International Journal Of Fertility and Sterility
Volume:6 Issue: 3, Oct-Dec 2012

Varicocele is considered as one of the main etiologies of male infertility. Along with altered semen parameters, increased DNA fragmentation is believed to play an important role in varicocele-induced infertility. DNA damage may result from intra- or extra-testicular factors. Among these, apoptosis, abnormal chromatin packaging and oxidative stress are the most researched and are addressed in this review. Significant evidence suggests that varicoceles have a harmful effect on testicular function and a varicocelectomy not only prevents progressive decline in testicular function, but also reverses the damage. However, the degree to which varicocele repair improves pregnancy rates and the success of assisted reproductive technology (ART) remains controversial. Therefore, the role of varicocele repair on DNA fragmentation is also discussed.

Advances in stem cell biotechnology hold great promise in the field of tissue engineering and regenerative medicine. Of interest are marrow mesenchymal stem cells (MSCs), embryonic stem cells (ESCs), and induced pluripotent stem cells (iPSCs). In addition, amniotic fluid stem cells (AFSCs) have attracted attention as a viable choice following the search for an alternative stem cell source. Investigators are interested in these cells because they come from the amniotic fluid that is routinely discarded after birth. There have been multiple investigations conducted worldwide in an attempt to better understand AF-SCs in terms of their potential use in regenerative medicine. In this review we give a brief introduction of amniotic fluid followed by a description of the cells present within this fluid. Their history related to stem cell discovery in the amniotic fluid as well as the main characteristics of AF-SCs are discussed. Finally, we elaborate on the potential for these cells to promote regeneration of various tissue defects, including fetal tissue, the nervous system, heart, lungs, kidneys, bones, and cartilage.

We designed this study to detect the cryoinjury rate on human sperm after serial freezing and thawing، taking into consideration the effects of using cryovials and straws. In this experimental study، semen specimens obtained from 15 subjects were divided into normozoospermic and oligozoospermic groups. Each of the normozoospermic and oligozoo spermic semen specimens were additionally divided into two groups: i. washed and ii. unwashed. Specimens were repeatedly freeze-thawed by using cryovials and straws with the fast liquid nitrogen vapor method، until no motile sperm remained. Sperm motility، recovery، and morphology rate were then determined after thawing، and compared between the groups while taking into consideration the effects of using cryovials and straws. Motile spermatozoa were observed in all normozoospermic samples up to thaw 6 with both cryovials and straws while in oligozoospermic specimens up to thaw 4 (straw) and thaw 3 (cryovial) in the freeze-thawing cycle. Normozoospermic sample analysis showed no significant difference in morphology rate. There was a significant increase in motility and recovery percentages for washed samples، which was observed with straws in compared to the unwashed groups. Oligozoospermic sample analysis indicated a significant increase in motility، recovery (p<0. 01)، and morphology (p<0. 001) rates in washed specimens compared to unwashed specimens using straws. The importance of washing sperm was obvious for oligozoospermic specimens. Normozoospermic sperm resisted freezing longer than oligozoospermic sperm. Use of straws and cryovials made significant differences in motility، recovery، and morphology of sperm in each thaw. This difference was slightly higher for oligozoospermic specimens. Results indicated that the percentage of motility was higher for washed normozoospermic specimens in each thaw when straws were used، whereas the percentage of motility، recovery، and morphology were promoted after frozen oligozoospermic specimens were washed using straws.

Varicocelectomy is considered as standard treatment for male infertility for clinical varicocele. The aim of this study is to address the effects of varicocelectomy on semen parameters، chromatin packaging، and pregnancy outcome. This retrospective study was carried out between June 2006 and February 2011 on 145 infertile men with grade II or III varicocele. Microsurgical varicocelectomy was performed as part of patient management. Sperm count، motility، morphology، and chromatin packaging were assessed with a Makler counting chamber، light microscopy، Papanicoulaou and chromomycin A3 (CMA3) staining، respectively. In addition، we assessed spontaneous clinical pregnancy and miscarriage rates The percentages of spontaneous cumulative pregnancies post-surgery were 33. 1% (3 months)، 42. 06% (6 months)، 46. 2% (9 months)، 48. 9% (12 months)، and 55. 8% (after 12 months). Percentages of spontaneous cumulative miscarriage post-surgery were 2. 46% (3 months)، 4. 93% (6 months)، 4. 93% (9 months)، 6. 17% (12 months)، and 6. 17 % (after 12 months). Both sperm parameters improved and the percentage of sperm protamine deficiency decreased significantly after varicocelectomy. These results confirm that varicocelectomy improves sperm parameters and chromatin packaging، thereby improving the chance of pregnancy. Positive aspects of this study include the large number of patients studied، duration of follow up، one surgeon who performed all of the surgeries، and type of surgery (microsurgery). The spontaneous pregnancy results also suggest that if pregnancy is not achieved within twelve months post-surgery، an alternative approach such as assisted reproductive technology (ART) treatment should be considered.

Human chorionic gonadotropin (HCG)، one of the initial embryonic signals، is probably a major regulator of the embryo-endometrial relationship. This study aims to assess the advantage of HCG supplementation during the secretory phase of hormonally prepared cycles for the transfer of cryopreserved-thawed embryos. This study was a randomized clinical trial. Infertile women who were candidates for frozen-thawed embryo transfers entered the study and were divided into two groups، HCG and control. The endometrial preparation method was similar in both groups: all women received estradiol valerate (6 mg) po per day from the second day of the menstrual cycle and progesterone in oil (100 mg) intramuscular (I. M.) when the endometrial thickness reached 8 mm. Estradiol and progesterone were continued until the tenth week of gestation. In the HCG group، patients received an HCG 5000 IU injection on the first day of progesterone administration and the day of embryo transfer. In this study، 130 couples participated: 65 in the HCG group and 65 in the control group. There was no statistically significant difference between groups regarding basic characteristics. Implantation rate، chemical pregnancy، clinical pregnancy، ongoing pregnancy، and abortion rates were similar in both groups. Although HCG has some advantages in assisted reproductive technology (ART) cycles، our study did not show any benefit of HCG supplementation during the secretory phase of frozen cycles (Registration Number: IRCT201107266420N4).

The aim of this study was to investigate whether several clinical variables can affect the pregnancy rate of intracervical insemination (ICI) using cryopreserved donor spermatozoa. In this retrospective study، age، years of infertility، cervicitis، urinary luteinizing hormone (LH) surge، insemination number، uterus position، endometrial thickness and morphology، maximal follicle diameter، and the number of dominant follicles on the day of human chorionic gonadotropin (HCG) administration were retrospectively analyzed in 501 women who underwent their first ICI cycle using cryopreserved donor spermatozoa. Increased age، length of infertility (>5 years)، retroverted uterine position، and endometrial thickness (<7 mm or >14 mm) were associated with lower rates of pregnancy. In older women with infertile periods longer than five years، especially those with a retroverted uterus، intrauterine insemination (IUI) combined with ovarian stimulation should be recommended. In vitro fertilization with donor spermatozoa (IVFD) should be offered earlier to achieve a much higher success rate.

Our goal was to assess the diagnostic value of creatine phosphokinase (CPK) and its isoenzyme CPK- muscle brain (MB) in ectopic pregnancy (EP) in order to locate a simpler diagnostic approach for EP. This was a prospective study that performed consecutive sampling for 20 months in two major hospitals in Isfahan, Iran. All pregnant patients in their first trimester of gestation that presented with complaints of vaginal bleeding, abdominal pain, or both enrolled in this study. Blood sampling was performed for laboratory analyses (CPK, CPK-MB). After their diagnosis was established, patients were put in either the EP or non-EP group. We used SPSS software version 10 for data analysis, diagnostic parameters were determined, and a relative operating characteristic (ROC) curve was plotted for each biochemical marker A total of 106 patients, 53 in the EP group and 53 in the non-EP group enrolled in this study. The results for CPK were as follows: sensitivity (69.81%), specificity (64.15%), positive predictive value (PPV; 66.07%), negative predictive value (NPV; 68%), positive likelihood ratio (PLR) (1.95), and negative likelihood ratio (NLR) (0.49). The results for CPK-MB were: sensitivity (71.7%), specificity (56.6%), PPV (62.29%), NPV (66.7%), PLR (1.65), and NLR (0.5). The area under the ROC curve for CPK was 0.692 and for CPK-MB it was 0.647. Although we have observed a significant elevation in CPK and CPK-MB serum levels in EP, transvaginal ultrasound (TVS) is still the better diagnostic tool for EP.

The purpose of this study was to compare the success rates of 70 patients from the same database, each with an ectopic pregnancy (EP) that was treated with either the single- or multi-dose methotrexate (MTX) protocols for unruptured EPs. This study was a blinded, randomized clinical trial. Treatment protocols were either single- (50 mg/m2) dose MTX or multi-dose (1 mg/kg MTX + 0.1 mg/kg folinic acid). There were 35 cases in each group. The outcome was measured by adverse events, resolution of pregnancy without surgical treatment, success rate of MTX treatment, and fertility outcome in each group. With the single-dose protocol, response to treatment was considered successful in 29 (82.9%) patients; in the multi-dose protocol 31 (88.6%) responded to treatment. The difference between success rates in the groups was not statistically significant (p=0.587). In the singledose group, 2 (5.7%) patients and in the multi-dose group, 6 (17.2%) patients had complications (p=0.28). Of the 14 patients in the single-dose group. Clinical pregnancy occurred in 9 (75%) whereas clinical pregnancy occurred in 3 (25%) patients from the multi-dose group. Infertility was seen in 4 (33.3%) patients in the single-dose group and in 8 (66.7%) in the multi-dose group. We believe that the single-dose MTX protocol could be as successful as multi-dose MTX for the treatment of EP. It is effective, cost-effective, and associated with better fertility outcomes than the multi-dose MTX protocol (Registration Number: IRCT201112178435N1).

There is a lack of studies regarding the effects of ultrasound (US) and replication of its exposure on pre-implantation events in mammals. Thus, this study assesses the reproductive performance of mouse oocytes that have been obtained from ovaries irradiated with US waves versus non-irradiated ovaries. Also comparision of their parthenogenesis, ovulation, fertilization, and pre-implantation development rates. In this experimental study, we divided extracted ovaries into three experimental groups that received the same dosage, but different replicates of radiation for each group. Results were compared with the control and sham groups. Continuous wave (CW) US, at a spatial average intensity of 355 mW/cm2 and a frequency of 3.28 MHz, was administered for 5 minutes to the ovaries at an interval between pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) injections. Statistical analysis was performed using the ANOVA test and the level of significance was determined to be 0.05. Data collection was based on microscopic visualization. According to the obtained results, metaphase II (MII) oocyte numbers and the percentage of blastocysts significantly reduced in the USexposed groups versus the unexposed groups. Fertilization rate was comparable between groups while parthenogenesis was significantly higher in the US-exposed groups compared to the unexposed groups. Structural damage to cells, intracellular organelles and proteins, as well as changes in signaling pathways induced by US may be reasons for some of the observed adverse effects in groups that have received more US exposure.

Cervical ectopic pregnancy (EP) is an infrequent, life-threatening form of ectopic gestation pregnancy that implants within the endocervical canal. With the increase in use of assisted reproductive technology (ART) worldwide and more liberal use of transvaginal sonography (TVS) during early pregnancy, more cases of cervical ectopic pregnancy are being diagnosed. Early diagnosis of this condition by using ultrasound imaging allows for prevention of maternal morbidity due to hemorrhage and leads to conservative management of this condition.We present the case of a 38-year old woman (gravida 1, para 0) who was found to have acervical ectopic pregnancy at six weeks of gestation.