International Journal of Reproductive BioMedicine
Volume:9 Issue: 4, Apr 2011

There is an upward trend for parents to resort to assisted reproductive technology (ART) treatment due to delayed childbirth or birth difficulties. This study investigates the pregnancy health and birth outcomes of women who underwent ART and analyzes the factors that influence birth weight to become<10 percentile when undergoing ART. This study analyzed results of the first wave of the Taiwan Birth Cohort study. Through stratified systematic sampling, 24,200 mother-and-child sampling pairs were obtained from a total of 206,741 live births in Taiwan in 2005; 366 of the babies were born with the use of ART. During pregnancy, mothers who used ART suffered from higher risks of complication than the natural conception counterparts, including gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), and placenta previa. Additionally, babies born through ART had poorer outcomes than the natural conception groups: the low birth weight (<2500g) was 33.1% compared to 6.4% for babies born naturally. Pregnancy health and birth outcomes of women who underwent ART were worse than those who got natural conception. Types of maternal complication among ART women included GDM, PIH, and placenta previa. Having multiple births was the most important factor that causes low birth weight in babies. The results of this study can be used as a reference for the health and care of mothers and babies who use ART.

Non obstructive azoospermia (NOA) is one of the causes of male infertility in which spermatogenesis process is disturbed. Recent studies suggested the possible role of endothelial nitric oxide synthase (eNOS) in spermatogenesis process. The aim of the present study is to evaluate the expression of eNOS in human testicular tissue in men with NOA and men with normal spermatogenesis by using immunocytochemistry. In this case-control study, testicular biopsies were obtained from 10 men with NOA and 7 men with normospermia who were attended to infertility center for diagnosis or infertility treatment. Immunohistochemistry was used to localize the isoform of eNOS in these tissues and the intensity of staining was semi quantitively assessed. In addition, the histopathological evaluation was examined in both groups. The isoform of eNOS enzyme activity was detected in the cytoplasm of sertoli and leydig cells in both groups. There was, however, a considerable variability in the intensity of staining between two groups. The expression of eNOS in Leydig cells in control group was significantly (p<0.05) higher than those in the NOA group. In contrast, expression of eNOS in Sertoli cells in NOA was more than those in the control group. eNO Simmune staining was absent in the normal germ cells but was intense in the abnormal germ cells with piknotic neucleous. The most histopathological finding were hypospermatogenesis (27.2%), Sertoli cell only syndrome (18.1%) and tubular fibrotic (13.6%). These results suggested that increase level of eNOS may play an important role in the apoptosis process in the abnormal germ cells and disturbance of spermatogenesis process.

Human fertility has been declined all over the world. Advanced women’s age is one of the most important factors in determining the success of reproduction and ageing has negative impact on ART outcome and advanced female age decreases the chance of live birth rates achieved using ART, especially after 40 years of age. To evaluate ART outcomes regarding to pregnancy, abortion, cycle cancellation and live birth rates in women 40 years and older. A retrospective study was performed on three hundred-thirteen women undergoing ART cycles in the Madar Hospital in Yazd. Women with age? 40 years who indicated for ART enrolled the study regardless of the infertility type or etiology. In this study, we used data from IVF or ICSI cycles using fresh embryo transfer. Follow up was performed in regard to pregnancy, abortion, cycle cancellation and live birth rates. The mean age of women was 41.87±1.97 years. Chemical pregnancy rate was 8.6% (27/313) per cycle. Clinical pregnancy rate was 3.8% (12/313) per cycle. Spontaneous abortion was observed in 63% (17/27) of patients with positive pregnancy test. The overall cancellation rate was 23.3% per oocytes retrieval. The overall live birth rate per cycle for all women who initiated an ART cycle at age? 40 years was 3.2% (10/313) that eight of those women were under 42 years old. Based on our results, we suggest that women with age 42 years and above should be advised to use other options, including oocyte donation or adoption.

Despite numerous developments in the field of assisted reproduction the implantation rate remains low. Recent studies suggested that local injury to endometrium in controlled ovarian hyper stimulation cycle improves implantation rate. Studies have attempted to intervene in the development of endometrium. The aim of the present study was the exploration of the possibility that local injury of the endometrium increases implantation rate. In this interventional study, 100 good responders to hormone stimulation patients were divided into control group (n=50) and experimental group (n=50) which undergo endometrial biopsy by biopsy catheter)piplle) on day 21 of their previous menstrual cycle with use of contraceptive pills before the IVF-ET treatment. In total, 26 patients were removed from the study because the number of stimulated follicles were below 3, or there was no embryo or there was the risk of OHSS. The remaining patients were 33 in experimental group and 41 in the control group. There were no significant differences between the two groups in terms of the age of the patients, duration of infertility and BMI, base line FSH level and responses to hormone stimulation. The rates of embryo implantation, chemical and clinical pregnancy in the experimental group were 4.9%, 18.2% and 12.1% with no significant differences with the control group (6.7%, 19.5%, 17.1%). Cancellation rate was 26%. In our study, endometrial biopsy didn’t increase the chances to conceive at the following cycle of treatment.

Citrus aurantium is a small citrus tree, with scented white flowers. The C. aurantium is used in Asian herbal medicine primarily to treat digestive problems. The goal of this study is to investigate the effect of C. aurantium flower's aqueous extract on uterine contraction in presence of some known uterus stimulants. In experimental study 30 virgin Wistar rats 200-300gr were obtained. After laparatomy, a piece of Uterus was dissected out and mounted in an organ bath (10ml) containing De Jalon (29°C) and contracted by KCl (60mM), oxytocin (10mU/ml) and barium chloride (4mM) then the effect of C. aurantium flower's aqueous extract (1-8 mg/ml) on the uterine contractions was investigated. Uterus was separately incubated with propranolol (1?M), naloxone (1?M) and the role of? -adrenoceptors, opioid receptors were evaluated. Cumulative concentrations of the extract (1-8 mg/ml) decreased KCl, oxytocin and barium chloride induced uterine contractions, dose-dependently (p<0.001). C. aurantium flower's aqueous extract was unaffected on incubation the tissue with propranolol and naloxone. It seems that the extract induced antispasmodic effect mainly via calcium influx blockade. However, neither? -adrenoceptors nor opioid receptors were involved. Since the extract has antispasmodic effect on uterus contraction therefore we can suggest that more study will be necessary to relief dysmenorrheal.

The effects of estrogene on central nervous system are still controversial. We aimed to investigate the effects of raloxifene on the antioxidant enzyme [superoxide dismutase (SOD) and catalase (CAT)] activities and malondialdehyde (MDA) levels in brain homogenates of ovariectomized female rats and its effect on cognitive process of learning. Female Sprague Dawley rats (n=24) were divided into three groups. Three weeks after ovariectomy; nonovariectomized group (control group) (n=8) was given physiological saline (SP) as placebo. First ovariectomized group (n=8) received raloxifene 1mg/kg dissolved in a 1% solution of carboxymethylcellulose (CMC) subcutaneusly (sc) and second group of ovariectomized rats were given 1 % CMC 1mg/kg (sc) every day for 14 days. Learning behaviors of rats were evaluated in active avoidence cage with using sound and electrical stimulation. The levels of oxidative stress (MDA) and antioxidant enzymes (SOD, CAT) in different regions of the brain homogenates were compared between three groups of decapitated rats. Raloxifene had a significant attenuating effect on the levels of MDA in brain tissues suggesting raloxifene’s effect against lipid peroxidation at the end of training days. With the comparison of brain regions, cortex showed the highest average activity of SOD and CAT and cerebellum had the lowest average levels for both. Its effects on learning and cognitive process with active avoidence task were considered insignificant. Raloxifene treatment may have preventive effects for the brain against oxidative stress and lipid peroxidation in rats.

The pregnancy rate during in-vitro fertilization (IVF) following progesterone supplement still remains very low at around 20%. To investigate the effects of peanut oil itself on the endometrial receptivity, the pregnancy success rate and fertility during the peri-implantation time in hyper stimulated and normal rats. Thirty-six adult Sprague Dawley rats with at least four regular oestrus cycles were randomly divided into 4 groups: two groups were hyper stimulated by human chorionic gonadotropin (hCG) and treated with progesterone or with peanut oil; the two other groups were not hyper stimulated and treated with saline solution or peanut oil. On day 5.5 of pregnancy, the uterine horns were removed and blood was collected for histomorphometric and serum progesterone evaluation. 12 rats were allowed to continue the presumed pregnancy to term. Analysis of variance (ANOVA) and student t-test were used to compare the means of morphometric and radioimmunoassay data between groups. p-values less than 0.05 were considered statistically significant. The mean values of morphometric parameters and serum progesterone varied significantly between the groups (ANOVA, p<0.0001). The lowest values of progesterone parameters were observed in the hyperstimulated groups that did not deliver pups; both hyperstimulated groups had deleterious luminal epithelium with varying degrees of mucosal projections. There were isolated decidualised zones observed in hyper stimulated peanut oil group, whereas peanut oil group had the highest number of implantation sites and deliveries. The results show that hype stimulation reduces the endometrial receptivity, while peanut oil increases endometrial receptivity, pregnancy rates and fertility by triggering decidualisation.

The prevalence of infertility is variable between 5-30% around the world. In Iran, more than 2 million couples suffer from infertility. Infertility causes depression, anxiety, social isolation and sexual dysfunction. This descriptive study was undertaken to determine general health in infertile couples. One hundred and fifty infertile couples attending Yazd Research and Clinical Center for Infertility were randomly selected during March till September 2009. The GHQ-28 questionnaires were completed by researchers, based on face to face interview. It contains 28 items, which have been divided to four sub- items. The results come out by scoring the patients answer from 0 to 84. All data were analyzed by Chi-square and t-test in SPSS software. GHQ scores of all sub-scales and total in women were more than men, which shows general health condition in women is worse than men. There was no relation between the duration of infertility and general health scores. This study suggests that the infertility has significant effect (p=0.001) on health situation of infertile couples, especially infertile women. They are at risk of somatic symptoms (p=0.0001), social dysfunction (p=0.0001) and severe depression (p=0.0001). GHQ could provided help and support in order to improve the health situation of infertile couples.

The differential efficacy between long GnRH agonist with antagonist can partly be due to the preexisting differences in the early antral follicles before ovarian stimulation. To compare the effect of pretreatment by estradiol with GnRH antagonist on antral follicular size coordination and basal hormone levels in GNRH antagonist protocol. On cycle day 3 (control/day 3), women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones then were randomized to receive oral estradiol 4mg/day (n=15) or 3mg cetrorelix acetate (n=15) in luteal phase before subsequent antagonist protocol. Participants were re-evaluated as on control/day 3. There was a significant reduction of mean follicular sizes in each group after medical intervention (7.63±2.11 Vs. 4.30±0.92 in group A and 8.73±1.96 Vs. 4.13±1.11 in group B) (p=0.0001). The magnitude of follicular size reduction was significantly higher in group B (-4.60±2.04 Vs. -3.33±2.28) (0.027). There was a non significant attenuation of follicular size discrepancies in two groups. FSH and inhibin B levels in the day 3 of the next cycle in both groups were significantly decreased but did not have significant difference between two groups. Both luteal E2 and premenstrual GnRH antagonist administration reduces the follicular sizes significantly and GnRH antagonist acts more potently than E2 in this way but attenuation of follicular size discrepancies in both treatment is not significant.

Although heterotopic gestation is common in assisted reproductive techniques, it is very rare in natural conception and clomiphene induced pregnancy. Diagnosis and appropriate intervention of heterotopic pregnancy requires a high index of suspicious. Case: In this paper a case of heterotopic pregnancy in a 30-year old woman with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 9 weeks of gestation is reported. This case suggests that a heterotopic pregnancy must always be considered particularly after the induction of ovulation by clomiphene citrate or assisted reproductive technology. Every clinician treating women of reproductive age should keep this diagnosis in mind. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.