International Journal of Reproductive BioMedicine
Volume:5 Issue: 4, Mar 2007

Endometriosis is a common gynaecological disease that can cause severe pelvic painsuch as dysmenorrhoea and dyspareunia, however the mechanisms by which pain isgenerated are not well understood. Nerve fibres in endometriotic plaques have beenreported by several authors. We have recently demonstrated the presence ofunmyelinated sensory nerve fibres (using the pan-neuronal marker PGP9.5) in thefunctional layer of endometrium in women with endometriosis and a significantlyincreased nerve fibre density in endometrium and myometrium in women withendometriosis compared with women without endometriosis. Sensory C nerve fibreswere only detected in the functional layer of endometrium of women with endometriosisand never in women without endometriosis. This finding is so consistent that it maybecome an effective means of making the diagnosis of endometriosis. Nerve fibresexpressing a range of neuronal markers and an over-expression of nerve growth factor(NGF) and nerve growth factor receptor (NGFRp75) were also demonstrated inperitoneal endometrial plaques in women with endometriosis. Effects of currentlyavailable medications for endometriosis on nerve fibres in eutopic endometrium inhormonally treated women have been also studied. This review will describe nervefibres in eutopic endometrium and ectopic endometriotic plaques in women withendometriosis.

Immune system disturbances have an important role in endometriosiswhich may lead to infertility. It seems that inflammatory cytokines specially tumornecrosis factor alpha (TNF-α) which were produced by activated macrophages have animportant role in pathology of endometriosis. Based on this theory, anti TNF-α drugslike pentoxifylline (PX) are suggested as new drugs for Endometriosis.

This experimental study has been done on female rats to determine theeffect of PX on the endometrial implants and leukocytes in serum.

In proestrous phase, one horn of rat’s bicorn uterus wasremoved surgically and the endometrium was implanted to different places as follows:subcutaneous, peritoneum and near ovaries. After two months observation, female ratsdivided into two groups randomly. In treated group (n=10) PX (5mg/kg twice a day)and in control group (n=10), normal saline (same dose) were injected subcutaneously.Then, via second laparotomy and in the same phase of the cycles, the size of implantsand the amount of leukocytes in serum were measured.

In treated group compared with control, the size of implants was decreasedsignificantly in right subcutaneous (8.05mm vs 13.50mm) p<0.01, left subcutaneous(7.64 mm vs 14mm) p<0.01, right ovary (6.64 mm vs 15.22mm) p<0.001 and left ovary(7.18 mm vs 14.56 mm) p<0.005. In treated group, the total leukocyte count (5259.54 ±178.78 vs 15833.33 ± 259.27) p<0.02 was decreased. The number of esterous cyclewas similar in both groups.

PX can reduce the size of endometrial implants as well as leukocyte count.

Recent reports have suggested that ultrasound-guided embryo transfer (UG-ET) might improve pregnancy rates.

To determine whether transabdominal UG-ET is a useful tool for increasing pregnancy and implantation rates in patients undergoing IVF or ICSI.

A prospective randomized clinical trial was conducted in 180 patients in order to compare embryo transfer under abdominal ultrasound-guidance (n=90) with embryo transfer by clinical touch method (n=90).

The Clinical pregnancy rate was 21.1 % in the ultrasound-guided group and 15.5 % in the clinical touch group (p =0.3). The implantation rate in the ultrasound guided group was 11.1% while this was 7.2% in the clinical touch group (p =0.12). The percentage of difficult transfer was not significantly different in both groups, this was 8.9% in the ultrasound-guided group and 13.3% in the clinical touch group (p =0.47).

Although the clinical pregnancy and implantation rate are higher in UGET group than the clinical touch group, but this difference was not statistically significant.

Mullerian disorders are present in 5-25% of infertile women. Myoma,polyp and endometrial adhesions are among other involved factors in infertility.

The aim of this study was to determine the frequency distribution ofpregnancy occurrence in infertile women after the diagnostic-surgical hysteroscopy onselected infertile cases including those with abnormal uterine.

One hundred and fifteen women with at least 12 monthsinfertility who had abnormal uterine cavity and patients who had at least 4 unsuccessfulART cycles with no confirmed diagnosis of uterine cavity problem, underwentdiagnostic hysteroscopy and if required hysteroscopic surgery. Follow up sonographyand HSG performed 2-3 months later and all subjects were followed for pregnancyoccurrence for 12 months.

Mean age of subjects was 32.65 ± 6.2 years and mean of infertility durationwas 8.33 ± 5.25 years. Based on the sonography and HSG performed prior to thehysteroscopy, respectively 69.6% and 41.8% of the subjects had abnormality. In 65.2%of the cases, hysteroscopy showed septum, myoma, endometrial adhesion andirregularity and all of them underwent hysteroscopic operation. Among the operatedcases, in 27 cases pregnancy occurred during the first 6 postoperative months and in 2cases during the second 6 postoperative months of whom one case was EP.

There was no significant difference in the rate of pregnancy occurrencebetween those who had abnormal hysteroscopy and those who were normal (p= 0.63).This can show the variation of infertility causes and the fact that infertility is not justdue to uterine problems. Therefore, the repetition of therapeutic measures and longerfollow up of infertile cases are necessary.

Matrigel (extracellular matrix) can improve the growth of many celltypes in vitro.

The aim of the present study was to determine the effect of Matrigel on thedevelopment of 2-4 cells human embryos in culture.

Surplus 2-4 cells human embryos, resulting from ICSI, weredivided into two groups (control and test). Quality of embryos in both groups wasmorphologically similar. The test group (n=140) was cultured in Hams’ F10supplemented with 10% human serum albumin and 150 μl liquid Matrigel. The controlgroup (n=140) was cultured in the same medium devoid of Matrigel. Embryos werecultured for an additional 4 days and their morphology was assessed every 24 hours.Both groups were then statistically compared.

The percentage of the human embryos that reached the morula stage in thecontrol and test groups were 79.2% and 80%, respectively (p>0.05). However, 36.4%of embryos reached the blastocyst stage in the test group as compared to 5.7% in thecontrol group after 144 hours in culture. This difference was statically significant (p<0.01). In addition, culture of embryos on Matrigel and medium versus medium alonesignificantly improved in vitro hatching (25.7% versus 3.5%; p <0.01).

Matrigel at low concentration enhances human blastocyst formation andhatching in vitro.

The basis of spermatogenesis is the spermatogonial stem cells (SSCs).The concentration of SSCs is very small. However, a system that supports theproliferation and maintenance of SSCs in vitro could be used to preserve and expandSSCs numbers as well as increase success in transplantation. It is a new avenue torestore spermatogenesis in azoospermia subjects.

Proliferation and enhancement of frozen-thawed SSCs numbers during in vitroculture.

Both Sertoli and spermatogonial cells were isolated fromadult mouse testes. Frozen-thawed spermatogonial cells were cultured in two groups: simpleculture (Experimental 1) and co culture with Sertoli cells (Experimental 2). Also, Fresh cellswere considered as control groups: simple culture (control1) and co culture with Sertoli cells(control 2).Assay of the spermatogonial-cell-derived colonies was carried out at the endof each week.

Results indicated that the viability rate of the frozen cells after thawing(68.4±10.2%) was influenced by cryopreservation procedure significantly (p ≤0.001). Inaddition, the number of the colonies and their diameters in the co-culture system withfresh cells (25.1±5.2 and 205.8±50 μm, respectively) were more than other groups andthe differences were significant (p<0.001). Number of the colonies and their diametersin experimental 1(9.5±4.3 and 124±35.9 μm, respectively), experimental 2 (15.6±3.5and 157.6±41.9μm, respectively) groups were better than control 1 group (3.1±2.2 and87.5±30.6μm, respectively) and the differences were significant (p<0.001).

We demonstrated that co-culture system with Sertoli cells can increase invitro colony formation of adult fresh and frozen-thawed spermatogonial cells in mouse.

Phospholipids are distributed asymmetrically between inner and outerleaflets of the plasma membrane of live cells. Early during apoptosis, this asymmetry isdisrupted and phosphatidylserine becomes exposed on the outside surface of the plasmamembrane. There is little information about the effects of vitrification on apoptosis.

The aim of the present study was to evaluate the effect of vitrification onapoptosis of subfertile and fertile men.

In this study, semen samples were collected from subfertile(n=20) and fertile men (n=10) after 48h abstinence of intercourse. After semen analysisaccording to WHO criterias, each semen sample was divided into two portions. Firstportion was assessed by Annexin V-flous staining kit for showing apoptosis insubfertile and fertile men and second portion was assessed after vitrification-thawing.Results were analyzed by Paired t-test and Independent t-test.

After vitrification-thawing, mean percentage of apoptotic spermatozoa hasincreased 6 and 3 times in subfertile and fertile men respectively. This difference issignificant.

Vitrification-thawing could disrupted membrane asymmetry andcaused apoptosis. Therefore, it will cause reduction of functional spermatozoa in accessof Assisted Reproduction Technologies (ART).

There is mounting evidence for HPV involvement in cervical cancer HumanPapilloma Virus DNA is detected by hybridization techniques in 75 – 100% of patients withcondylomas, precancerous cervical dysplasia, and invasive carcinoma.

The aim of this study was investigating factors that may contribute to falsenegativecolposcopic biopsy results in positive high-risk HPV DNA results.

Patients positive for high-risk human papillomavirus (HPV)DNA with negative cervical histopathologic findings were examined between January2004 and August 2006.

Patients with atypical squamous cells of undetermined significance (ASC) inPapanicolaou smears, with positive HPV DNA results, but negative cervicalhistopathologic findings accounted for 4.5% of all ASC smears submitted for HPVDNA testing. We found 4% of the cases had focal HPV infection or mild dysplasia.When serial sectioning of the biopsy material were examined, we found that 29% hadclinically significant lesions: HPV infection or cervical intraepithelial neoplasia CIN 1,18%; CIN II/III, 8%; and dysplasia, not otherwise specified (which we can notcategorize into any group), 3%. Of the remaining patients, follow-up revealed squamousabnormalities in 25%. About 5% of patients with positive HPV DNA results had anegative follow-up biopsy result. "False-negative" biopsies accounted for one third ofcases.

In almost one third of cases, clinically significant lesions were found whenadditional levels were examined.

Sodium arsenite and/ or vasectomy may cause variation in sex hormoneswhich affect pathophysiology of reproductive organs.

The aim was to investigate the morphological changes in structure of testisand hormonal imbalance in bilateral Vasectomised rats treated with sodium arsenite.

Four groups of rats: bilateral vasectomy + sodium arsenite,bilateral vasectomy, sham operated + sodium arsenite and sham operated only wereconsidered, and 8 mg/kg/ day of sodium arsenite was given for 8 weeks to the rats. Thetotal volume of testis, volume of interstitial tissue, volume of seminiferous tubules,diameter of seminiferous tubules and germinal epithelium thickness were evaluatedusing stereological methods. Hormones were also measured and the results wereanalyzed using one way ANOVA.

A significant reduction of total volume of testis (p<0.01), mean volume ofseminiferous tubules (p<0.002) as well as germinal epithelium thickness (p<0.05) inboth vasectomy + sodium arsenite and vasectomy rats was seen compared to shamoperated only. In addition a significant reduction of testosterone was observed invasectomy + sodium arsenite group when compared to the other groups (p<0.001). LHlevel decreased significantly in vasectomy + sodium arsenite when compared to shamoperated ones (p<0.05).

Vasectomy and treatment with sodium arsenite affect the structure of testiswith respect to its volume, volume of seminiferous tubules and thickness of germinalepithelium, which may be due to variation of LH and testosterone level in the rats.

Inversion of the uterus is very uncommon. Patients may present withpelvic pain, vaginal discharge, or hemodynamic shock.

Case: 

We report a case of 35 years old women (virgin) who was admitted with profusevaginal bleeding and cramps of uterus. In the vaginal examination at litothomy positiona mass of 5×8 cm in size was protruded from the vagina. At first myomectomy wasperformed and after that laparotomy with total abdominal hysterectomy was done.

Early diagnosis, immediate treatment of shock, and replacement areessential in uterine inversion.