Asian Pacific Journal of Reproduction

Pages 258-261

Authors: Giorgio Cavallini, Giulio Biagiotti

Objective It was the aim of this research to assess whether Tadalafil 5 mg once daily can improves the sperm count of unexplained infertile males with erectile deficiency induced by the emotional stress of attempting to father children. Methods Two groups, each made up of 30 unexplained infertile males with psychogenic erectile deficiency related to attempts to father children received Tadalafil 5 mg once daily (Group 1) or a placebo (Group 2) for one month. Unexplained infertile men are intended as normospermic men who could not father children over a one year period and whose female partner is free of factors causing infertility. The endpoints were: differences between the groups in restoring erectile response, modifying sperm count, side effects and modifications of sperm analyses with respect to resolution or not of the erectile deficiency irrespective of the substance (Tadalafil or placebo) used. The means were compared using analysis of variance and the percentages using the chi square test. Results The patients who received Tadalafil had their sperm volume, concentration and motility increased, but not the percentage of typical forms. Patients who received a placebo had no significant improvement. Additional analyses indicated that sperm volume, concentration and motility (but not morphology) significantly increased only in the patients who restored erectile response to sexual stimulation, independently of Tadalafil or placebo administration. No significant side effects were present. Conclusions It is thought that therapies aimed at removing emotional stress linked to the performance anxiety of fathering children might improve sperm count in unexplained infertile couples. Keywords Unexplained infertility; Pychogenic erectile deficiency; Tadalafil; Emotional stress

Pages 265-268

Authors: Zulqarnain Masoodi, Imran Ahmad, Fahad Khurram

Objective To ascertain changes in fertility in post Fournier's gangrene patients on account of changed scrotal environment. Methods Sixty post Fournier's patients were as cases and 50 non Fournier's individuals aptlyserved as controls. All subjects were followed up for 1 year. Aspects of fertility were investigated by means of a seminogram at 6 months and analysis for volume, viscosity, sperm concentration, motility and morphology according to WHO guidelines was done. Ability of the couples to conceive children in 1 year was also noted. The control group was investigated similarly and values were compared for significance. Results The seminogram results were found out to be highly significant as there was marked difference in values (chi-square value 6.28, P-value< 0.012) whereas there was no significant association between attaining pregnancy at 1 year in two groups. Conclusions A readily palpable difference in the seminogram values observed in Fournier's patients is the most significant finding of this study. Also highlighted was that despite such seminogram changes the overall ability of the couple to achieve pregnancy remains unaltered. Keywords Fournier's gangrene; Spermatogenesis; Fertility; Temperature-regulation; Scrotum

Pages 277-282

Authors: Ursula Zollner, Sonja Bischofs, Irena Lalic, Klaus-Peter Zollner

Abstract Objective There is strong evidence that the cytokines leucemia inhibitory factor (LIF) and tumor necrosis factor (TNF) alpha are related to embryo development and implantation. The aim of this study was to determine the levels of LIF and TNF alpha in embryo culture media and to assess its relationship to the outcome of in-vitro fertilization and embryo transfer. Methods A total of 99 patients were included in this prospective trial and underwent either IVF or ICSI procedure. A total of 865 oocytes were collected. Embryos were cultured in sequential media until day 5. A standardized morphology evaluation of all embryos, including a detailed pronuclear scoring, was performed daily during this period followed by the replacement of one or two selected embryos. Collected embryo culture fluids of days 3 and 5 were analysed for LIF and TNF alpha on days 3 and 5. Results Mean TNF alpha concentration in culture media on day 3 was 0.54 and 0.37 pg/mL on day 5 and was significantly lower in women conceiving than in not conceiving (0.43 pg/mL versus 0.59 pg/mL on day 3). Mean LIF concentration on day 3 was 31.5 pg/mL and 35.5 pg/mL on day 5 and was significantly higher in women conceiving (56.2 pg/mL versus 22.2 pg/mL on day 3). Conclusions The results indicate that LIF could have a function in early embryogenesis and as a factor required for embryo implantation. High TNF alpha concentrations seem to be predictive of implantation failure.

Pages 287-292

Authors: Laurence A. Cole

Abstract Introduction The three dimensional crystal structure of hCG has been publish by Wu et al., Lapthorn et al., and Lustbader et al. The problem is that the crystal is missing 50% of the hCG molecular weight. It is missing the 4 N-linked and the 4 O-linked oligosaccharides and β-subunit amino acid residues 113–145. Here we add back in these missing structures, and considering 11 reported consequences we predict the final structure of hCG, hyperglycosylated hCG, nicked hCG and hCG free β-subunit. Methods The consequences of 11 report are considered. The missing structures are examined by 2 webware programs, Bioinformatics Toolkit (Max Planck Institute), and Bioinformatics and Computational Biology (IIT Delhi). Results & Discussion Structures are proposed for hCG, hyperglycosylated hCG, nicked hCG and hCG free β-subunit, considering the charge effect that the 12 or 19 sialic acid residues may have, movement of α-subunit loop 2 and movement of β-subunit safety belt.: Nicking causes a major structural change to β-subunit loop 2.

Pages 300-302

Authors: Wei Wang, Fangxiong Shi

In order to study the effect of constant light on the ovary, 12 young adult female rats were exposed to constant light for 37 days and their estrous cycles were recorded by daily examination and the ovaries were examined histologically. The results showed that constant light induced in an abnormal and uncontrolled division of oocytes. In these divided-oocyte follicles (DOFs), two or more divided-oocytes shared one zona pellucida and usually floated freely in the follicular antrum. This fantastic phenomenon was discovered for the first time, and it was different from multioocyte follicles (MOFs) and polyovular follicles (POFs) founded in rats, humans, rabbits, mice and dogs.

Pages 308-311

Authors: Nada A.S. Alwan, Jwad K.A. Al-Diwan, Wafa' M. Al-Attar, Raghad A. Eliessa

Objective To evaluate the level of knowledge, attitude and practice towards breast cancer and breast self examination (BSE) among a sample of educated Iraqi population affiliated to Kirkuk University in Iraq. Methods The total number of participants was 304 (256 females and 48 males); comprising students (85.2%; n=259), teaching staff (8.2%; n=25) and administrative university staff (6.6%; n=20). The mean age of the participants was (23.8±8.3) years. Each was asked to complete a pre-coded standardized questionnaire. Variables were dichotomized and multiple logistic regressions were applied to test the association of independent variables with practicing BSE. Results It was observed that 177 (69.1%) of females have heard about the BSE. One hundred and nine of the female respondents (42.6%) reported that they have practiced BSE. Of those who have heard about BSE only 57.4% were in fact practicing the technique. Multiple logistic regression revealed that age of the respondents and knowledge on the means of early detection, the effect of nulliparity on the probability of contacting the disease and factors that could decrease the incidence of breast cancer were significantly associated with practicing BSE (P=0.019, 0.03, 0.03 and 0.007 respectively). Overall, it has been demonstrated that 89.7% of the female participants in this study presented a positive attitude towards learning the correct procedure of BSE with an intention to instruct others on the technique. Conclusions although the knowledge about breast cancer and practice of BSE was relatively weak in Kirkuk, probably attributable to the long standing conflicts in the city, yet the positive attitude towards learning the screening techniques and the intention to teach others were fairly encouraging. Knowledge and practice can be endorsed by promoting nationwide public health awareness campaigns and establishing sustained educational framework and policy guidelines.

Pages 315-317

Authors: Chinwe Lucy Marchie

Objective To investigate the socio-cultural factors that contribute to Maternal Mortality in Edo South Senatorial District. Methods The population of the study was made up of 2 157 females of reproductive age and multi-stage random sampling technique was used. The instrument for data collection was a self developed structured and validated questionnaire with a reliability of 0.82. Focus group discussion (FGD) and in-depth interview guide were employed to complement the instrument. Inferential statistics of multiple regressions were also employed to test the hypotheses at 0.05 level of significance. Results The results showed that the socio-cultural variables when taken together contributed positively to maternal mortality [R2 = 0.32; CV = 16.5; df = 7). The finding further revealed that six, out of seven of the independent variables in the study significantly contributed to maternal mortality in Edo South Senatorial District. The implications of these findings in maternal and child health care were highlighted. Conclusions The study had shown that in addition to medical causes of maternal mortality, there are socio-cultural factors that contribute to women dying during pregnancy, labour and pueperium.

Pages 320-322

Authors: Mohamed Elessawy, Thoralf Schollmeyer, Atefee Rajabi, Thilo Wedel, Liselotte Mettler, Walter Jonat, Ibrahim Alkatout

The incidence of iatrogenic splenic injury during gynecological laparoscopic surgery is rare or probably underreported. The spleen is situated principally in the left hypochondrium, connected to the colon, the omentum majus and the lateral abdominal wall. The estimated prevalence of iatrogenic trauma after the more common operative procedures is considered relatively low, however, immediate identification and management either by splenic repair or splenectomy should result in avoiding any potential complications. We presented a case of uterine myoma enucleation of the anterior wall of the uterus with an accidental injury of the spleen that implicated splenectomy. Constant awareness of the prevalence of this operative complication and the mechanisms by which it may arise should enable its early identification and prevention of any potential sequelae.

Pages 326-329

Authors: Mieczyslaw Uszyński, Waldemar Uszyński

There are four concepts (theories) of amniotic fluid embolism (AFE). The aim of the study was to perform their critical review and to popularize a novel integrated concept. We searched Medline (from its inception to 2011), using key words: amniotic fluid embolism, amniotic cells, tissue factor, leukotriene and microparticles. Articles most eligible for the study of etiopathomechanism of AFE were chosen by title and/or abstract contents. The analysis of the publications revealed that: (i) the integrated concept of AFE is an adequate tool to interpret the complication, being particularly useful for taking direct therapeutic decisions; (ii) disseminated intravascular coagulation (DIC) in this complication is induced not by tissue factor (TF) of amniotic origin but by spectacular procoagulant activity of apoptosis-affected amniotic cells. Descriptions of molecular processes were provided. In clonclusioin, there are two independent pathways of AFE–the DIC pathway and the leukotriene pathway. It is not the TF but the apoptosis-affected amniotic cells that are responsible for the process of DIC in AFE. 3. One of the therapeutic conclusions of the new approach to the concept of AFE indicates that attempts to use heparin in AFE are justified (at the onset of the complication).

Pages 177-182

Authors: Ursula Zollner, Marie-Theres Specketer, Klaus-Peter Zollner, Johannse Dietl

Objective To assess the role of the uterine artery blood flow in the prediction of implantation in women undergoing embryo transfer during the periimplantation period. Methods A total of 233 couples were included in this prospective study. All patients had embryo transfer, 125 were performed in in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and 108 in cryo cycles. Ultrasound measurements were performed immediately before transfer. The pulsatility index (PI), Resistance index (RI) and the peak systolic velocity (PSV) were measured in both uterine arteries using endovaginal ultrasound. Results In IVF/ICSI cycles the doppler parameters PI (2.48 vs. 2.15), RI (0.78 vs. 1.30) and PSV (60 vs. 63) did not differ significantly between the pregnant and non-pregnant group. The pregnancy rate per transfer was similar in women showing an unilateral (24%), bilateral (33%) or no (27%) notch in the uterine blood flow. In cryo cycles the uterine artery blood flow parameters PI (3.2 vs. 3.0), RI (0.9 vs. 0.9) and PSV (53.2 vs. 51.2) did not differ either between pregnant and not pregnant patients. Conclusions Previous studies were aiming at the measurement of arterial doppler parameters during the follicular phase which may not be adequate for the prediction of implantation. However, our results show that doppler studies during the early luteal phase of assisted reproductive technology cycles are not indicative for the likelihood of pregnancy, too. Keywords Uterine artery blood flow; Embryo transfer; Pulsatility index; Resistance index; Peak systolic velocity

Pages 187-192

Authors: Yanhe Liu, Kelli Peirce a, Kailin Yap , Kate McKenzie, Jay Natalwala, Vince Chapple, Margo Norman, Phillip Matson

Objective To study the performance of thawed zygotes and cleavage stage embryos transferred either on the day of thaw or after overnight culture. Methods A retrospective study of 864 frozen embryo transfer cycles. Cryosurvival rates per thawed embryo and implantation rates were analysed for embryos frozen on Day 1, Day 2 or Day 3 relative to oocyte collection (Day 0) and transferred on the day of thaw or after overnight culture, together with clinical pregnancy rates and prevalence of multiple gestations. Results Survival of Day 3 embryos was significantly lower than those frozen on Day 1 (P=0.017) or Day 2 (P=0.015). Following overnight culture, resumption of mitosis of zygotes was more frequent than Day 2 (P=0.000) which are in turn higher than Day 3 (P=0.000) embryos. The implantation rate for Day 2 embryos dividing overnight was significantly higher than those that did not divide for women <35 yrs (P=0.001) but not those women <35 yrs (P=0.055). There were no differences in the implantation rates for those dividing or not after culture, for embryos frozen on Day 3 for women <35 yrs (P=0.254) or <35 yrs (P=0.403). Conclusions Later cleavage stage post-thaw embryos survive and resume mitosis less frequently compared to earlier stages. Embryos not resuming mitosis after culture overnight can implant, particularly Day 3 embryos, suggesting that they can further increase the cumulative pregnancy rate per oocyte collection and that discarding them is wasteful. Overnight culture is best used for logistical reasons rather than a strategy to improve pregnancy rates. Keywords Cryopreservation; Resumption of mitosis; Early cleavage human embryo; Implantation rate; FET

Pages 198-202

Authors: Amal M. AboEl-Maaty, Fawzia Y.H. Shata, Manal B-E Mahmoud, Faten I. Gabr

Objective To study the role of some oxidative stress biomarkers in conception during foal heat. Methods Ultrasound scanning was used to confirm the presence of mature ovulating follicle (>30mm) in mares exhibited foal heat on days 7 to 9 postpartum. Daily blood samples were collected from parturition till foal heat to measure equine lysozymes, nitric oxide (NO), catalase (CAT), total proteins and globulins. Lipid peroxide (MDA), reduced glutathione (GSH), ascorbic acid (AA) and zinc were measured during foal heat expression form day 7 to 10 post foaling. Results Lysozymes were high on days 1 and 9 postpartum but low level was recorded on day 6. NO, total proteins and globulin peaked on days 5 and 6 but low level was recorded on day 9. High MDA (P<0.03), zinc (P<0.05) levels were observed on days 8 and 9. High GSH was observed on day 9. AA (P<0.03) and CAT levels were low on days 8 and 9. Non conceived mares had high MDA, low zinc, AA, CAT and GSH. Conclusions Mares during the foal heat are subjected to oxidative stress on days 8 and 9 as expressed by low AA, zinc, and GSH and high MDA and mares with sufficient antioxidant capacity can overcome this stress and conceive. Some mares need to be supplied during foal heat with antioxidants to improve their immunity and overcome oxidant/antioxidant imbalance to conceive. This study recommends the use of ascorbic acid and zinc as supplements during foal heat. Keywords Oxidative stress; lysozyme; Nitric oxide; Foal heat; Mare

Pages 212-216

Authors: Marcel Leppée, Josip Culig, Mirela Eric

Objective To assess the prevalence of cigarette smoking in pregnancy, and the rate of congenital malformations in children at in utero exposure. Methods The trial was designed as a cross-sectional study to measure exposure of pregnant women to adverse influence of smoking and their health status. The study consists of two arms: one was conducted at four Zagreb maternity hospitals (Croatia) and the other at the same hospitals in Novi Sad (Serbia). Results Data analysis revealed the habit of cigarette smoking during pregnancy in 829 (11.9%) of 6 992 (6 099+893) women. Malformations were found in 105 (1.5%) fetuses and newborns. Major congenital malformations were present in 4 (0.6%), minor malformations in 73 (10.5%) and low birth weight in 12 (1.7%) newborns. In all these pregnant women smoked until becoming aware of pregnancy or during pregnancy. Tobacco smoking and congenital abnormalities that define the contingency table were not significantly related in Zagreb (P=0.385), as well as in Novi Sad (P=0.345). Conclusions The proportion of pregnant women reporting cigarette smoking was quite similar in Zagreb and Novi Sad. There is no statistically significant association between cigarette smoking and congenital malformations. Keywords Smoking; Pregnancy; Congenital malformations; Zagreb; Novi Sad

Pages 224-230

Authors: Mónica Ferreira, Joana Vieira Silva, Vladimiro Silva, António Barros, Odete Abreu Beirão da Cruz e Silva, Margarida Fardilha

Objective To investigate the impact of acute lifestyle changes on human sperm functional quality. Methods In the academic festivities week, young and apparently healthy male students who voluntarily submit themselves to acute lifestyle alterations (among the potentially important variations are increase in alcohol, caffeine, and tobacco consumption and circadian rhythm shifts) were used as a model system. Sperm samples were obtained before and after the academic week and compared by traditional semen analysis (n=54) and also tested for cleaved Poly ADP-ribose polymerase (PARP) protein, an apoptotic marker (n=35). Results Acute lifestyle changes that occurred during the academic week festivities (the study model) resulted both in a significant reduction in sperm quality, assessed by basic semen analysis (decrease in sperm concentration, total number of spermatozoa, progressive and non-progressive motility and increase in sperm morphological abnormalities) and by an increase in the expression of the apoptotic marker, cleaved PARP, in the ejaculate. Conclusions Acute lifestyle changes have clear deleterious effects on sperm quality. We propose cleaved PARP as a novel molecular marker, valuable for assessing sperm quality in parallel with the basic semen analysis method. Keywords Poly ADP-ribose polymerase; Alcohol; Reactive oxygen species; Male infertility; Apoptosis

Pages 233-235

Authors: Hikmet Hassa, Yunus Aydin, Fulya Taplamacioglu

Lumbar peritoneal shunt is a technique of cerebrospinal fluid diversion from the lumbar thecal sac to the peritoneal cavity. By diverting, a second compartment of the body; abdomen starts to accompany the case as a new problem source. 32 years old woman who had been considered to be primary infertile for fifteen years applied to our infertility clinic. She had a transsphenoidal surgery due to macroadenoma of pituitary gland fourteen years ago. By trans-vaginal ultrasonography we revealed 4 antral follicles and diffuse ascites in pouch of douglas due to the shunt. There were spicular projections fom uterus and bowel serosa to inner abdominal wall, that we thought about severe intraabdominal adhesions. Controlled ovarian hyperstimulation was started with 300 IU menotropin on third day of the cycle. We yielded 4 oocyte. One grade-1 embryo transferred at day two. After two weeks hCG positivity was determined. At 39th week 3 900 g female baby was born vaginaly with 1st minute apgar score as 9 and 5th minute apgar score as 10. Keywords cerebrospinal fluid shunts; hypogonadism; reproductive techniques; assisted

Pages 238-246

Authors: A Jerome, N Srivastava

Decline in fertility in bovines is attributed to various reproductive problems viz. anoestrus, repeat breeding, abortions and post parturient disorders. Among these, repeat breeding has been an important cause for reducing the animals' fertility and life-time productivity. Many researchers have reported embryonic mortality as a major cause of repeat breeding arising due to premature corpus luteum lysis. Prostaglandin F2 α released from the uterus causes alterations in luteal blood flow, induces luteal lysis, and hence reduces progesterone secretion from the bovine corpus luteum. Therefore various strategies have been tried to modulate prostaglandin F2 α synthesis and secretion in order to prolong the lifespan of CL. Administration of cyclooxygenase inhibitors which include non-steroidal anti-inflammatory drugs acting by competitive inhibition of key enzymes of prostaglandin synthesis is one such method. Feeding of diet rich in polyunsaturated fatty acids during critical period significantly reduces prostaglandin synthesis. Other drugs, which are potential candidates for reducing prostaglandin synthesis, include oxytocin receptor antagonist, recombinant bovine somatotropin, lysophosphatidic acid and prostaglandin F synthase inhibitors. To conclude, there is much scope of using various compounds to reduce prostaglandins synthesis during the critical period of pregnancy for improving the embryo survival rate. Keywords Bovine; Embryonic mortality; Prostaglandins; Luteolysis; Cyclooxygenase

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

Pages 7-12

Authors: Laurence A. Cole a, *, larry@hcglab.com, Stephen A. Butler b

Objective Hyperglycosylated human chorionic gonadotropin (hCG) is a variant of hCG made by cytotrophoblast cell. Here we examine the role of hyperglycosylated hCG in placenta growth and invasion. Methods JEG-3 choriocarcinoma cells and term cytotrophoblast monolayer culture were prepared. The effect of supplemental hyperglycosylated hCG and hCG was investigated. Growth of these cells was examined by increase in cell number. Invasion was investigated using Matrigel basement membrane cells. The proportion of cell invading Matrigel was determined. Results Term cytotrophoblast cell and JEG-3 choriocarcinoma cells grew to 5 427±834 cells (109%) and 7 114±553 cells (142%). With the supplementation of hyperglycosylated hCG, they grew significantly wider to 7 633±177 cells (142%) and 10 315±1 477 cells (206%). With the supplementation of hCG they diminished to 4 227±769 cells (78%) and 5 620±657 cells (79%). Term cytotrophoblast cell and JEG-3 choriocarcinoma cells penetrated Matigel membranes to (40.0±10.0)% and (46.0±9.8)%. Hyperglycosylated hCG significantly enhanced penetration to (76.0±13.0)% and (84.0±6.6)%. hCG diminished penetration to (32.0±9.1)% and (32.0±4.5)%. Conclusions Hyperglycosylated hCG enhances both cytotrophoblast growth and cytotrophoblast cell invasion. hCG minimally suppresses growth and invasion. Keywords hCG; Hyperglycosylated hCG; Cytotrophoblast; Syncytiotrophoblast; Glycoprotein

Pages 17-21

Authors: MartÍn MartÍnez-torres a, *, martor@servidor.unam.mx, E Martha PÉrez-armendariz b, M Elena Hernández Caballero c, Juanaluis a, guadalupe ortÍz-LÓpez d

Objective To relate the histological characteristics and histochemical Δ5−4-isomerase-3 beta hydroxy steroid dehydrogenase (Δ5−43β-HSD) activity of the corpora lutea (CL) and the atresic vitellogenic follicles (AVF) with progesterone (P4) plasma concentrations in three different times of gestation (early, medium and late) in the viviparous lizard Sceloporus mucronatus (S. mucronatus). Methods The histological characteristics as well as histochemical activity of Δ5−43β-HSD of the CL and AVF and their relationship with plasma P4 levels were studied during three different times of pregnancy of the viviparous lizard S. mucronatus. Results Corpora lutea develops during the first third of gestation. In second third, the luteal tissue reaches maturity and starts the first regressive changes. The last third of gestation was characterized by a considerably advance in the luteolysis. Activity of Δ5−43β-HSD was observed in he luteal cell mas. The activity of this enzyme were high during the first third and scantle activity was detected in the last third. Even though atresic vitellogenic follicles are found throughout the whole period of gestation, Δ5−43β-HSD activity is very low in relation with showed by CL and does not change significantly in the studied period of time. Another hand, we observed a direct relationship among the histological aspect of the corpus luteum, Δ5−43β-HSD activity and progesterone levels. Conclusions These observations suggests that the corpus luteum is the most important source of ovarian progesterone (P4) during pregnancy and that the participation of the AVF in the production of this hormone is little or non-existent. Keywords Corpus luteum; Atretic vitellogenic follicles; Progesterone; Ovary; Lizard; Introduction

Pages 27-33

Authors: Alfredo Medrano a, b, c, *, Paul F Watson b, William V Holt c

Objective To relate semen susceptibility in cooling protocols to sperm plasma membrane properties. Methods A series of experiments was performed using the fluorescent markers, progesterone-BSA-FITC and BSA-FITC. Results These experiments indicated that both progesterone-BSA-FITC and BSA-FITC bound to specific sperm plasma membrane domains, thus producing four different binding patterns, revealing probable changes in membrane organization during capacitation and during cooling. Those patterns seem to make a sequence progressing from non-capacitated status to capacitated status. The proportion of each pattern was different during incubation than during cooling, showing the latter had a higher proportion of dead sperm than the former. Conclusions At this stage, the association of sperm plasma membrane alterations was revealed by BSA-FITC probes and cryosensitivity remains unclear. Keywords Cooling; Incubation; Capacitation; Acrosome reaction

Pages 38-41

Authors: floricultural plant from twin scale explants Author links open the overlay panel. Numbers correspond to the affiliation list which can be exposed by using the show more link. Lekha Kumar *, Sincy Joseph, Narmatha Bai

Objective The present study was performed to standardize an effective protocol for micropropagation of Tigridia pavonia using tissue culture. Methods The explants were cultured on Murashige and Skoog (MS) medium supplemented with cytokinins like thidiazuron (TDZ), zeatin, kinetin and auxins such as indole-3-acetic acid (IAA), 1-naphthalene acetic acid (NAA) and indole-3-butyric acid (IBA), individually at different concentrations. Results Multiple shoots were obtained on MS medium containing either 2.0 mg/L TDZ or 2.0 mg/L IAA or 0.5 mg/L IBA and in the same medium for a long period (120 d) produced tiny bulbs at the base of the senescent leaves. TDZ favored only multiple shoots without roots, whereas IAA or IBA individually or in combination with TDZ produced rooted shoots. Shoots developed on MS medium supplemented with TDZ were rooted on MS medium containing either IBA or NAA at 0.5 mg/L. The plantlets were acclimatized in pots containing garden soil. Regenerated plantlets developed into normal plants. The plants showed 99% survival. Conclusions The highest number of bulblets obtained in the present study represents an effective alternative to the conventional method. Keywords Tigridia pavonia; Twin scale explant; Murashige and Skoog medium; Growth regulator

Pages 48-54

Authors: Jun-Qing Wu, Yu-Yan Li, Jing-Chao Ren, Na Li, Yin Zhou, Rui Zhao, Yu-Feng Zhang

Objective To explore the male condom use and the using problems as well as the influencing factors among Shanghai women. Methods A prospective follow-up was conducted among 1 562 subjects who used either the condom or the combined regimen as their method for fertility regulation in nine districts in Shanghai. The study began in the October, 2003 with a baseline survey, and finished in the December, 2007. There were two groups, group I with condom use combined regimen (condom + ECP) and group II with condom use only. Totally 812 eligible subjects were assigned to group I, and 750 to group II. Data was collected with a daily diary card, on which menses, acts of intercourse, information on condom and ECP use, and condom using problems were recorded. Data were analyzed with binary logistic regression models adjusting the potential confounding factors. Results During the whole study years, in group I the mean condom using frequency was (59.5±17.9) times and the whole course condom using frequency was (58.1±18.5). In group II, the mean condom using frequency and the whole course condom using frequency are (57.4±19.0) and (56.4±19.7), respectively. The condom using problem rate (CUPR) in group I and group II in the first month were 5.05 and 9.64 per 100 condoms. With the progress of the study, the CUPR in both groups were decreasing. The total year's CUPR in group I and group II were 0.82% and 1.45% (P=0.002). The study showed that the common condom using problems during the 1st year were too loose (41.9% in group I and 27.1% in group II), too long (15.6% in group I and 25.6% in group II), and too slippery (21.2% in group I and 20.2% in group II) among those reported condom using problems. Condom problems were more common in the inexperienced and in those who had not experienced problems previously. Subject's age, education and occupation might influence condom using problem rate. Conclusions The condom using problems indicated that condom manufacturers should continue to refine the products so as to increase the condom acceptability. Experience was significant associated with condom using problem. Keywords Condom using problem; Contraception; Sexual intercourse

Pages 60-62

Authors: Mostafa A. Borahay, Gokhan S. Kilic, Mary C. Haver

Ovarian vein embolotherapy is a relatively new treatment for pelvic congestion syndrome that is claimed to be safe and effective. A 36-year-old woman underwent ovarian (without internal iliac) vein embolotherapy for pelvic congestion syndrome. Her pain was improved following the procedure. Within three months of the procedure, she started experiencing distressing abnormal uterine bleeding. Specifically, she developed profuse bleeding after intercourse. After thorough evaluation and counseling, a total abdominal hysterectomy was eventually performed. The use of ovarian vein embolization for treatment of pelvic congestion syndrome may be associated with abnormal uterine bleeding. Keywords Pelvic congestion syndrome; Ovarian vein embolotherapy; Ovarian vein embolization; Chronic pelvic pain; Abnormal uterine bleeding; Interventional radiology; Uterus; Ovary

Pages 67-68

Authors: Melanie Walls, Emily Zuvela , Cheryl Ayres , Deborah Sherrin , Asma Chhotani , Liz Butler , Kelli Peirce , Jenny Krapez , Renae Parker , Cherise Mooy , Patrick Mohan , Sally Catt , Matthew Wiltshire, Hassan W Bakos, Mary Whyte, Phillip Matson

Objective To undertake a multi-centre study to maximize the number of Makler chambers used. Methods A total of 15 laboratories participated with 31 Makler chambers. A suspension of latex beads was prepared to a concentration of 20 millions per milliliter, and 0.5 mL aliquots distributed to each participating laboratory. They measured the concentration on their Makler chamber(s) used for routine semen analysis by adding 3, 4, 5, 7 and 10 μL volumes of bead suspension to the chamber. Results There was no difference in within-chamber analysis of the bead concentration according to the volume of bead suspension applied within the range of 3–10 μL (F4,14=2.634, P=0.056). However, the between-chamber effects were significantly different (F30,124=4.937, P=0.000), and 24/31 (77.5%) chambers tested had an average bias>10% compared to the target bead concentration. Conclusions A volume of 3–10 μL added to Makler counting chambers does not influence the concentration measured of latex beads, but the between-chamber variability and positive bias seen would suggest that other sources of error are present which are yet to be identified. Keywords Volume; Semen; Makler chamber

Pages 76-84

Authors: Zi-Liang Ji, Yong-Gang Duan , Li-Sha Mou , Jean-Pierre Allam , Gerhard Haidl , Zhi-Ming Cai

It has been well established that heat shock proteins (HSP) and heat shock factors (HSF) are involved in wide varieties of physiological regulation process and signal pathway. Numerous members of heat shock family exhibit a cell-type-specific expression pattern during spermatogenesis and play crucial roles in germ cell development. This led to the emerging studies to reveal the association between heat shock family and male infertility. Aberrant expressions of HSP/HSFs observed in sterile men and animal models indicate the two opposite effects, both protective and harmful, of heat shock family on male fertility. Moreover, HSP/HSFs are also involved in the two major causes of male infertility. It seems that different behaviors of HSP/HSFs patients with varicocele and Chlamydia trachomatis infection lead to distinct outcomes of male fertility. In addition, emerging evidence has demonstrated that the altered expression of HSP/HSFs may be responsible for the abnormal germ cell apoptosis and subsequently results in impaired spermatogenesis. Therefore, heat shock family may play an important role in the quality-control of germ cells during spermatogenesis, raising the prospect of their utility for novel treatment targets in male infertility. Keywords Apoptosis; Heat shock; Infertility; Spermatogenesis