International Journal of Reproductive BioMedicine
Volume:9 Issue: 1, Jan 2011

An important part of male infertility of unknown etiology may be attributed to various environmental and occupational exposures to toxic substances, such as lead. The reproductive effects of lead are complex and appear to involve multiple pathways, not all of which are fully understood. It is still unclear, for example, if male reproductive issues in lead-exposed persons are mostly related to the disruption of reproductive hormones, whether the problems are due to the lead’s direct effects on the gonads, or both? This question has been difficult to answer, because lead, especially at high levels, may adversely affect many human organs. Although lead can potentially reduce male fertility by decreasing sperm count and motility, inducing abnormal morphology and affecting functional parameters; not all studies have been able to clearly demonstrate such findings. In addition, research has shown that the blood-testis barrier can protect testicular cells from direct exposure to high levels of blood lead. For these reasons and considering the wide spectrum of lead toxicity on reproductive hormones, the present review suggests that lead’s main influence on male reproduction probably occurs by altering the reproductive hormonal axis and the hormonal control on spermatogenesis, rather than by a direct toxic effect on the seminiferous tubules of the testes. As blood lead concentrations below the currently accepted worker protection standard may still adversely affect male fertility, future studies should aim to establish more concrete links between lead exposure (especially at low levels) and subsequent male infertility. Research should also pay more attention to lead’s effects on reducing male fertility rates based on not only hormonal axis alteration, but also on the changes in sperm characteristic among exposed subjects.

? -thalassemia is the most common hereditary disease in Iran and more than 2 million carriers of the? -thalassemia mutant gene are living in this country.

To determine pregnancy outcome of women with? -thalassemia minor.

In this retrospective, case-control study in two universities affiliated hospitals in Shiraz, all pregnancies occurred between 2006 and 2008 were included. Patients were divided in two groups regarding the presence of? -thalassemia minor. Patients in case and control groups were matched according to maternal age, gestational age and number of previous pregnancies. Cesarean delivery, hypertensive disorders, gestational diabetes mellitus, premature rupture of membranes and preterm labor were recorded in each group and were compared using the? 2 or Fisher exact tests.

Overall 510? -thalassemia minor subjects and 512 healthy controls were studied. Cases with? -thalassemia minor had significantly higher prevalence of oligohydramnios (p<0.001) and cesarean section delivery (p=0.001). There was no significant difference regarding Apgar score in 1st (p=0.65) and 5th minute (p=0.25), IUGR (p=0.073), gestational diabetes mellitus (DM) (p=0.443) and preeclampsia (p=0.116) between two study groups.

? -thalassemia minor does not significantly influence the pregnancy outcome in the negative way.

Controlled ovarian hyperstimulation and intrauterine insemination (IUI) cycle is an ideal protocol for some subfertile patients. So, we decided to try this therapeutic protocol for the patients with unilateral tubal blockage diagnosed by hysterosalpingography (HSG).

To evaluate the effect of unilateral tubal blockage diagnosed by HSG on cumulative pregnancy rate (CPR) of the stimulated IUI cycles.

A cross-sectional analysis was performed between October 2006 and October 2009 in an academic reproductive endocrinology and infertility center. Two groups of patients undergoing stimulated IUI cycles were compared. Sixty-four infertile couples with unilateral tubal blockage diagnosed by HSG as the sole cause of infertility in the group (?), and two hundred couples with unexplained infertility in the group (II). The patients underwent 3 consecutive ovarian hyperstimulation (Clomiphen citrate and human menopausal gonadotropin) and IUI cycles. The main outcome measurements were the CPRs per patients for 3 consecutive stimulated IUI cycles.

Cycle characteristics were found to be homogenous between the both groups. CPRs were similar in group? (26.6%) and group II (28%) (p=0.87; OR=1.075; 95% CI: 0.57 -2.28).

Unilateral tubal blockage (diagnosed on HSG) has no effect on success rate of stimulated IUI cycles, so COH and IUI could be recommended as the initial therapeutic protocol in these patients.

This study was conducted to determine the clinical patterns and major causes of infertility in mazandaran province in north of Iran.

The medical records of 3734 consecutive couples attending two infertility clinics in Mazandaran province north of Iran from 2003 to 2008 were recorded. The couples had not had a viable birth after at least 1 year of unprotected intercourse and were investigated fully.

Of the entire sample 78.7% had primary infertility and 21.3% had secondary infertility. The mean duration of infertility of couples was 5.7 ± 4 years. The etiology of infertility in couples revealed a male factor in 38.9% a female factor in 34.7% combined factors in 14.6% and an undetermined cause in 11.8%.

In this study delayed attendance of infertile couples to the infertility clinic was found. Therefore there is a need to revise public health program on infertility to focus on the education and prevention of infertility and its risk factors.

Control of the medium osmolarity and temperature during long or short time sperm manipulation is essential.

The objectives of the present study were to find the effects of different osmolarities of modified Tyrode's solution and milk on the bull sperm during incubation at above zero temperatures.

Semen samples were collected twice from five Najdi bull. Centrifuged and most parts of seminal plasma were removed. First experiment: The concentrated semen were splited into nine aliquots to incubate in three different osmolarities (200, 300 and 400 mOsm) at three temperatures (5, 25 and 39°C) for 15 and 60 min of incubation. Second experiment: The semen samples were splited, mixed with the same volume of whole cow milk (5 and 25°C) and milk with 7% glycerol (5°C) and incubated for 15 and 60 min.

Sperm motility severely affected (p<0.05) by incubation at low ionic tension (200 mOsm/l) especially at low temperature (5°C). The impact of low osmolarity on sperm viability can reduce by increasing the incubation temperature to 39°C. The decreased sperm motility, which was induced by lowering osmolarity, was not improved (p>0.05) by increasing temperature during 1 h of incubation. Milk can protect the sperm viability and motility at cool conditions and there is no beneficial effect of glycerol in combination of milk on sperm incubation at above zero temperatures (p<0.05).

Iso- and hyper-osmotic solutions protect bull sperm motility and viability at 25 and 39°C, while milk can be used for protecting sperm at 5°C.

Polycystic ovary syndrome (PCOS) is associated with approximately 75% of women who suffer from infertility due to anovulation. Additionally, around 20– 25% of anovulatory women with PCOS do not respond at all to clomiphene citrate and are considered to be “clomiphene– resistant”. Aromatase inhibitors have been suggested as an alternative treatment to clomiphene as the discrepancy between ovulation and pregnancy rates with clomiphene citrate has been attributed to its anti-estrogenic action and estrogen receptor depletion.

The aim of this study is to compare results of Metformin-letrozole with Metformin-clomiphene citrate in clomiphene resistance PCOS patients undergoing IUI.

In this single blind randomized trial, ovarian cycles were studied in 100 clomiphene- resistant patients with PCOS. The inclusion criteria were patients who received 150mg clomiphene citrate daily for 3 cycles and failed to become pregnant. The patients were matched for their age, body mass index (BMI), and infertility period. They were randomly allocated to a metformin-letrozole group (n=50) and a metformin-clomiphene citrate group (n=50). Chemical and clinical pregnancies were assessed after IUI. Abortion rates were determined in both groups.

Regarding pregnancy rate, there was no significant difference between the two groups. One miscarriage (2%) occurred in the metformin-clomiphene citrate group, whereas none was seen in the metformin-letrozole group.

There is no significant difference in pregnancy rate between clomiphene citrate and letrozole groups although it has been 2% in the former and 5% in the latter.

Undescended testis (UDT) is the most common endocrine disorder in male children. Delayed diagnosis and treatment of UDT lead to complications such as infertility, malignancy and testis rotation.

The aim of this study was to evaluate the causes of delay in proper treatment of patients with undescended testis in our population.

An observational, descriptive, cross sectional study of 143 male patients, who applied to Shahid Sadoughi University Hospitals for orchiopexy operation was performed. The maximum recommended age for orchiopexy was 18 months.

The mean age at referral was 5.34 years. Only 44 (30.8%) cases were operated on before the age of 18 months. The most common reasons of delay in treatment were absence of early diagnose (42.5%), parent's unawareness of surgery necessity and its complications associated (33.7%) and parent's disregard (23.5%). Only 19.6% of patients were diagnosed at born in the hospital. 49% of parents had the correct information for proper operation age and 40.6% of them had enough information about necessity of surgery and side effects of disease. Parent’s literacy, place of living and type of cryptorchidism had no significant relation with delay diagnosis (p> 0.05).

These results revealed that late diagnosis by physician and lack of insight of parents are the main reasons in delayed diagnosis and treatment of UDT. Therefore, education of parents and careful physical examination of the babies at birth and regular follow-up until 18 months can prevent the delay in diagnosis.

Many studies have been carried out to understand the effect of endometrial thickness on the reproductive outcome while the factors affecting the pattern itself are still unknown.

To determine the factors such as age and the number of follicles that could affect the endometrial thickness

This study was conducted as a retrospective study on 680 infertile women considered for intrauterine insemination (IUI). IUI protocol was sequential regimen of clomid and gonadotropin. Endometrial thickness measurement was done on the day of HCG administration. Correlation between endometrial thickness and factors such as age, total follicle numbers, dominant follicle numbers, gonadotropine ampule numbers and pregnancy rate were assessed.

The mean endometrial thickness was 7.2±1.8 mm. The endometrium was thinner in older patients compared with younger ones. But in all age ranges pregnancy rate was higher in endometrial thickness 6< ET?10 mm (p<0.05).

We did not find any correlation between age, number of follicles and gonadotropine ampoules with endometrial thickness but in all age ranges, there is a possibility of higher chance of pregnancy in endometrial thickness 6 < ET?10 mm.

Premature ovarian failure (POF) is a common condition; its incidence is estimated to be as great as 1 in 100 by the age of 40 years. Physiologic replacement of ovarian steroid hormones seems rational until the age of normal menopause. Temporary return of ovarian function and pregnancy may occur rarely in women with POF. We report a case of POF who conceived during hormone replacement therapy.

Case:

 A 30 years-old woman with confirmed POF after pelvic surgery and sever emotional stress conceived spontaneously.

Return of ovarian function and achievement of pregnancy is possible in women with POF.