Journal of Reproduction & Infertility
Volume:21 Issue: 3, Jul-Sep 2020

There is a growing need for information regarding maternal and neonatal outcomes during coronavirus pandemic. In this study, a comprehensive investigation was done regarding the possibility of vertical transmission using the available data in the literature.

A systematic search was conducted using electronic databases, including PubMed, Scopus, Web of Science, Embase, and Scholar. All studies containing infected COVID-19 pregnant women who had given birth were included, and the search was done up to April 14, 2020.

Overall, 21 articles were reviewed, and clinical characteristics of 90 pregnant patients and 92 neonates born to mothers infected with COVID-19 were reviewed. The most common symptoms included fever, cough, and dyspnea. The main laboratory findings included leukocytosis, lymphopenia, thrombocytopenia, and elevated C-reactive protein. The most commonly reported complications were preterm labor and fetal distress. Three mothers were admitted to ICU and required mechanical ventilation; among them, one died, and one was on extracorporeal membrane oxygenation. Overall, 86 neonates were tested for the possibility of vertical transmission and 82 cases were negative in RT-PCR, while 4 were positive. Out of 92 neonates, one died, and one was born dead. Nineteen patients reported having no symptoms, while breathing problems and pneumonia were reported as the most common neonatal complications.

There were no differences in the clinical characteristics of pregnant women and non-pregnant COVID-19 patients. COVID-19 infection has caused higher incidence of fetal distress and premature labor in pregnant women. Although the possibility of vertical transmission in infected pregnant women is rare, four neonates’ test results for COVID-19 infection were positive in this review.

Endometriosis is a chronic inflammatory condition associated with an increased risk of epithelial ovarian cancer. Our previous studies found that the anti-inflammatory effect of octyl gallate in endometriosis cell culture was more effective than gallic acid and heptyl gallate. This study aimed to analyze the anti-inflammatory effect of octyl gallate in rat endometriosis model.

Thirty female Wistar rats were randomly divided into three groups. Group I was the sham-operated group, group II was the surgically-induced group, whereas group III was the surgically-induced group and each rat was administered with 20 mg</em> of octyl gallate dissolved in 1 ml</em> Na-CMC via oral gavage once a day for 30 days. When all rats were euthanized, the endometrial tissue from group I and last two groups were collected for further analysis. TNF-α levels were measured using Luminex, while non-phosphorylated NF-κB and COX-2 levels were analyzed using ELISA. 

The average of non-phosphorylated NF-κB levels in group III (4.970±0.971 pg/mgP</em>) was significantly higher than group II (3.97±0.656 pg/mgP</em>). Moreover, the proportion of rats with the high level of non-phosphorylated NF-κB in group III was 45.6% higher than group II (p<0.05). The proportion of rats with the high level of COX-2 in group III was 22.3% lower than group II (p<0.05). However, there was no significant difference in TNF-α levels between all groups. 

The anti-inflammatory effect of octyl gallate may has effects in NF-κB activation and reduction of COX-2 levels in rat endometriosis model.

Management of Poor Ovarian Reserve (POR) in in vitro fertilization remains a difficult challenge. The purpose of this retrospective cohort study was to compare the effectiveness of embryo banking strategy over a cohort of several mild stimulation cycles (Embryo Banking Strategy for Poor Prognosis/Embargo) to conventional full-dose antagonist protocol for IVF.

Subjects identified as having poor ovarian response (POR) based on the Bologna criteria were recruited. In total, there were 113 subjects included in the analysis. Fifty-three subjects underwent embryo banking procedure (Embargo) protocol, and sixty subjects underwent the conventional full-dose antagonist protocol for IVF. The Chi-square test was used to compare the clinical pregnancy rate, miscarriage rate as well as live birth rate, while the Mann-Whitney U test was utilized to analyze the cost per clinical pregnancy between the two groups. A p<0.05 was considered statistically significant.

The two studied groups showed similar outcomes regarding clinical pregnancy rate, miscarriage rate, as well as live birth rate (p=0.966, p=0.310, and p=0.469, respectively). Cost analysis of subjects who underwent mild ovarian stimulation followed by Embargo revealed the high cost of the protocol compared to conventional full-dose antagonist protocol ($10.507±6.181 vs. $9.533±2.530, p=0.002). 

The clinical outcomes of both protocols were comparable. Embargo procedure was not efficient in improving the overall clinical outcomes in patients who were expected poor ovarian responders as the protocol costed more comparing with conventional full-dose antagonist protocol. A larger prospective randomized control trial is needed to evaluate this finding.

Sexually transmitted infections (STIs) can be associated with infertility. Human papillomavirus (HPV) has been identified as a potential agent in male infertility. Also, anti-sperm antibodies (ASA) have been detected in men with infertility. The aim of this study was to investigate the prevalence and association of HPV and ASA in infected semen of infertile men.

This cross-sectional study was performed on 96 infertile men referring to infertility treatment center of Kashan University of Medical Sciences during March 2017 till September 2017 in Iran. Semen analysis and diagnostic PCR test were performed for detection of HPV DNA. The semen parameters in HPV infected and ASA positive samples were compared with HPV non-infected and ASA negative samples. Chi square test was used to determine the correlation between variables and p<0.05 was considered statistically significant.

HPV DNA and ASA were detected in 17.4% and 15.2% of 96 semen samples, respectively. Semen volume, sperm count, sperm motility and the normal morphology rate were significantly decreased in HPV-positive subjects (p=0.004, p= 0.016, p<0.001, and p=0.017, respectively). Also, sperm motility was significantly decreased in ASA-positive subjects (p=0.002), also patients with HPV infection had a higher rate of ASA than the non-HPV group. In contrast to ASA, HPV infection had a significant correlation with education level (p=0.039).

The findings suggest that asymptomatic seminal infection of HPV and ASA by adversely affecting sperm quality, in particular sperm motility and count, may play an important role in male infertility.

Noninvasive prenatal testing (NIPT) has been performed worldwide to detect common fetal chromosomal aneuploidies.

Pregnant women (n=3743) with advanced maternal age who visited Nagoya University for NIPT were enrolled in this study. The K6 mental stress scores, that is non-specific psychological distress scores were obtained by questionnaires which were administered pre-NIPT and postpartum. High K6 scores (10) indicate anxiety or depression. The K6 stress scores at pre-NIPT and postpartum were evaluated about the relationship between mode of conception and non-specific psychological distress using binomial logistic regression.

In general, 7.5% of pre-NIPT women (179/2393) and 5.1% of postpartum women (121/n) were found with high K6 scores. They also did not differ significantly based on maternal age, previous live birth, previous miscarriage, and mode of conception, i.e., natural conception, artificial insemination with husband (AIH), or assisted reproductive technology (ART). Moreover, the prenatal K6 scores were not significantly higher than those at postpartum.

Our present data suggest that mental distress in women undergoing NIPT during pregnancy and after birth has no statistical relationship with maternal age, previous live birth, previous miscarriage, or infertility treatment, and continuous mental care may help reduce mental distress in the postpartum period.

Adolescents are increasingly at risks of HIV infection through high-risk sexual behaviors. This paper aimed to assess the effectiveness of a HIV/AIDS educational intervention among female adolescents in Tehran.

A randomized controlled trial was conducted among high school girls aged 12-16 years studying in Tehran in 2016-17. The sample was selected using multistage random cluster sampling. Four schools per district were randomly selected using probability-proportional to size. Adolescents were randomly assigned to the experimental (n=289) and the control (n=289) groups. The theory of planned behavior (TPB) was the basis of both the intervention and the evaluation phase. Both experimental and control groups completed a questionnaire designed for HIV related behaviors for female adolescents (HBQFA) at baseline and after six months follow up. A theory-based educational program was implemented for the experimental group. 

The mean age of participants was 14.1 years (SD=0.96).  In the experimental group, significant improvements were shown in adolescents’ HIV knowledge (31.9%, 95% CI: 28.8-35.0), attitudes towards HIV (16.6%, 95% CI=14.4-18.8), subjective norm (16.8%, 95% CI=12.9-20.6) and perceived behavioral control (19.1%, 95% CI=16.2-22.1), perceived parental support (17%, 95% CI=13.8-20.2), behavioral intention to prevent HIV (19%, 95% CI=16.3-21.6), and HIV preventive behavior (17.3%, 95% CI=13.9-20.6) (p<0.001).

Theory-based educational intervention on HIV/AIDS prevention can significantly protect adolescents from misconceptions, wrong attitudes and risky behaviors and unsupportive social environment that expose them to greater HIV risk. Health policy -makers are advised to consider effective training programs related to HIV/AIDS prevention behaviors in the school system.

Many women experience oocyte retrieval during an IVF treatment as a stressful and emotionally difficult situation. Women fear the pain as associated with oocyte retrieval. Based on the existing literature, a coping intervention for oocyte retrieval (CIFOR) was developed to deal with the stress and pain during oocyte retrieval. The objective of this study was to explore the experiences of women using coping intervention for oocyte retrieval (CIFOR) while undergoing oocyte retrieval.

For this generic qualitative study, a purposeful sample of fifteen women was gathered from a university clinic in the Netherlands and each participant was interviewed. Background information about the IVF treatment was collected from medical files. Semi-structured interviews were performed approximately 15 min after the OR procedure. Data were analyzed using the Qualitative Analysis Guide of Leuven and processed using MAXQDA.

Twenty-five women were approached for this study between January and May 2018. This study identified five themes that were important in the experiences of women using CIFOR: highly valuing the CIFOR, feasible in daily practice, need for information, sense of control and partner’s involvement. 

Women highly valued the tool. They found CIFOR feasible in daily practice and it fulfilled their needs for information. In addition, women had a sense of control using the intervention. Future research will involve performing a pilot study according to the Medical Research Council framework with outcomes based on the patient’s sense of control, ability to cope, coping strategies, anxiety and pain.

Implantation failure has long been identified as a common problem underlying low success rate of IVF. Currently, endometrial receptivity has gained expert attention as it is demonstrated to contribute to successful embryo implantation. MicroRNAs (miRNAs) is known to affect endometrial receptivity through post-transcriptional gene expression regulation. This study aimed to evaluate the expression of miRNA 135b and HOXA-10 during the implantation window in endometrial tissue of infertile women.

A total of 14 patients diagnosed with infertility in the gynaecology clinic of Cipto Mangunkusumo and Daya Medika hospitals Jakart, Indonesia were selected as the observed group, and 9 fertile patients were enrolled in the control group. Total RNA was isolated from endometrial tissues collected at the secretory phase of the menstrual cycle. The miRNA 135b and HOXA-10 mRNA expression were measured using quantitative real-time PCR (qPCR). The correlation between these variables was then determined using Pearson’s correlation coefficient.

The expression of miRNA 135b in the infertile group was significantly higher by 1.81-fold compared to the control group (p<0.01), whereas, expression of HOXA-10 mRNA was significantly lower in the infertile group compared to the controls (p=0.047). Significant negative correlation was observed between the expression of miRNA 135b and HOXA-10 mRNA in infertile women (p=0.021; r=-0.607).

Taken together, this study provides that alteration of miRNA expression is involved in regulating the implantation process partly via modulation of the expression of gene required for implantation.

Klinefelter syndrome (KS) mosaicism 46,XX/47,XXY is an extremely rare disorder of sex development characterized by the presence of both ovarian and testicular tissues in the same individual. Both elements can be present in the same gonad (ovotestis) or separately in the same individual or as a unilateral ovotestis and the other side with testis or ovary. A mosaic with 46,XY would present with problems related to male infertility and in general, testicular insufficiency, but with a 46,XX mosaic, it is a completely rare presentation. As adolescents, these boys may experience severe emotional and behavioral issues; it is up to the parents to identify these conditions early and get them physician evaluated for possible abnormalities so that they can get the benefit of treatment. 

A case of a rare disorder of sexual differentiation with a mosaic 46,XX/47,XXY in a KS individual is reported for whom karyotyping and SRY-FISH work-up was done. 

Early cytogenetic testing is essential to identify these individuals and testosterone replacement therapy and breast reduction for case management are helpful. Assisted reproductive technology (ART) may assist these individuals father children in some cases.

Isolated tubal torsion is a rare condition that its management remains a challenge.

In this case report, an isolated torsion of the right fallopian tube was described in a virgin girl who was treated laparoscopically. The patient presented to the University Hospital of Larisa, in Greece (January 2017) after 5 days of sharp pain in right iliac fossa. Through this period, she looked for medical care in her home country, in Albania. However, further treatment was not available there.

This case manifested that laparoscopy plays an important role in the accurate diagnosis of isolated torsion of the fallopian tube. It thwarts unnecessary delay in treatment and it requires an endoscopy unit. Unfortunately, endoscopy is not commonly the main diagnostic procedure in many countries, including Greece.