International Journal of Reproductive BioMedicine
Volume:6 Issue: 2, Jan 2008

It has been shown that reactive oxygen species (ROS) can lead to deleterious effects on a range of sperm parameters. Vitamins E and C are capable of reducing ROS levels and lipid peroxidation.

The aim of study was to determine the level of lipid peroxidation as indicated by Malondialdehyde (MDA) and vitamins E and C in sperm and seminal plasma of asthenoteratozoospermic and normozoospermic men and their relationships with semen parameters.

Forty men with normozoospermic and 60 infertile men with asthenoteratozoospermic semen profiles were randomly selected. Semen analysis was done according to the WHO standard. Sex hormonal profiles were measured by ELISA methods. The level of vitamins (C and E) and MDA were measured by HPLC and tiobarbiotic acid, respectively.

MDA concentration in the spermatozoa (0.1±0.06 nmol/ml) and seminal plasma (1.9±0.35 nmol/ml) of asthenoteratozoospermic were significantly higher than in normozoospermic males (p<0.001).The level of vitamins E and C in seminal plasma of normozoospermic were significantly higher than in asthenoteratozoospermic males (p<0.01). However, the amount of vitamin C in the spermatozoa of normozoospermic was significantly less than in asthenoteratozoospermic males (p<0.01). Sensitivity, specificity, positive and negative prognostic value of MDA of seminal plasma and spermatozoa were more than vitamins C and E. The level of vitamin C of spermatozoa had more diagnostic value when compare to vitamins C and E in seminal plasma.

The level of MDA in seminal plasma and spermatozoa and vitamin C in spermatozoa may be a diagnostic tool for etiology of infertility in the asthenoteratozoospermic patients.

Nelumbo nucifera has been used as antifertility agent in females by the local tribals of Rajasthan especially of Udaipur district India.

The present study was conducted to investigate the effect of Nelumbo nucifera on the fertility and general physiology in female rats.

20 female albino rats were taken and divided into two groups. Group 1 served as control and group 2 received ethanolic extract at dose of 800mg/kg b.wt. for investigating the nature of the drug and antifertility effect. Vaginal smear was monitored everyday in the morning to study the estrous cycle. On day 41st all the animals were sacrificed and various haematological and biochemical parameters were estimated.

Data revealed that oral administration of Nelumbo nucifera extract brought about a significant decline in the weight of Ovary; Control (43±4.75mg), Nelumbo extract treated (25±3.86mg), Uterus; Control (236±0.004mg), Nelumbo extract treated (214±0.007mg) and Vagina; Control (221±0.002mg), Nelumbo extract treated (178±0.003mg) as well as protein and glycogen level, however cholesterol level increased significantly. In addition, the diestrous phase of the estrous cycle was found to be prolonged; Control (1.81±0.21) days, Nelumbo extract treated (3.62±0.42) days.

These results suggest that Nelumbo nucifera has the anti-estrogenic nature without altering the general physiology of the female rats.

It is established that sperm DNA integrity is essential in fertilization and normal embryo and fetal development. Routine semen analysis gives an approximate evaluation of the functional competence of spermatozoa, but does not always reflect the quality of sperm DNA. Therefore, the evaluation of sperm DNA integrity, in addition to routine sperm parameters, could add further information on the quality of spermatozoa and reproductive potential of males.

The objective of this study was to determine the levels of sperm DNA damage in fertile and infertile males and its correlation with semen parameters.

Semen samples were collected from 45 infertile men selected from couples attending the infertility clinic with a history of infertility of ≥1 years and 75 healthy volunteers of proven fertility (initiated a successful pregnancy) served as the control group. After routine sperm analysis, DNA damage was determined using single cell gel electrophoresis (comet) assay method.

The mean of DNA damage (comet value) in the sperms of infertile males was significantly higher than that of fertile males (12.9±7.59 vs. 48.77±24.42, p<0.001). A significant negative correlation was observed between DNA damage and sperm motility in fertile group (p<0.02, R=-0.263). In infertile males, significant negative correlations were observed between DNA damage with sperm motility (p<0.002, R=-0.45) and morphology (p<0.03, R=-0.317). There was no significant correlation between sperm concentration and sperm DNA damage in both groups.

These results indicate that sperm DNA damages in infertile males is significantly higher than fertile males and sperms with abnormal morphology and low levels of motility has more abnormal DNA damages than motile and normal sperms.

Despite numerous developments in the field of assisted reproduction, the implantation rate remains low. Among the various reasons of implantation failure, endometrial regularity has an important role. Hysteroscopy is an accurate method for evaluating the endometrial characteristics, with the ability to treat uterine pathology.

The aim of the present study was to evaluate the findings on hysteroscopy and thereafter the result of subsequent IVF/ICSI in infertile women with the history of frequent unexplained and unsuccessful IVF/ICSI attempts.

In this observational study, the hysteroscopy findings and the outcomes of subsequent IVF/ICSI were evaluated in 89 infertile women admitted in Avicenna Infertility Clinic, with previous repeated (more than two) failed IVF/ICSI-ETs, including the patients with normal Hysterosalpinography (HSG) and excluding severe male factor infertility and also thrombophilia, genetic and immunologic problems. The data were analyzed with SPSS software and Fisher exact, chi-square, and MC-Nemar tests.

In 53 (59.5%) cases, hysteroscopy revealed abnormal intrauterine findings including adhesions 7 (13.7%), single polyp 11 (20.7%), endometrial polyposis 10 (18.8%), endometrial hyperplasia 10 (18.8%), uterine cavity hypoplasia 4 (7.8%) and myoma 5 (9.8%). These abnormalities were significantly higher in women with more than 8 years of infertility (chi-square=4.7, p-value=0.03). After hysteroscopy and subsequent IVF/ICSI-ET attempt using standard long protocol, pregnancy rate were significantly higher compared with the previous repeated IVF/ICSI attempts (35.8% versus 0%).

According to this study, we strongly suggest evaluation of endometrial integrity by hysteroscopy in patients with repeated IVF/ICSI-ETs failure, before entering any other fertilization procedures.

Intrapartam complications such as foetal malpresentation, placental abruption, dysfunctional labour, and postpartum haemorrhage are associated with grandmultiparity. In developing countries and many parts of Africa and sub-Saharan Africa, there is limited access to medical care. There is a need in these areas to identify women whose pregnancies are at risk of complication and it is an important part of antenatal screening and care during delivery to reduce adverse outcomes.

The objectives of this study were to evaluate the complications during pregnancy and delivery of grandmultiparity and to compare it with other parity groups.

A retrospective case control study was conducted targeting women delivered at Empangeni Hospital during April to December 2004. Among all women who delivered at the hospital, 352 grandmultimaras, 3326 nulliparas and 3772 who had parity 1 to 5, were taken as cases and controls respectively for the study.

Significantly higher rates of ante partum (1%) and post partum (2%) haemorrhages, post term delivery (3%), and intrauterine foetal deaths (4.5%) were observed in grandpultiparas compared to nulliparous women but there was no difference with parity group 1-5. Assisted vaginal delivery rates were significantly lower in grandpultiparas women (2%) compared to nulliparous (5%) group (p < 0.05) but there was no difference with parity group 1-5. There were no significant differences in anaemia (14%), hypertension (10%), eclampsia (0.5%) and diabetes (3%), elective and emergency caesarean delivery (14.2%) and low-birth-weight delivery rates (13.2%) among different parity groups.

Grandmultiparity was not safer compared to other lower parity groups. Thus strategies are needed to guide women to seek proper care during pregnancy and if possible to avoid pregnancy if they had higher parity.

Recently different studies suggested that discontinuation of gonadotrophin releasing hormone analogue (GnRHa) at beginning of ovarian stimulation (improvement of ovarian response to gonadotrophins) may have some benefit to poor responder patients in invitro fertilization (IVF) cycles.

The efficacy of GnRHa stop protocol in poor responder patients in IVF cycles was assessed.

This study was a prospective, randomized controlled trial that 40 poor responder patients (less than three mature follicles in a previous cycle) with normal basal follicle stimulating hormone (FSH) were randomly allocated into two protocols: 1) Non-stop protocol: long GnRHa suppression, and start gonadotrophins from day 3 of mense. 2) Stop-protocol: GnRHa is stopped with the onset of menses, and gonadotrophin doses remained similar to group 1.

A significantly higher number of follicles, oocytes, embryos and fertilization rate also shorter stimulation days and lower human menopausal gonadotropins (HMG) ampoules were recorded in the stop protocol compared to the control group. Both protocols resulted in a similar cancellation rate, pregnancy rate, estradiol level and LH level.

Early follicular cessation of GnRHa permitted the retrieval of a significantly higher number of follicles, oocytes and embryos, and can reduce the number of HMG and stimulation days.

The lipids of the spermatozoa membrane are important for the fluidity and flexibility of spermatozoa. However, spermatozoa’s lipids are the main substrates for peroxidation, which may provoke severe functional disorder of sperm.

The aim of this study was to investigate the fatty acids composition of spermatozoa in men with asthenozoospermia, asthenoteratozoospermia and oligoasthenoteratozoospermia compared with normozoospermic males.

A cross-sectional study was designed. The patients were 51 men with seminal parameters abnormalities undergoing infertility screening. The patients were grouped into asthenozoospermic (n=15), asthenoteratozoospermic (n=21) and oligoasthenoteratozoospermic (n=15). The patients were compared with 21 males with normozoospermia. Sperm fatty acid analysis was performed using capillary gas chromatography.

Levels of stearic acid and oleic acid were significantly higher in oligoasthenoteratozoospermic subjects compared with these levels in normozoospermic males. Levels of arachidonic acid and DHA were significantly lower in the sperms of oligoasthenoteratozoospermic males than normozoospermic men. Sperm motility and morphology were correlated positively with levels of arachidonic acid and DHA while a negative correlation was observed with levels of stearic acid and oleic acid.

In conclusion, impaired sperm function can originate from the disorder of sperm lipid metabolism. Low levels of DHA and arachidonic acid in spermatozoa of oligoasthenoteratozoospermic subjects may be the result of breakdown of them.

Ectopic pregnancy is one of the pathologic entities that it destroys the fallopian tube and impairs the future pregnancy. There are different medical and surgical therapies in order the treatment and reserve of fertility. The aim of this report is discuss a case of successful intrauterine after management of ectopic pregnancy with local injection of KCL in an infertile PCOD patient.

Case: 

The patient was a PCOD woman with gestational age of 8.5 weeks. One gestational sac and alive fetus with normal heart beat was seen in the right adnexa. Hemodynamic situation was stable. 0.5cc KCL 10% was injected to the fetal heart and the extracted tissue sent for pathology. We evaluated the effects of this treatment by measuring serial human chorionic gonadotropin (hCG) titers. Moreover, we used hysterosalpingogrphy to diagnose and to evaluate the patency of the tubes. Induction ovulation and intrauterine insemination was done and pregnancy occurred. Patient passed the pregnancy very good and she delivered by cesarean section due to breech presentation at 39 weeks of gestational age. There was no sign of pathologic finding in the tubes or adhesion or sequel of ectopic pregnancy.

The beneficial outcomes of this kind of treatment suggest that local injection of KCL as a low invasive treatment can be the choice treatment for alive and progressed ectopic pregnancy or heterotopic pregnancy. Because of rarity of this management and successful intrauterine we reported the usefulness of local KCL injection for the successful conservative treatment of alive ectopic pregnancy in Iran.