International Journal Of Fertility and Sterility
Volume:14 Issue: 1, Apr-Jun 2020

Obesity has been associated to negative effects on natural fertility and a worse prognosis when assisted reproduction techniques are performed. Patients attending for fertility treatments are often advised to optimize their weights to improve outcomes. There are doubts about how effective are weight-loss interventions for improving fertility in women who are overweight or obese.

We conducted a systematic review according to a registered protocol (PROSPERO registration number: CRD42017074964) to evaluate whether weight loss achieved by lifestyle program improves natural or assisted reproduction in obese infertile women. We searched CENTRAL, MEDLINE and EMBASE up to March 2018. Two reviewers selected randomised trials assessing a lifestyle intervention in women with obesity preceding a treatment for infertility and appraised their risk of bias. We extracted data on pregnancy, birth and miscarriage rates as primary outcomes and pooled effect estimates using a random effects model. The primary outcome was live birth rate. The summary measures were reported as relative risk (RR), 95% confidence interval (CI) and percentage of heterogeneity (I2).

We included eight randomised trials with 1175 women. Lifestyle programmes, improved pregnancy rates (RR 1.43, CI 95% 1.02 to 2.01; I2=60%; 8 RCTs; N=1098) but have no impact on live births (RR 1.39, CI 95% 0.90 to 2.14; I2=64%; 7RCTs; N=1034). Our findings suggest that women participating in lifestyle interventions had an increased risk of miscarriage (RR 1.50, CI 95% 1.04 to 2.16; I2=0; 6RCTs; N=543). We rated the quality of evidence for these outcomes as moderate to low.

Lifestyle interventions slightly increase pregnancy rate and it is uncertain that it can improve live birth; furthermore they can increase miscarriage. More research is needed to further explore lifestyle interventions on reproductive outcomes in obese infertile women.

Infertility as one of the painful experiences of life can become a tension for a person. Assisted reproductive technology such as IVF due to the low success and high costs results in a depression in infertile women. Therefore, mindfulness-based group counseling can deal with depression by increasing concentration.

The present Clinical trial study was performed on 90 infertile women under IVF treatment. Samples were divided into two groups of intervention and control. After filling demographic and Beck Depression Inventory (BDI) by both groups, eight 90-minute sessions group mindfulness-based group consultation was held in intervention group two times a week. After the intervention, BDI was again completed by both groups.

Results showed the significant difference between infertile women depressions of intervention and control group before and after intervention (P<0.001). Besides, there was a significant difference between infertile women depressions in intervention group and control group after intervention (P<0.001).

According to the findings of the present research, mindfulness-based group counseling can result in a reduction in the depression of infertile women under IVF treatment.

Infertility is a major worldwide problem which is affected by several factors such as environmental, physiological, and genetic conditions. Several studies have shown that oxidative stress or reduction of antioxidant defense can contribute to pathogenesis and depression symptoms. Lycopene is one of the most important antioxidants that can contribute to reducing or preventing the psychological damage that affects infertility. The aim of this study was to evaluate the effect of lycopene supplementation on depression, anxiety and stress scales and quality of life in infertile men.

In this randomized, double-blind, placebo-controlled trial study 44 infertile men with oligozoospermia were randomly divided into two groups, the experimental group was supplemented with 25 mg lycopene once a day and the control group received placebo for 12 weeks. Anthropometric, physical activity, dietary assessment, mood status including depression, anxiety, stress and quality of life scores were measured pre- and post-intervention.

There were no significant differences between depression scores, anxiety and stress between the two groups while depression score significantly decreased in both groups compared to the baseline levels. No significant differences were observed on four domains of quality of life, except psychological domain was improved in the lycopene group compared to baseline (P<0.05).

Short term supplementation of lycopene has no effect on mood status and quality of life except psychological status in infertile men. This field warrants futher studies.

The aim of this study was the evaluation of the impact of single-dose methotrexate (MTX) treatment on ovarian reserve in women with ectopic pregnancy undergoing infertility treatment in Iranian population.

This prospective cohort study was conducted between March 2015 and March of 2017 in Tehran General Women Hospital in Tehran, Iran. We enrolled 20 patients with ectopic pregnancy (EP) whose pregnancy happened during infertility treatment and they received a single–dose MTX (50 mg/m2) intramuscularly. Serum anti-mullerian hormone (AMH), 17 beta-estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH) as well as antral follicle count (AFC) on trans-vaginal ultrasonography were evaluated before and 8 weeks after administering MTX.

Mean±SD of AMH was not statistically significant before and after the administration of MTX (9.50±4.23 vs. 9.15±4.24, P=0.36). FSH, Estradiol and AFC changes were not statistically significant, while increasing the value of LH was significant (P=0.02).

Results indicated that single-dose MTX treatment had no effect on ovarian reserve in women with ectopic pregnancy. Further randomized controlled clinical trial study with larger sample size, multiple dosage of MTX, long-term follow up is suggested.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Anti-Muller hormone (AMH) is a valid indicator of ovarian function and PCOS diagnosis. Some studies have shown that adipokines are effective in the synthesis of AMH, and a relationship would have existed between them. The aim of present study was to determine the relationship between serum levels of anti-Mullerian hormone, adiponectin and other related factors in PCOS patients.

In this cross-sectional study, PCOS and healthy women (80 cases) were investigated. Serum levels of AMH, adiponectin, gonadotropins, androgens, insulin resistance, total antioxidant capacity and nitric oxide (NO) measured by standard methods. Independent T-test was used to compare two groups and Pearson correlation coefficient was used to determine the relationship between variables.

There was a significant difference between the mean of AMH (5.16±5.3 vs 2.44±2.5 ng/mL) (P=0.007) and adiponectin (24.55±9.41 vs 30.57±14.2 µg/L) (P=0.029) among PCOS and control group respectively. The correlation between AMH and adiponectin in control group was statistically significant and negative (P = 0.028, r = -0.35), while that of PCOS group was not significant (P=0.113, r=-0.25).

Various biochemical and hormonal factors differ between PCOS and normal women. Different factors can impudence AMH and adiponectin levels independent of PCOS in women of reproductive age.

The aim of this retrospective study is to investigate the Cumulative Live Birth Rate (CLBR) following one or more completed in vitro fertilization cycles (up to 6 cycles) stratified by maternal age and type of infertility.

Five hundred forty-seven women who received 736 fresh ovarian stimulation/embryo transfer cycles between January 2016 and December 2016 were included in a tertiary referral center in the Middle East.

In all women, the live birth rate for the first cycle was 33.0% (95% CI 27.8-38.2). The CLBR showed an increase with each successive fresh cycle to reach 56.9% (95% CI 51.2-62.4) after 3 cycles and 67.9% (95% CI of 62.5-73.0) after 6 cycles. The CLBR following 6 cycles reached 69.9% (95% CI 63.8-75.6) in women younger than 35 years. In women older than 40 years, the live birth rate for the first cycle was significantly low at 3.1% (95% CI 0.3-9.5) with a plateau in success rates after 4 cycles reaching 21.9% (95% CI 9.2-40.0). Couples with different types of infertility had CLBRs ranging from 65% to 72%, with the exception of women with low ovarian reserve where CLBRs reached 29.4% (95% CI 10.3-56.0).

The CLBR in a referral center in a Middle Eastern country reached 67.9 % after 6 cycles, with variations by age and type of infertility treatment. These findings are encouraging for patients insisting to extend their treatment beyond 4 to 5 cycles.

Pre-eclampsia (PE) is a pregnancy complication and one of the leading causes of maternal and neonatal morbidity and mortality in the world. PE is characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Given the importance of mutation in the VEGF gene and its correlation with the incidence of pre-eclampsia, the relationship between polymorphisms rs922583280 ,rs3025040 and rs10434 of encoding gene VEGF with the incidence of pre-eclampsia in the population of Iranian women was studied in this research.

100 pregnant women with pre-eclampsia diagnosis and 50 healthy pregnant women for determination of genotypes rs922583280, rs3025040 and rs10434 were evaluated using the Sanger sequencing method.

There was no significant difference in the frequency of alleles of rs922583280 and rs3025040 polymorphisms between case and control groups (P>0.05), but the frequency of recessive allele G in rs10434 polymorphism was significantly higher in the case group than in the control group (Pvalue=0.014, case=24%, control=12%), while the frequency of the allele A in the control group was higher than that of the patient group (case=76%, control=88%) The frequency of AG genotype in the patient group was also higher than the control group and the frequency of AA genotypes in the control group was higher than that of the patient group (case=57%, control= 78).

The results of this study demonstrated that polymorphism rs10434 of the gene encoding VEGF has a significant difference among individuals of the control group and the patient group and can affect the incidence of pre-eclampsia among Iranian women.

Varicocele is a common cause of male infertility with multifactorial etiology. Inflammation is a characteristic pathological event that occurs in the testis tissue following varicocele. The aim of this study was to investigate the expression of Nod-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome components and cytokines in semen of varicocele and control subjects.

Seminal plasma was collected from 32 varicocele patients and 20 control subjects. The concentrations of interleukin-1b (IL-1b), IL-18 and caspase-1 in seminal plasma were measured by ELISA. Apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC) and Nod-like receptor family, pyrin domain containing 3 (NALP3) were identified in seminal plasma by Western blot. The statistical significance between the mean values was determined by student’s t test.

According to our data the level of IL-1b significantly (p=0.03) increased in the seminal plasma of varicocele patients in compared to the control subjects. We analyzed the amount of IL-18 in both groups and the level of this interleukin markedly (p=0.28) decreased in varicocele patients. There were no changes in the level of caspase-1 in both groups. Western blot analysis revealed that ASC (p=0.0002) and NLRP3 (p=0.005) were significantly elevated in semen of varicocele patients.

This study provides the first evidence of NLRP3 components in semen of men with varicocele. These finding suggests a role of NLRP3 inflammasome for abnormal semen quality in varicocele patients.

Telomeres are the sequence of DNA at the end of the eukaryotic chromosome that is essential for genome integrity. Several studies have shown that telomere length in sperm differs between individual men and individual spermatozoa. In addition, decreased telomere length in sperm from infertile men are associated with the reduction of fertility potential and embryo quality. In this regard, previous studies showed that density gradient centrifugation (DGC) and swim up are useful techniques for separation of sperm with longer telomeres. On the other hand, recent studies showed that selection of sperm based on surface negative electric charge or “Zeta potential”, can separate high percentage of sperm with intact chromatin compared to DGC alone, and also the combination of DGC-Zeta can improve clinical outcomes in infertile men candidate for intracytoplasmic sperm injection (ICSI). Therefore, we compared sperm telomere length and DNA fragmentation between two sperm preparation procedures (DGC and Zeta).

In this experimental study, we assessed sperm telomere length and DNA fragmentation by quantitative Real-time PCR and TUNEL assay, respectively in prepared spermatozoa by either DGC or Zeta method of fifteen infertile men with normozoospermia from September 2017 to December 2017. Sperm telomere length was expressed as relative, and absolute.

When the results compared to washed semen samples or control, we did not observe any significant difference in mean of relative or absolute sperm telomere length after DGC or Zeta method (P>0.05). While the mean percentage of DNA fragmentation was significantly lower in both DGC or Zeta methods compared to control (P<0.05).

This is the first study that compared the effect of DGC and Zeta sperm preparation methods on sperm telomere length and concluded that both these methods can select sperm population with high DNA integrity and same sperm telomeres length.

Micronutrients in support of the carbon cycle have been shown to reduce sperm DNA damage both in animal models and in infertile men. Besides supporting DNA methylation, their positive effect may be sustained by an improved performance of the endogenous antioxidant system but this has not yet been proven in the clinical setting. The present study aimed at testing a micronutrient supplementation in infertile men partners to ART resistant couples and to investigate the nature of their effects.

Infertile men partners to couples resistant to at least one ART cycle and with a sperm fragmentation rate > 20% (TUNEL) underwent a 4-month oral supplementation with micronutrients in support to the carbon cycle including folates, B vitamins, zinc and cysteines. Semen analysis, sperm DNA fragmentation (TUNEL), nuclear maturation (CMA3 and blue aniline staining) and lipid peroxidation (BODIPY) were assessed before and after treatment. The couples were followed-up to record clinical outcomes.

Forty-three patients completed the program but full data pre and post treatment were available only for 25 patients. The treatment did not modify sperm concentration and motility but improved morphology. Nuclear maturation, DNA fragmentation and lipid peroxidation significantly improved after treatment. Overall 10 clinical pregnancies (23.3%) and 4 live births (9.3%) were recorded during the follow-up following expectant management (25 couples) or a new ICSI cycle (18 couples).

The micronutrients appeared to induce both DNA methylation, resulting in improved sperm nuclear maturation, and antioxidant defenses, resulting in less of DNA fragmentation and lipid peroxidation. The clinical outcomes were aligned with a possible positive effect on reproductive function. Micronutrients qualify as an alternative to antioxidants in correcting oxidative damage in infertile men and warrant further clinical investigation.

In embryological culture dishes, there is a temperature decline when removed outside incubators. This study aimed at investigating this decline within a certain time frame and type of dish, with or without the use of laminar air flow and whether it is possible to achieve a sufficient thermal control with the use of a heating stage.

The temperature of four types of polystyrene dishes (50mm ICSI, 35mm, 60mm, 90mm), with culture medium and oil, was recorded for a period of 10 minutes outside the incubator. Temperature was measured with an infrared thermographic camera. The reference temperature was 37oC. Four parameters were analyzed: type of dishes, air flow, heating stage at 37oC and 38.5oC.

There was a time-dependant significant temperature decline outside the incubator in any type of dish and any type of experimental conditions. Under air flow, temperature decline increased. The use of a heating stage, at 37oC or 38.5oC, slightly improved the situation in most cases. Three minutes out of the incubator: without a heating stage and air flow, the temperature was <34oC; with air flow and without a heating stage, the temperature was <33oC. When a heating stage was used, the temperature was <36oC, except ICSI dishes. ICSI dishes, on a heating stage, maintained a temperature close to 37oC, with or without air flow. In all experimental conditions, the highest decline was recorded with 90mm dishes.

Time is crucial for temperature decline. Under air laminar flow, the heat loss is greater; with a heating stage at 37oC or better at 38.5oC this loss is lower but still exists. ICSI flat bottom dishes give the best results, when heated stages are used. Bottom flat dishes maintain the temperature efficiently. In our opinion, the use of flat bottom dishes should be generalized in IVF.

0:Fertility treatments are scientific achievements that began in 1970s. Almost concurrently, these technologies developed in India as well. Despite various advancements in IUI and IVF, empirical investigations on the psychological endurance and emotional tolerance of women to such treatments are rather scarce. Thus, the aim of this study is to estimate the prevalence of psychiatric disorders in women seeking fertility treatments. It is a cross-sectional study with three hundred women participants undergoing various treatments at the Manipal Assisted Reproductive Centre, situated in the Kasturba Medical College, Karnataka, India. Psychiatric disorder were assessed in women using the “ICD-10 Classification of Mental and Behavioral Disorders (CDDG version)” followed by descriptive data analysis. The results reveal that 78% of women are found to have psychological issues and 45% of them have a diagnosable psychiatric condition. Adjustment Disorders, Major Depressive Disorders and Anxiety Disorders are established as the top three categories of diagnoses. The findings of this study suggest that women have a higher stake holding in infertility treatments. A sizable proportion of them are at the verge of deteriorating mental health. The data highlights the need for modification of the existing treatment protocol (in Indian clinics) in ways that ensure the emotional well-being of patients.
Key words: Cross-sectional study, Distress, Infertility, Psychiatric Disorder, Depression, Anxiety, Women.

Endometriosis is a common condition that occurs in 6-10% of all reproductive age women. This number increases to approximately 40% in women with infertility, and nearly 75% in women with complaints of chronic pelvic pain. Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity. The most common complaints associated with endometriosis are dysmenorrhea and pelvic pain, however, patients often present with a variety of symptoms and on occasion are asymptomatic. When presenting with hemorrhagic ascites, endometriosis mimics ovarian malignancy. Conservative medical treatment is a feasible management option, especially in young patients with desire to preserve fertility. This article aims to present an extremely rare presentation of endometriosis, hemorrhagic ascites, and a review of associated literature.

In the recent original research published on International Journal of Fertility and Sterility the association between tumor necrosis factor-alpha (TNF-α) genetic polymorphisms and endometriosis in 150 Iranian patients suffered this disease. The authors notably found a lower frequency of TNF-α -863C/A allele A among the affected patients in comparison with healthy women, although this difference was not significant by adjusting multiple testing. We deem that the authors should specify, if these patients had peritoneal nodules, ovarian endometrioma/deep infiltrating endometriosis (DIE) nodules or combination of them, since it has been hypothesized that these phenotypes may represent three distinct pathogenetic entities of endometriosis.

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