Asian Pacific Journal of Reproduction

Pages 89-92

Authors: Ibrahim A. Abdelazim, Maha M. Belal, Hanan H. Makhlouf c

Objective To investigate the role of Anti-Mullerian hormone and antral follicle count in predicting the ovarian reserve, and success of IVF. Methods Ninety two infertile couples complaining of infertility due to male or tubal or unexplained factors were included in this comparative prospective study for IVF/ICSI. Day-3 basal hormonal level of FSH, LH, E2, and AMH were measured, followed by Transvaginal ultrasound (TVS) to evaluate the AFC. Controlled ovarian hyperstimulation was done using the long protocol for ovarian hyperstimulation. Methods According to the number of retrieved oocytes women included in this study were classified into two groups; good responders (≥ 4 retrieved oocytes) and poor responders (< 4 retrieved oocytes). Ovarian reserve in this study was assessed by day-3 basal hormonal levels and AFC. The mean Day-3 AMH and mean AFC were significantly high (4.93±1.22) ng/mL, and (12.72±5.70) ng/mL; respectively) in good responders compared with poor responders, also, the number of retrieved oocytes were significantly high in the good responders group compared with poor responders (13.52±9.70) versus (3.91±1.20) (P<0.05). The numbers of chemical and clinical pregnancies were significantly high (6 cases (75%) and 13 cases (72.2%); respectively) in the good responders compared with poor responders (2 cases (25%) and 5 cases (27.8%); respectively). Conclusions Day-3 AMH and AFC are good predictors for ovarian reserve, there were positively correlated with the number of retrieved oocytes and numbers of chemical and clinical pregnancies. Keywords AMH; AFC; Ovarian reserve; IVF

Pages 98-101

Authors: Kahraman Ülker, Tuncay Ok , İsmail Temur , Ürfettin Hüseyinoğlu , Kemal Kılıç, Barlas Sülü

Objective To compare the amounts of any clinically detectable gas passage into the urinary bag in laparoscopic and open surgeries. Methods Seventy-nine women were allocated into two surgical groups; Group 1: carbon dioxide (CO2) laparoscopy (n=37) and Group 2: gasless laparoscopy or laparotomy (n=42). All patients had urinary catheter during the surgeries. After checking the tightness of the connection of the urinary catheter and bag operations were performed. At the end of each surgery the urine volumes were recorded. The bags were immersed into a water containing container with a volume scale. The volume rise of the container was recorded. The valve of the outlet of the bag was turned on under the water and any leakage of air bubbles was observed. The final volume of the container was recorded once again while the bag was still in the water. The two groups were compared by using the Student's t or Mann Whitney U tests. Results We did not observe and hence measure any gas accumulation in the urine bags of both groups. The women's ages, total intraoperative urine volume, urine production rate and total operative times of the groups were not significantly different. The mean operative time was (82.98±62.14) min in open surgeries and (73.46±52.74) minutes in CO2 laparoscopic surgeries. The difference between the groups was not significant (P=0.468). Conclusions Any gas accumulation in the urine bag during CO2 laparoscopic surgery should raise the suspicion of urinary tract injury. Urinary catheterization helps to diagnose the unnoticed bladder injuries. Keywords Surgical injuries; Intra operative; Laparoscopy; Laparoscopic surgery; Urinary tract; Urinary bladder; Urinary catheterization

Pages 105-110

Authors: Amal M. Abo-El maaty , K.H. El-Shahat

Objective The current study is an endeavor for profound understanding hormonal and biochemical constituents in Arabian mare serum during the estrous cycle. Methods Ten Arab brood mares of previous foaling records were scanned with ultrasound each other day, and blood samples were collected with each ultrasound examination. The diameter of follicles and corpus luteum was measured. The follicles were classified into small, medium, dominant, 1st and 2nd largest according to their diameter. Hormonal concentrations of thyroxin, progesterone, estradiol and testosterone were assayed. Superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO) and total antioxidants concentrations (TAC) were measured. Besides, the levels of total proteins, albumin, globulin, glucose, total cholesterol, and triglycerides were assayed. Results The data revealed that multiple follicles underwent progressive enlargement (≤30 mm). Only the largest (dominant) follicle reached a maximal diameter of (35.82±1.57) mm during estrous phase. During the luteal phase, the corpus luteum reached a maximum diameter of (31.78±1.4) mm. The serum progesterone levels in mare were significantly (P<0.05) higher in luteal phase than those recorded at time of estrus. The reverse was true for estradiol. However, the levels of testosterone and thyroxin did not significantly change during estrous cycle in mare. No significant difference was observed in the serum levels of total protein, albumin and globulin in both phases of estrous cycle. Similar finding was observed in SOD concentrations. In contrast, the concentrations of glucose, cholesterol and triglyceride tended to be significantly (P<0.05) higher at estrous stage than those recorded at luteal one. The same finding was observed in NO levels. On other hand, TAC significantly increased (P<0.05) in mare serum obtained from luteal phase than those obtained at estrous one. A reverse was true for MDA levels. Conlcusions The steroid hormones and metabolic constituents of mare serum (glucose, cholesterol and triglyceride) as well as NO, MDA and TAC vary according to the stage of the estrous cycle, suggesting their possible role in the process of follicular development in mare. Keywords Mare; Estrous cycle; Hormone; Biochemical constituent

Pages 117-119

Authors: Anthony Sabasthin, Venkataswamy Girish Kumar , Sumanta Nandi, Virupakshaiah Chandrasekhar Murthy

Objective The present study was envisaged to examine the hematological and biochemical, parameters in three different groups of buffaloes (regularly cycling, pregnant and repeat breeding) maintained in isothermic and isonutritional conditions to establish the variations in blood and/or serum components in these groups. Methods Blood samples were analyzed for hemoglobin, PCV, TLC, neutophil, lymphocyte, eosinophil, and monocyte count, glucose, total protein, albumin, globulin, urea and cholesterol. Results The results revealed significantly lower haemoglobin and packed cell volume value in repeat breeding when compared to pregnant and regularly cycling animals. The WBC value significantly higher in repeat breeding when compared to regularly cycling animals. The average mean values of neutrophils, lymphocyte and eosinophils revealed a no significant difference in the neutrophils, lymphocyte and eosinophils in between the group. The mean values of monocytes revealed a significantly higher value in repeat breeding animals when compared to pregnant animals. The serum glucose, total protein, cholesterol and urea levels were significantly lower in repeat breeding compared to pregnant and regularly cycling animals. The levels of albumin and globulin revealed non-significant difference among the groups. Conclusions A significant decrease in the hemoglobin, PCV, glucose, total protein, cholesterol and urea was observed in the repeat breeding animals when compared to pregnant and regularly cycling animals. Keywords Haematology; Biochemical parameter; Buffalo; Reproductive status

Pages 125-134

Authors: Geok Ling Lee, Eric Douglas Blyth , Cecilia Lai-Wan Chan

Objective To examine how Hong Kong Chinese women and men coped with and adjusted to the infertility problem over time. Methods Using purposive sampling and theoretical sampling, nine heterosexual couples and ten women who had completed IVF were recruited. Data were collected using a narrative interviewing technique and autobiographical timeline, based on a grounded theory approach. Results Regardless of the outcome of IVF, coping with infertility and treatment was emotionally taxing. Four themes relating to the coping experiences were identified and captured innovatively in pictorial and narrative forms. They were: ‘one of the many’, resilience, recovery and prolonged grief. The findings concurred with the existing literature – coping with infertility is emotionally taxing, and variability exists in the degree of adjustment to infertility, which in turn influences well-being. The study also demonstrated the advantages of creative use of clinical-interview methods in research on couples subjective and lived experience of infertility. Conclusion The findings suggest that the participants varied in their coping and adjustment to the experience of infertility, with most of them demonstrated positive meanings and resiliency over time. The combined use of both clinical-interview methods helped to facilitate exploration and articulation of the lived experiences of infertility among participants, allowing both in-depth understanding of the phenomenon and adherence to methodological rigor. The clinical-interview research methods can also promote evidence-based reflective practice for researchers and an empowering experience for participants. Keywords Assisted reproduction; Autobiographical timeline; Coping, infertility; Meaning making; Narrative

Pages 142-146

Authors: Andrew E. Czeizel, Attila Vereczkey

Objective To summarize the arguments for the introduction of preconception care based on the experience of the Hungarian Periconception Service (HPS), 1984–2011. Methods This new health infrastructure, as part of primary health care is performed by qualified nurses/midwifes after their special training. Couples at risk selected by nurses are referred to specialists to reject or confirm the supposed risks, in addition to treat them if necessary as part of the secondary care. The HPS includes counseling, examinations and medical interventions in three steps: (I) Reproductive health check-up as a preconception screening of reproductive risk factors. (II) The 3-month preparation for conception because the beginning of life is at conception, and the major events of life such as conceptus' sex, health and/or disease are determined at that time, therefore it is necessary to prepare it. (III) Better protection of early pregnancy. In general pregnant women visit prenatal care clinics between the 8th and 12th gestational week though the embryo has passed through his/her most sensitive and vulnerable period, thus it is too late to protect them from congenital abnormalities that occur before the 8th week of pregnancy. Results The most important arguments for the introduction of pre/periconception care/service are the following: (1) The optimal infrastructure for periconception folic acid/multivitamin supplementation. (2) Preconception screening of sexually transmitted infections/disorders in women. (3) Avoidance of smoking and alcohol beverages. (4) Early diagnosis of infertility. (5) More effective participation in genetic counselling. (6) Selection of female participants at high risk. (7) Vaccination. (8) The benefits of early pregnancy diagnosis. (9) The more effective avoidance of teratogenic and other risks. (10) Long-term beneficial effects for children. Conclusions Hungarian experiences show the feasibility and usefulness of pre/periconception care/service in the prevention of preterm births and congenital abnormalities. Keywords Pre/periconception care/service; Reproductive risk; Periconception folic acid/multivitamin supplementation; Protection of embryo; Congenital abnormalities; Preterm birth

Pages 152-154

Authors: Brad B Swelstad, Paul R Brezina, Clark T Johnson, Nina Resetkova, Irene Woo, Lisa Kolp

Neuroendocrine tumors of the appendix (NET-A), formerly called appendiceal carcinoids, are rare tumors of the gastrointestinal tract. Appendiceal tumors have also been associated with infertility. However, in many of these cases, significant abdominal pathology, specifically pseudomyxoma peritonei, was identified during definitive surgical intervention. A 34-year-old nulligravid woman undergoing infertility evaluation presented to an academic tertiary care fertility center. An abnormal mass was identified on hysterosalpingogram and CT confirmed appendiceal mass. Surgical removal of the mass was performed and histopathology was consistent with an NET-A with negative margins extending to the serosa. Two months after surgical intervention, the patient spontaneously conceived pregnancy and subsequently delivered a normal infant. This case exemplifies the importance of careful inspection of radiologic films by the gynecologic physician. Of added interest, this case describes an asymptomatic NET-A associated with primary infertility. To our knowledge, this is the first report of an incidentally indentified NET-A that resulted in primary infertility. Keywords Appendiceal; Appendiceal carcinoid; Carcinoid; Infertility

Pages 157-158

Authors: Randy A. McCool

Postpartum patients with an unrecognized primary immunodeficiency disease, including common variable immunodeficiency, demonstrate increased susceptibility to Mycoplasma hominis infection. Diagnosis, treatment, and clinical course in a postpartum patient presenting with joint pain and episodic fever are presented. Keywords Mycoplasma hominis; Septic arthritis; Immunodeficiency; Postpartum

Pages 161-168

Authors: Karishma Khullar, Ashok Agarwal, SS du Plessis

The increasing incidence of obesity worldwide combined with the parallel trend of declining sperm quality has given rise to the notion that obesity and infertility are linked. While investigations of sperm quality in obese individuals have yielded inconclusive results, studies of the adverse hormonal, physical, and proteomic changes induced by obesity are more definitive. Unfavorable hormonal abnormalities reported in obese males that affect reproduction are decreased levels of testosterone, inhibin B, and ghrelin and increased levels of estrogen, leptin, and resistin. Moreover, erectile dysfunction and elevated scrotal temperatures have been associated with obesity and are important physical barriers to successful male reproduction. Recently, important advances have been made in proteomics and factors have been identified in obese individuals that may impair spermatogenesis and sperm quality. Although obesity contributes to a host of adverse effects on the reproductive system, certain lifestyle modifications can be made to alleviate such effects. Natural weight loss and surgical weight loss have demonstrated favorable results in obese patients by restoring normal hormone levels and reversing the effects of both erectile dysfunction and testicular heat stress. Pharmacological interventions have also proven to be promising in combating the effects of obesity. Particularly, aromatase inhibitors such as anastrozole, letrozole, and testolactone, have been reported to decrease the aromatase over-activity and increased estrogen levels present in obese males. An understanding of abnormalities associated with obesity and possible lifestyle modifications may help clinicians effectively guide their infertile obese male patients and increase fertility rates. Keywords Obesity; Male infertility; Adipocytokines; Erectile dysfunction; Leptin