International Journal of Reproductive BioMedicine
Volume:11 Issue: 10, Oct 2013

Preterm labor (PTL) is one of the most important causes in neonatal mortality and morbidity. Late preterm labor (34-36w) includes 75% of such birth. Assisted reproductive technology (ART) pregnant women are at increased risk of PTL. The study has been undertaken to determine whether beginning and continuing 17-α hydroxy progesterone caproate can reduce risk of PTL or change neonatal mortality. In a double-blind clinical randomized control trial, 106 women were treated by ART technique for their infertility and in gestational age at 16 weeks entered in our study. In one group, 17-α hydroxy progesterone caproate (Femolife) was injected intramuscularly every week until 36 weeks of gestation and in another group; placebo was injected from 16 until 36 weeks of gestetion. Data collected from pregnancy outcomes, infancy, and subsidiary problems were statistically analyzed by a questionnaire. The risk of PTL in placebo group was 2.48 higher than control group that was not significant (Cl: 0.81-9.94). Femolife side effect in case group was gestational diabetes and local complication was not frequent. NICU admission was not significantly different between groups. Although it seems that 17-α hydroxy progesterone caproate does not cause significantly decrease in PTL in singleton ART gestations but any reduction of PTL in such high risk pregnancies may improve final gestational outcome. There is critical need for larger clinical trials to better understanding causes of PTL, specifically late preterm labor, to prevent mortality and morbidity in ART gestation

Gonadotropin-releasing hormone (GnRH) is a reproductive key hormone. The GnRH analogues are widely used in in vitro fertilization and treatment of sex hormone-depended cancers induced by the materials used in chemotherapeutic agents. The aim of this study is to evaluate the effects of cyclophosphamide and decapeptyl (analogues of GnRH) on histomorphometry and stereology of testicular tissue as well as gonadotropic and gonadal hormones indices in mice. For this study, 24 adult male Balb/C strain mice were divided in four groups; first, cyclophosphamide (65 mg/kg/body weight (BW)), second, decapeptyl (0.05 mg/kg/BW), third, decapeptyl at first, and after 10 days of cyclophosphamide injection, and control group was received same volume of sterile saline. In order to evaluate the tissue changes in testes of the mice, sections were prepared and stained with Hematoxylin-Eosine, Periodic Acid Schief''s (PAS) and Oil-Red-O staining techniques. The cyclophosphamide causes histomorphologic changes in the testicular tissue; whereas such changes by decapeptyl were comparatively mild. The morphometric results revealed significant reduction in diameters of seminiferous tubules (p=0.02), and the stereological results confirmed significant differences in spermatogenesis (SI) as well as rate of tubal differentiation (TDI) indices between experimental and control groups (p=0.001). In addition, the morphometric findings proved that, there are significant decrease (p=0.001) in thicknesses of epithelia and stereologic result revealed reduction in number of cell layers in both decapeptyl and chemotherapy groups, but the decrements of these parameters were significant (p=0.02) in later group. In groups that had received cyclophosphamide, and decapeptyl alone, the LH and testosterone levels were decreased significantly (p=0.03), whereas in those that had received decapeptyl along with cyclophosphamide, the LH and FSH levels showed a decline but the level of testosterone increased. These results demonstrated that, analogue of GnRH i.e., decapeptyl protect morphologic, morphometric, and stereologic alterations of the testes tissue, as well as gonadotropic and gonadal hormonal changes preceding cyclophosphamide treatment in male mice.

The postpartum period is a time of transition for a pregnant woman and her new family. In this period many pregnant women are in search about the family planning methods. But contraceptive options differ depending on women’s desires such as cultural and religious believes, partner attitudes, previous contraceptive experiences. This study was conducted to identify status of using a contraceptive method before pregnancy and the factors associated with preferences of contraception in postpartum period. The descriptive research was conducted in a State Hospital March-May 2012 in Turkey. The population of study was formed with 200 pregnant women who applied follow-up pregnant clinics. We took permissions from local authorities and participants. 182 voluntary pregnant women were surveyed. We prepared a 20 item question are form which was asking socio-demographic futures, contraceptives methods before-after delivery and the factors related with using contraceptives after screening literatures related with subject. The 49.5% of women reported that they didn’t use any methods before. There was a significant relation between using contraceptives before pregnancy with the idea of using contraceptive during the postpartum period and receiving contraception counseling during pregnancy (p=0.004, p=0.035 respectively). The 86.4% of pregnant implied that they would use a contraceptive method in postpartum period. IUD was the most preferred method. Status of using contraceptive before and receiving contraception counseling in pregnancy were the effective variables on thoughts about using a contraceptive method. To achieve desired goals for maternal and child health in our country health professionals should be more focused on postpartum contraception in antenatal care programs

Endometrial development has an important role in blastocyst adhesion and implantation. During IVF cycles, endometrial development is enhanced by progesterone. The aim of this study was to compare ultrastructural and morphometrical characteristics of mice uterine endometrium in natural cycle with those in superovulated cycles received progesterone or Sildenafil. In This study, 60 female bulb/c mice were divided into 4 groups: a control and 3 experimental; gonadotropin, gonadotropin+ Sildenafil and gonadotropin+ progesterone. In experimental groups the mice superovulated mated. In the gonadotropin+ progesterone and gonadotropin+ Viagra groups, the mice respectively received 1mg progesterone and 3 mg Sildenafil citrate. Their uterine specimens were prepared for morphometrical and ultrastructural study. Height of the epithelial cells was measured, using motic software. Statistical analysis was performed using ANOVA. Microscopy revealed that in control group the cells had numerous apical microvilli and the height of the cells was 20.52±2.43 μm. In gonadotropin+ progesterone group, the granules were found in basal and apical portions and cellular height were 17.91±2.78 μm which were significantly shorter than in the control and gonadotropin groups (p<0.001). In this group, the apical membrane also contained pinopodes. In gonadotropin +Sildenafil group, the granules were found in both apical and basal portions and the height of the cells were 17.60±2.49 μm which were significantly shorter than in the control and gonadotropin groups (p<0.001). In this group, pinopodes appeared slightly extensive than the other groups. It is concluded that superovulatory drugs in mice stimulate endometrial maturation but injection of Sildenafil is nearly more positive

The interaction between follicular cells and oocyte leads to a change in gene expression involved in oocyte maturation processes. The purpose of this study was to quantify the expression of more common genes involved in follicular growth and oocyte developmental competence. In this experimental study, the expression of genes was evaluated with qRT-PCR assay in female BALB/c mice pups at 3-day of pre-pubertal and 8 week old virgin adult ovaries. The tissue was prepared by H&E staining for normal morphological appearance. The data were calculated with the 2-ΔCt formula and assessed using non-parametric two-tailed Mann-Whitney test. The p<0.05 was considered as significant. The data showed a significant increase in the level of Stra8 and GDF9 in adult compared with newborn mice ovaries (p=0.049). In contrast, a significant decrease in the level of Mvh, REC8, SCP1, SCP3, and ZP2 was observed in adult mice ovaries compared to those in the newborn mice ovaries (all p=0.049 except SCP1: p=0.046). There was no significant difference in the level of OCT4 and Cx37 expression between adult and newborn mice ovaries. The modifications in gene expression patterns coordinate the follicular developmental processes. Furthermore, the findings showed higher expression level of premeiotic gene (Stra8) and lower level of meiotic entry markers (SCP1, SCP3, and REC8) in juvenile than newborn mouse ovaries.

In vitro maturation (IVM) is a promising treatment option for certain infertile women. Nowadays, with the aid of PolScope, it has become possible to evaluate zona pellucida (ZP) characteristics as a parameter of oocyte quality. Moreover, quality of oocytes can be influenced by many factors, such as patient’s age. The PolScope system is a non-invasive technique to assess birefringent structures such as the meiotic spindle and ZP in living oocytes. The aim was to determine the influence of the woman''s age on ZP birefringence, a sign of oocyte quality, and morphology of in-vitro matured human oocytes using non-invasive polarized light (PolScope) microscopy. ZP birefringence and morphology were determined in 105 retrieved oocytes from 58 women undergoing ICSI in two age groups (≥30 years and <30 years). The immature oocytes were selected and after IVM, the quality of metaphase ΙΙ (MII) oocytes was assessed. The oocytes abnormalities were classified as intracytoplasmic and extracytoplasmic abnormalities. Oocyte maturation rates were significantly reduced in ≥30 year’s women (56%) in comparison with other age group (80.7%). In addition, the ZP birefringence was significantly higher in MII oocytes in the younger group compared with the older group (76.2% vs. 38.1%; p=0.00). Following morphologic assessment, the rates of oocytes with extracytoplasmic (p=0.02) and both abnormalities (extra- and intracytoplasmic) (p=0.01) were higher in aged versus the younger women. There was a positive relationship between advanced maternal age with decreased ZP birefringence and oocyte morphological quality in in-vitro matured human oocytes.

Most previous research has focused on polycystic ovary syndrome (PCOS) characteristics and their association with psychological disorders, such as anxiety and depression. In the present study, our aim was to study whether PCOS characteristics are associated with several aspects of psychological well-being namely self-esteem and body satisfaction. This was a cross-sectional study of 300 women with PCOS that was carried out in Kashan, Iran. Main outcome measures were the Body Image Concern Inventory (BICI) and the Rosenberg’s Self-Esteem Scale and clinical information of PCOS. Major clinical PCOS features including obesity (BMI), excessive body hair (hirsutism score), acne, menstrual cycle disturbances and infertility. The findings of regression analysis indicated that infertile women had lower levels of self-esteem (β=-0.11, p=0.049) and poorer body satisfaction (β=0.121, p=0.036) compared with PCOS women without infertility. Furthermore, hirsute women experienced poorer self-esteem than women without hirsutism (β=-0.124, p=0.032). Women with menstrual irregularities had higher body dissatisfaction (β=0.159, p=0.005). Moreover, women with higher body mass index scores had poorer body satisfaction (β=0.151, p=0.009) but were not associated with self-esteem. The emotional well-being of the patients presenting with the syndrome needs to be recognized more fully, particularly in relation to the low self-esteem, poor body image, and struggles with weight, menstrual irregularities, hirsutism and infertility. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of women with PCOS.

Comparison of albumin and cabergoline in the prevention of OHSS. 95 high risk infertile women for OHSS (more than 20 follicles in both ovaries at day of Human Chorionic Gonadotropin (HCG) injection) were randomly divided into two groups. First group including 48 women received 10 unit intravenous albumin at starting oocyte retrieval, and second group including 47 women received 0.5 mg/day dopamine agonist (Cabergolin) at day of HCG injection till 8 days. The dosage of human Menopausal Gonadotropin (HMG) used, total number of follicles developed, number of oocytes retrieved, serum E2 concentrations during the luteal phase, development of ascites, number of embryos generated, clinical pregnancy rate, results of the in vitro fertilization-embryo transfer (IVF-ET) cycles and incidence and severity of any OHSS were evaluated. There was evidence of a statistically significant reduction in the incidence of OHSS in the cabergolin group (53.7%) versus albumin group (46.3%) (p=0.04). But there was no significant difference of a reduction in severe OHSS (p=0.62). There was no difference in clinical pregnancy rate too. Administration of cabergolin can prevent incidence of OHSS and does not appear to effect on its severity. Ovarian hyperstimulation syndrome (OHSS) is the most serious and potentially life-threatening iatrogenic complication associated with ovarian stimulation during Assisted Reproductive Technology (ART) protocols. OHSS typically is a result of ovarian expression of vascular endothelial growth factor (VEGF) which increases vascular permeability.

The aim of our study was to assess the effect of storage duration of frozen embryo on ART outcome. In this retrospective study the data of 651 frozen-thawed embryo transfer cycles were assessed over a 36-months period. Our patients were categorized according to storage time of freeze. Group I: less than 90 days, Group II: between 90-365 days. Group III: between 365-730 days. Group IV: between 730-1095 days. Group V: more than 1095 days. Clinical pregnancy and implantation rate were defined and statistical analysis was performed using Student t-test and Chi-square. According to our finding patient’s mean age was 31.05±5.231 years (range, 18-53 years), and 1204 embryos were transferred. The mean storage duration was 296.72±301.82 days. The mean number of embryo transferred per cycle was similar between groups (p=0.224). According to our analysis clinical pregnancy rate per embryo transfer cycle was similar between groups (p=0.563). Our results showed that duration of storage had no negative effects on implantation of cryopreserved embryos. In our literature review we found a little article In this context. However our study showed duration of freezing don’t have any negative effects on implantation and pregnancy outcome, but more studies are needed to evaluate long term effects of storage duration on babies were born by cryopreserved embryos. Cryopreservation of embryos has been an usual component of clinic in assisted reproductive technology (ART) programs. Recently the dramatic increase in cryobiology activity in the clinical centers has enhanced methods of freezing and improved vitrification protocols are being developed.

Adenomyosis is an idiopathic and benign disease in which ectopic endometrial glands embedded deeply in myometrial smooth muscle with the compensatory hypertrophy of the myometrium surrounding the ectopic endometrium (1, 2). There is a correlation between depth of the infiltration and initial too high stage of adenomyosis. Lesions may characterize as a diffuse or focal lesions. The highest prevalence occurs in parous women 30-50 years old and in half of the cases remains asymptomatic (2, 3). By now, there are no definitive detection methods for adenomyosis and the condition still remains a diagnostic challenge. Transvaginal ultrasound (TVS) is the primary imaging modality for preoperative diagnosis of diffuse adenomyosis. Recent studies showed that the irregular endometrial-myometrial junction (junctional zone, JZ) with increased thickness depicted on coronal view of 3D-TVS as a sonographic criteria has a high diagnostic accuracy particularly for diagnosis of initial adenomyosis based on the reasonable hypothesis that adenomyosis is caused by infiltration of endometrial tissue across the junctional zone and into myometrium(7, 9). Ahmedet al found the positive predictive value (PPV) and accuracy of 3D-TVS in the diagnosis of adenomyois to be 95% and 80%, respectively, based on detection of irregular junctional zone on coronal plane. This picture of month aims to illustrate a typical feature of adenomyosis on three-dimensional ultrasound (Figure 1 a, b). 3D-TVS provide the most comprehensive and detailed view of the uterus and improves the evaluation of adenomyosis in the office as a first line diagnostic tool. There is a broad spectrum of ultrasound features in adenomyosis. Typical adenomyosis on two-dimensional ultrasound (2D-TVS) is characterized by the presence of focal or diffuse myometrial heterogeneity (4, 5). Diffuse adenomyosis represents as asymmetric myometrial thickening and/or enlarged and globular uterus. Other findings in adenomyosis include echogenic nodules or linear striations extending from the endometrium into the myometrium results from presence of ectopic endometrial glands and stroma and also dilated cystic glands result in small myometrial cysts(1).In a recent review Reinhold and colleagues reported that TVS had a sensitivity of 80-86%, specificity of 50-96%, and overall accuracy of 68-86%for diagnosing diffuse adenomyosis (1). However, TVS can yield equivocal result in the case of focal adenomyosis and if there are co-existent fibroids (6). Furthermore, the 2D-TVS findings are more likely appears in advanced stage of disease. With the advent of real time three-dimensional ultrasound (3D-TVS) the diagnostic potential of ultrasound examination of adenomyosis has improved significantly. The coronal section of the uterus and post processing arrangement provided by 3D-TVS has led to substantial improvement in the diagnosis of adenomyosis on early stage (7, 8).

Embryo transfer and its related factors received little clinical attention and had been, until recently, the most inefficient step in in-vitro fertilization (IVF). Factors which appear to influence implantation rates are: contamination of the catheter tip with cervical bacteria, stimulation of uterine contractions during the procedure, the type of catheter, ultrasound guidance during the transfer, the position of the embryos in the uterine cavity and perhaps cervical mucus (1-4). Easy and atraumatic transfer is essential for successful implantation and the embryos need to be placed in the middle of the cavity, away from the fundus (5). The goal of trans-cervical embryo transfer is to non-traumatic deliver the embryo to an optimal intra uterine location for implantation. Cervical canal mucus may cover the catheter tip and it can be a source of bacterial contamination of uterine cavity. Therefore, aim of this study was evaluation of effect of removal of cervical mucus on clinical pregnancy rate. This study was carried out as a randomized controlled trial. Randomization was done for stratification of age, method of treatment and cause of infertility. A total of 120 women (18-35 years) with male factor infertility, was undergoing IVF cycles with long protocol, divided to two groups: 60 infertile women as cases (group A) that cervical mucus was aspirated and 60 women as controls (group B), without aspiration. In both groups scrub was done by normal saline. Aspiration of cervical mucus was performed by Mucat catheter just before embryo transfer in case group. Embryo transfer was done after 36 hours of puncture. Bed rest for all women after embryo transfer was 1 hours. Primary outcome and pregnancy defined as: positive βhCG 12 days after embryo transfer.The mean age of group A was 29.93±5.04 years, and in the group B was 29.03±4.5 years (p>0.05). The mean duration of infertility in group A was 7.6±5.6 years and in group B the mean duration of infertility was 5.5±3.2 years (p>0.05). The frequencies of previous IVF in group A and B was 38.3%, and 28.13% respectively (p>0.05, OR=1.64 in group A, OR=2.64 in group B). There was no significant difference between two groups in terms of number of transferred embryos statistically (p=0.06). The quality of transferred embryo in group A was as following: grade a 67.7%, grade b 16.7%, grade c 6.7%, and in group B was: grade a 85% and grade b 15%, and two groups were also no significantly different (p>0.05). Contact bleeding was happened in 1.7% of group A and 3.3% of group B. The rate of pregnancy (positive βhCG) in the group A was 11.7% (n=7), however, in the group B was 16.7% (n=10) and two groups had not significant difference statistically (p>0.05, OR=0.66). This study indicates that, removal of cervical mucus during embryo transfer (ET) has no positive effect on the pregnancy rate. However, according to some reports, removal of cervical mucus during ET had been postulated to increase the pregnancy and implantation rates by not interfering with embryo implantation (6). Some researchers suggested that, this is a time- consuming procedure that may increase the incidence of difficult transfers by removing the naturally lubricant mucus.In addition, any cervical manipulation at the time of embryo transfer may cause unwarranted uterine contraction. Several studies have shown a correlation between cervical mucus aspiration and increase pregnancy rates (4, 7). According to the study of Yazd University of Medical Sciences, cervical mucus aspiration with insulin syringe before embryo transfer can increase the pregnancy rate (8). According to some reports the presence of bacterial contamination of catheter tip during embryo is evidently limited and does not significantly affect the cycle outcomes (2). Several studies have shown that cervical mucus aspiration can decrease infection rate with E. coli, Mycoplasma, Uroplasma, Streptococcus B, D, Staphilococcus and increase implantation rate (9).In addition to cleaning cervical mucus, other interventions, such as drug prescription (ritodrine for example) also has no significant effect on pregnancy rate (10). Present study showed no positive correlation between this intervention and result of pregnancy outcome; however, total pregnancy rate in both groups was not high. Because of this procedure may increase the incidence of difficult transfer by removing the naturally lubricant mucus and may cause uterine contraction. In conclusion, the data presented in this study suggest that cervical area and uterus environment manipulation before embryo transfer is not recommended