Journal of Reproduction & Infertility
Volume:23 Issue: 3, Jul-Sep 2022

Infertility is a common disease that affects 15 to 20% of couples at some point in their lives. Among infertile couples, male factor accounts for 50% of infertile cases. Assisted reproductive techniques are the gold standard approach in case of failure in medical or surgical treatments. Moreover, the role of the urologist in these approach- es is to provide appropriate sperm on the day of oocyte pick-up. However, sperm re- trieval procedure is quite different in azoospermic and non-azoospermic men. Alt- hough most cases of infertile patients are not azoospermic, their ejaculation disorder prevents obtaining sperm for assisted reproductive techniques. This review article explains common problems of sperm retrieval in non-azoospermic patients with per- sistent ejaculatory dysfunction and introduces some management strategies. In fact, it is possible to design a classic approach for managing such patients, which definite- ly reduces the problems faced by clinicians as well.

Granulosa cells (GCs) play key roles in oocyte maturation by providing required estradiol (E2). Since the presence of immature oocytes has been reported in cases with polycystic ovary syndrome (PCOS), in this study, the levels of mitochondrial membrane transporter proteins involved in E2 synthesis were determined. E2 concentration and parameters of oxidative status were also measured in follicular fluids of PCOS women.

Forty-three women with PCOS and 43 healthy women who were candidates for IVF procedure due to their husbands' infertility were enrolled in this case-control study. The gene expression and protein levels of mitochondrial translocator protein (TSPO) and voltage-dependent anion channel 1 (VDAC1) were determined in GCs using RT-qPCR and immunocytochemistry assay, respectively. E2 level was measured with electrochemiluminescence, whereas total cholesterol, total antioxidant capacity (TAC), total oxidant status (TOS), and malondialdehyde (MDA) were determined using colorimetric methods in follicular fluids. Data were analyzed using unpaired t-test or Mann-Whitney U test, and Spearman’s correlation coefficient.

VDAC1 and TSPO were significantly lower in mRNA (p<0.05) and protein levels (p<0.001) of PCOS patients. PCOS patients had lower cholesterol, estradiol, and TAC levels, and higher TOS and MDA contents. E2 level had direct correlation with VDAC1, TSPO, and TAC while it was negatively correlated with TOS, oxidative stress index (OSI), and MDA (p<0.001). Higher E2 levels were associated with higher numbers of high-quality oocytes and conceived embryos (p<0.001).

Decreased E2 levels and increased oxidative stress in the follicular fluid may be the cause of immature oocytes in PCOS cases.

Polycystic ovary syndrome (PCOS) is commonest endocrine disease occurring in women of reproductive age. This study conducted to clarify altered con- centrations of Nesfatin-1, nicotinamide adenine dinucleotide phosphate (NADPH), and dopamine in PCOS women and controls. Also, to assess their role in PCOS pathophysiology and their correlation with measured biochemical parameters.

In this observational study, 60 PCOS patients and 24 controls included. Medical history was recorded and full examinations were done. Serum concentra- tions of lipid profile, fasting blood glucose (FBG), fasting insulin (FSI), luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, testosterone, proges- terone, estradiol, Nesfatin-1, dopamine, and NADPH were measured by ELISA kits. Values were analyzed using unpaired t-test and Pearson Chi-square test. The p<0.05 was considered statistically significant.

In this study, there was significantly elevated waist hip ratio (WHR) and body mass index (BMI) in PCOS patients versus controls (p<0.0001 and p=0.014). There was significant increase in FSH, LH, prolactin, estradiol, testosterone, Nesfat- in-1, and dopamine (p=0.021, p=0.015, p<0.0001, p<0.0001, p=0.006, p=0.017, p< 0.0001) and decrease of NADPH (p<0.0001) in PCOS patients. There were signifi- cant positive correlations between Nesfatin-1, prolactin, and dopamine levels. Also, there was significant positive correlation between dopamine and BMI, FSI, FSH, LH, estradiol, and prolactin levels; however, significant negative correlations ob- served between NADPH and BMI, FSI, estradiol, and prolactin levels.

Elevated serum Nesfatin-1 concentrations and their association with hyperprolactinemia indicate that they have a role in PCOS pathophysiology. Moreo- ver, elevated dopamine and decreased NADPH concentrations could play role in PCOS pathogenesis.

The purpose of the current study was to assess whether embryonic culture conditions has an impact on embryo ploidy in a preimplantation genetic testing for aneuploidy (PGT-A) cycle.

In this retrospective single center cohort study, a total of 1099 blastocysts from 278 PGT-A cycles were analyzed. The generated blastocysts were biopsied on days 5 and 6. Inseminated oocytes were allocated in different incubators (benchtop and time lapse) and assisted zona hatching was performed on day 3 of embryo development to facilitate the biopsy process which was performed on days 5 and 6 (blastocyst stage).

The average age across the groups was 38.7±3.6 years and the total number of mature eggs was 2912 which were randomly distributed across both incubators. The euploidy rate obtained from both groups showed a higher proportion of euploid embryos in the TLM incubator (37.03%, 95% CI 31.9-42.1) compared to those cultured in the BT incubator (30.4%, 95% CI 23.1-37.7). Regression analysis showed that female age remains to be the key variable driving euploidy rates (0.85, 95% CI 0.82-0.88) although incubator type could be an important covariable (0.54, 95% CI 0.45-0.59). A subgroup analysis of 74 single euploid embryo transfers showed comparable pregnancy and live birth rates.

This large cohort study demonstrates that uninterrupted controlled culture environment provides increased probability to develop euploid embryo in a PGT-A cycle. However, further evaluation is required to assess how environmental culture conditions at a cellular level could affect epigenetic mechanisms in embryo development and higher aneuploidy rate.

The purpose of this study was to assess the effect of combining low dose of Coenzyme Q10 with clomiphene citrate on ovulation induction in polycystic ovary syndrome (PCOS) women with clomiphene resistance.

A total of 149 women with clomiphene resistant PCOS who needed ovulation induction were randomly allocated to oral clomiphene citrate and Coenzyme Q10 group and oral clomiphene citrate only group using a computer generated allocation sequence. The study was conducted at Aziz Medical Center, Karachi, Pakistan from 1st July 2020 to 1st October 2020. Polycystic ovary syndrome was diagnosed according to Rotterdam criteria. The primary outcome was ovulation and conception rate per cycle. Chi square test and Fischer’s exact test were used to compare these variables at p<0.05 level of significance.

Of the 133 women assessed, the proportion of women who ovulated with combination (70% vs., 19%, p=0.001) was greater and the combination group had greater conception rate per cycle than those who received only clomiphene (48.6% vs. 6.3%, p˂0.001). When stratified according to obesity, 85.3% of non-obese women who received combination ovulated whereas only 55.6% of obese women ovulated (p=0.002). Moreover, 48.6% of non-obese women conceived in the combination group as compared to 6.3% of obese women (p=0.007). Women who received combination were six times more likely to conceive than women who only received clomiphene citrate (AOR=6.344, 95% CI: 1.452-27.71, p=0.014).

Coenzyme Q10 is a valuable adjunct in women with PCOS undergoing ovulation induction. It improves ovulation and conception in women with clomiphene resistance.

The cases with unexplained infertility may have an abnormality in their sperm chromatin structure. Sperm selection methods can be used to separate sperm with low DNA fragmentation. The purpose of this study was to compare the efficacy of physiological intracytoplasmic sperm injection (PICSI) with magnetic- activated cell sorting (MACS) in assisted reproductive techniques in cases with un- explained infertility.

The semen samples were collected from couples with unexplained infer- tility. After semen analysis and sperm DNA fragmentation (SDF) evaluations, sam- ples were prepared with swim-up method. The rates of SDF in different fractions in- cluding raw semen (n=20), swim-up (n=20), only motile sperm after swim-up (swim-up selection) (n=20), MACS sperm selection (n=20), only motile sperm after MACS (MACS selection) (n=20), and PICSI sperm selection (n=16) were evaluated. Also, the main sperm characteristics and fine morphology of sperm suspension after MACS were assessed. Statistical analysis was performed using GraphPad Prism. The p<0.05 was considered statistically significant.

DNA fragmentation index (DFI) values in PICSI and MACS groups were significantly reduced as compared to the swim-up group. The rate of this reduction was more pronounced in MACS (58.20±13.02) than PICSI (36.57±15.52) group. Al- so, our results showed that MACS resulted in decreased sperm motility, with no al- teration in their fine morphology.

MACS was found to be more efficient in reduction of SDF rates than PICSI. However, none of the sperm selection techniques can not totally eliminated the spermatozoa with DNA fragmentation in the final sperm sample.

The purpose of the current study was to evaluate the possible effect of follicular fluid paraoxonase 3 (PON 3) on oocyte quality and sex hormones.

This descriptive-analytical study was performed on totally 90 enrolled women including fifty infertile women presenting with polycystic ovaries and uni- lateral tubal factor and forty fertile women with male factor infertility referring to Umm-al-Banin Infertility Clinic in Dezful, Iran for in vitro fertilization during Octo- ber 2018 to November 2019. Oocyte removal was carried out under transvaginal ul- trasound guidance, and follicular fluid (FF) was removed and preserved to detect PON3, estrogen, and progesterone levels. In addition, oocyte number and quality were assessed and its association with PON3 activity in the FF was evaluated. One- way ANOVA and Fisher's least significant difference (LSD) were used for data analysis and p≤0.05 were considered statistically significant.

A significant increase was observed in the total number of the oocytes and mature metaphase II oocytes with ≥20 pg/ml of PON3 concentration in the FF (p≤0.05). Moreover, a positive relationship was shown between the increased estra- diol level in follicular fluid and PON3, so that the highest estradiol level was ob- served in the amount of 31-40 pg/ml of PON3 (p≤0.05).

According to the results, as the number of the mature oocytes in- creased, the amount of PON3 as well as estradiol levels in the FF increased. This re- search displays an increase in the level of PON3 with mature oocytes, thus support- ing the indirect evidence for the function of PON3 in follicle development.

The purpose of the current study was to assess pooled prevalence (PP) of SARS-CoV-2 in semen and pooled estimates including weighted mean difference (WMD) and risk ratio (RR) of semen characteristics in infected cases as compared with healthy controls.

Major databases were searched by two authors. SARS-CoV-2-positive cases were assigned to the exposed arm (group A), whereas the controls to the unex- posed (group B). Risk of bias was assessed with Newcastle-Ottawa Scale and PRISMA guidelines were followed. Random-effects model was employed for ana- lyzing the heterogeneity and fixed-effects model for homogeneity of studies.

Of 170 studies, 14 studies were eligible involving 507 subjects (316 in group A, 191 in group B). The risk of bias was the highest for "comparability" do- main. SARS-CoV-2 RNA was found in only two studies among 7 subjects (PP= 2.10%, 95%CI 0.58–4.42). There was a significant decrease in sperm concentration (WMD= -15.29, 95%CI -24.70 – -5.88) and total sperm in ejaculate (WMD= -47.58, 95%CI -86.40 – -8.75) in group A. The effect of COVID-19 upon progressive mo- tility, ejaculate volume, and leukocyte presence in semen was not significant.

Prevalence of SARS-CoV-2 in semen among the infected cases is low. Sexual transmission through semen is improbable and of little concern for public health. Sperm concentration and total sperm in ejaculate are significantly reduced as compared with controls. Due to limited information of the current research, longer follow-up is needed to identify delayed or progressive impact.

Endometriosis is an estrogen-dependent chronic progressive gynecological dis- ease that affects around 10% of women of reproductive age. A recent study shows that brain- derived neurotrophic factor (BDNF) has the potential as a clinical marker in the diagnosis of endometriosis. We aimed to determine whether BDNF levels are correlated with pain scores associated with endometriosis.

Fifty women who underwent laparoscopy surgery at Dr. Soetomo General Hos- pital and Dr. Ramelan Navy Hospital were prospectively recruited from October 2017 until August 2018. A blood sample was obtained before surgery and BDNF was measured using the Human BDNF Quantakine®️ kit. The relationship of BDNF levels in serum with the diseases's level of pain and stages was compared between cases and controls. BDNF validity as an endometriosis diagnosis biomarker was assessed using receiver operating characteristic (ROC) analysis.

Serum concentrations of BDNF were significantly greater in women with endo- metriosis (30.42±7.41 pg/ml), compared to controls (25.66±3.30 pg/ml). Serum concentra- tions of BDNF were moderately correlated with the patient’s reported pain scores (r=0.44, p=0.01). Receiver operating characteristic curve analysis confirmed the potential of BDNF in the diagnosis of endometriosis. Using a cut-off value of 27.06 pg/ml, the sensitivity and specificity were reported to be 66.7% and 64.3%, respectively.

BDNF serum levels in endometriosis women are significantly higher than in women without the disorder. BDNF serum level seems to have low accuracy and predictive value as a diagnostic marker for endometriosis. However, there was a moderate relationship between BDNF serum level and the degree of pain.

Chromosomal rearrangements play an important role in infertility. Carriers of chromosomal rearrangements have a lower chance of producing normal or balanced gametes due to abnormal segregation of chromosomes at meiosis, which leads to recurrent spontaneous abortions and infertility. Preimplantation genetic test- ing for structural chromosome rearrangements (PGT-SR) is offered to couples who have balanced chromosomal rearrangements in order to select embryos with a bal- anced karyotype prior to implantation, thereby increasing the chances of pregnancy. The purpose of the current study was to assess the outcomes of PGT-SR in patients carrying various balanced chromosomal rearrangements and to assess their clinical pregnancy outcome after in vitro fertilization (IVF).

In this study, infertile couples with balanced chromosomal abnormalities undergoing PGT-SR were retrospectively analyzed at a single fertility center from January 2016 to December 2019.

PGT-SR was performed on 87 embryos from 22 couples in whom one part- ner carried a balanced translocation or an inversion. Fifty-seven (65.5%) of these embryos had unbalanced or sporadic aneuploidies, 30 (34.5%) embryos were normal or chromosomally balanced, which were then transferred in 18 couples. A higher rate of unbalanced translocations in comparison to sporadic aneuploidies was ob- served in couples with reciprocal translocation. The live birth rate per embryo trans- fer was found to be 66.6% (12/18).

PGT-SR is a useful tool in selecting normal or balanced embryos for transfer in IVF, which could lead to a pregnancy by reducing the chance of miscar- riages due to chromosome aneuploidy in couples with balanced chromosomal rear- rangements.

Perivascular Epithelioid Cell Tumors (PEComas) are rare mesen- chymal tumors originating from perivascular epithelioid cells. The second common affected organ is uterine. Most of PEComas are benign and patients have good prognosis. At the present time, surgery is the main treatment and adjuvant chemo- therapy is used in malignant cases, although the best diagnostic and management method is yet to be discovered considering the rarity of this neoplasm.

The patient was a 53 year old lady with a history of two vaginal deliveries and no previous surgery. She had severe pelvic pain and underwent MRI with the primary impression of sarcoma. In MRI, she had a 7 cm mass in lower segment of uterus. The patient underwent laparoscopic hysterectomy, bilateral oophorectomy, lymphadenectomy, and omental biopsy in Jam Hospital. Pathologic report of the patient revealed malignant PEComa without lymph node and omentum involvement.

Diagnosis of PEComa before surgery is difficult and its differential diagnoses form uterine leiomyoma or leiomyosarcoma. Final diagnosis can be made after surgical biopsy and immunohistochemistry evaluation. Surgery is still the main treatment and adjuvant therapy is used in high risk patients.