 years, while that of the controls was 27.32 ± 4.58 years. The results revealed that L-arginine was more effective in reducing the incidence of PE than placebo [odds ratio (OR)=0.36, 95% confidence interval (CI): 0.17, 0.77]. Also, the results showed no statistically significant difference between the two groups in systolic blood pressure (SBP; standard mean difference (SMD):-0.35, 95% CI:-91, 21) and diastolic blood pressure (DBP; SMD:-0.50, 95% CI:-1.08, 0.07). There was a statistically significant difference in neonatal birth weight between the two groups (SMD:-0.16, 95% CI:-31,-0.01). No statistically significant difference existed between the two groups in terms of gestational age (SMD: 0.6, 95% CI:-0.06, 0.18). Furthermore, there was no significant difference between the two groups in the APGAR score at one minute (SMD: 0.40, 95% CI:-0.02, 0.82). Our findings revealed that L-arginine supplementation during pregnancy reduced the incidence of PE in high-risk pregnancies. However, it does not significantly improve maternal and neonatal outcomes.

Volume 18, Issue 4, October , 2024

There is a significant increase in the use of complementary and alternative medicine (CAM) by inf... more There is a significant increase in the use of complementary and alternative medicine (CAM) by infertile patients. This study aimed to assess the prevalence of CAM use by infertile patients. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The required data were obtained by searching English databases (PubMed and Web of Science) as well as Google Scholar as an additional source of records. We included cross-sectional studies published in English journals up to March 2023 that examined the prevalence of CAM use among infertile patients in different countries. The retrieved articles were independently assessed by two reviewers. Discrepancies were resolved by discussion with the intent to reach a consensus. We reviewed 1192 documents. From these, 29 studies were included in this systematic review and meta-analysis. The results of meta-analysis conducted on 32, 804 infertile patients showed a prevalence rate of CAM use between 26.3% [95% confidence interval (CI): 21.7%-31.3%] and 96.1% (95% CI: 95.7%-96.5%) in various countries. The pooled prevalence rate calculated by the random effects model showed that, overall, 54% (95% CI: 46%-61%) of both infertile women and men used CAM, whereas 55% (95% CI: 47%-67%) of infertile women and 29% (95% CI: 17%-41%) of infertile men reported treatment with CAM. More than half of the infertile patients used CAM. Therefore, healthcare practitioners need to be aware of this practice to better provide care for infertile patients. Further studies should examine the reasons for CAM use by infertile patients.

Volume 18, Issue 4, October , 2024

Endometriosis is a common gynecological disease that occurs in between 6 and 10% of women who are... more Endometriosis is a common gynecological disease that occurs in between 6 and 10% of women who are at reproductive maturity. The presence of endometrial tissue outside the uterine cavity is the defining characteristic of this disease. Although the etiology of endometriosis remains controversial, there is a general consensus that multiple biological processes such as angiogenesis and vasculogenesis, oxidative stress, and inflammation contribute to its complex pathophysiology. Patients' expectations and priorities influence the treatment plan that is selected. For instance, therapy with hormone medications is inappropriate for endometriosis patients who wish to become pregnant since these medications interfere with ovulation. On the other hand, considering that the current endometriosis treatments are associated with recurrence of pain and disease despite the treatment of the disease and have many side effects, the design and application of non-hormonal drugs in this field is very necessary. Therefore, in this article, we tried to have an overview on non-hormonal treatments by considering angiogenesis, oxidative stress, and inflammation as important biological processes involved in endometriosis.

Volume 18, Issue 4, October , 2024

While international guidelines on oncofertility practice have been published in developed countri... more While international guidelines on oncofertility practice have been published in developed countries, there is limited information available on oncofertility practice in developing countries, which often face limitations in their cancer health support networks. As survival rates improve in the field of cancer and other diseases, there is a growing need for stronger oncofertility services in developing countries. Given that 50% of cancer patients are under the age of 65, many of these patients are of reproductive age and preserving their fertility health prior to starting treatment is valuable. However, due to resource limitations and the heavy burden of treatment costs imposed on these patients and their families, fertility preservation (FP) may not be a top priority for them. As a result, many healthcare providers and their patients focus on eliminating cancer and its related treatments while overlooking the importance of fertility as a factor that can significantly impact their future quality of life. In this review, we have tried to increase the knowledge of healthcare providers involved in the oncofertility network by reviewing current cancer treatments, FP options in female cancer patients, and their challenges in developing countries.

Int J Fertil Steril, Vol 18, Suppl 1, June , 2024

Background: Severe oligoasthenoteratozoospermia (OAT), characterized by a reduced sperm count, mo... more Background: Severe oligoasthenoteratozoospermia (OAT), characterized by a reduced sperm count, motility, and altered morphology, presents a significant challenge in the field of male infertility. Platelet-rich plasma (PRP), renowned for its regenerative capabilities, emerges as a potential intervention for this condition. This study aims to explore the impact of PRP on male infertility, focusing specifically on individuals with severe OAT. Materials and Methods: The clinical trial study involved 88 infertile men diagnosed with OAT and devoid of underlying diseases. These participants were referred to the infertility center and subsequently divided into two cohorts: a control (44 individuals) and an intervention group (44 individuals). Patients in the intervention group received 2 cc of PRP in each testicle, prepared by centrifuging the patients autologous blood samples. Sperm parameters and DNA fragmentation index (DFI) of the patients were measured before and after the procedure. Statistical analysis used SPSS version 16 software, with a significance level set at less than 5%. Results: The statistical analysis revealed a significant difference in concentration (11.32 ± 8.44 vs. 16.06 ± 15.16, P=0.030), progressive motility (8.86 ± 7.79 vs. 11.97 ± 11.82%, P=0.014) and DNA fragmentation (25.62 ± 12.84 vs. 17.23 ± 9.15%, P<0.001) between the control and intervention groups after PRP injection. However, no significant difference was found in normal morphology (1.63 ± 1.44 vs. 1.81 ± 3.68%, P=0.628) and volume (2.13 ± 0.82 vs. 2.24 ± 1.43, P=0.663) between the control and intervention groups after PRP injection. Conclusion: This study demonstrates the effectiveness of PRP treatment in increasing sperm concentration and motility, while also reducing sperm DNA fragmentation. However, further studies are needed to validate these findings (registration number: IRCT20220317054318N2).

Int J Fertil Steril, Vol 18, Suppl 1, June , 2024

Background: In this phase I clinical trial, our primary objective was to develop an innovative th... more Background: In this phase I clinical trial, our primary objective was to develop an innovative therapeutic approach utilizing autologous bone marrow-derived mesenchymal stromal/stem cells (BM-MSCs) for the treatment of nonobstructive azoospermia (NOA). Additionally, we aimed to assess the feasibility and safety of this approach. Materials and Methods: We recruited 80 participants in this non-randomized, open-label clinical trial, including patients undergoing NOA treatment using autologous BM-MSCs (n=40) and those receiving hormone therapy as a control group (n=40). Detailed participant characteristics, such as age, baseline hormonal profiles, etiology of NOA, and medical history, were thoroughly documented. Autotransplantation of BM-MSCs into the testicular network was achieved using microsurgical testicular sperm extraction (microTESE). Semen analysis and hormonal assessments were performed both before and six months after treatment. Additionally, we conducted an in-silico analysis to explore potential protein-protein interactions between exosomes secreted from BM-MSCs and receptors present in human seminiferous tubule cells. Results: Our results revealed significant improvements following treatment, including increased testosterone and inhibin B levels, elevated sperm concentration, and reduced levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. Notably, in nine patients (22.5%) previously diagnosed with secondary infertility and exhibiting azoospermia before treatment, the proposed approach yielded successful outcomes, as indicated by hormonal profile changes over six months. Importantly, these improvements were achieved without complications. Additionally, our in-silico analysis identified potential binding interactions between the protein content of BM-MSC-derived exosomes and receptors integral to spermatogenesis. Conclusion: Autotransplantation of BM-MSCs into the testicular network using microTESE in NOA patients led to the regeneration of seminiferous tubules and the regulation of hormonal profiles governing spermatogenesis. Our findings support the safety and effectiveness of autologous BM-MSCs as a promising treatment modality for NOA, with a particular focus on the achieved outcomes in patients with secondary infertility (registration number: IRCT20190519043634N1).

Volume 18, Issue 4, October , 2024

Int J Fertil Steril, Vol 18, Suppl 1, June , 2024