International Journal of Fertility and Sterility

267-272

Authors: Asghar Beigi Harchegani, Ali Irandoost, Mahdiyeh Mirnamniha, Hamid Rahmani, Eisa Tahmasbpour, Alireza Shahriary

Calcium (Ca) is a significant element that acts as an intracellular second messenger. It is necessary for many physiological processes in spermatozoa including spermatogenesis, sperm motility, capacitation, acrosome reaction and fertilization. Although influences of Ca deficiency on sperm function and male infertility have been widely studied, mechanisms for these abnormalities are not well considered. Poor sperm motility, impairment of chemotaxis, capacitation, acrosome reaction and steroidogenesis are the major mechanisms by which Ca deficiency induces male infertility. Therefore, an optimal seminal Ca concentration is required to strengthen sperm function and all steps leading to successful fertilization. Furthermore, identification of these mechanisms provides valuable information regarding the mechanisms of Ca deficiency on male reproductive system and the way for developing a better clinical approach. In this review, we aim to discuss the proposed cellular and molecular mechanisms of Ca deficiency on male reproductive system, sperm function and male fertility. Also we will discuss the valuable information currently available for the roles of Ca in male reproduction.

278-283

Authors: Reza Omani-Samani, Payam Amini, Behnaz Navid, Mahdi Sepidarkish, Saman Maroufizadeh, Amir Almasi-Hashemi

Infertile women are at a higher risk of sexual dysfunction compared to fertile women. Infertility is a major source of stress, anxiety, and depression, which strongly affects sexual health. The aim of this study is to estimate the prevalence of female sexual dysfunction (FSD) among infertile Iranian women. We searched the main international databases (Web of Science, PubMed, Medline, and Scopus) and national databases (Scientific Information Database, Magiran, and IranMedex) from their inception until April, 2017. Due to heterogeneity between the studies, the extracted data were pooled using a random-effects model by Stata software. Out of 313 retrieved studies, we included 18 studies of 3419 infertile women in the meta-analysis. The pooled prevalence of FSD was 64.3% [95% confidence interval (CI): 53.3-75.3]. Our findings revealed that sexual desire (59.9%, 95% CI: 38.7-81.2) was the most prevalent disorder and vaginismus (19.2%, 95% CI: 11.3-27.2) was the least prevalent among infertile women. The results of our meta-analysis suggested that more than 64% of infertile Iranian women reported sexual dysfunction, which was meaningfully high. This study also showed that sexual desire was significantly more common than other sexual dysfunction dimensions and the prevalence of vaginismus was the least common.

293-297

Authors: Zeinab Hosseiny, Parvaneh Nikpour, Abbas Bakhteyari, Fatemah Mostafavi, Mohammad Matinfar, Mehrnaz Jahani, Roshanak Aboutorabi

Background Osteopontin (Opn) is one of the co-factors involved in cell adhesion and invasion during the implantation process. Several reports have shown Opn expression changes in diabetic condition in several tissues. In addition, an increased incidence of spontaneous abortion is reported in diabetic women. We, therefore, designed a study to evaluate the effects of diabetes on Opn expression at implantation time after treatment with metformin and pioglitazone. Materials and Methods In this interventional and experimental study, 28 rats were randomly divided into four groups, namely control, diabetic, pioglitazone-treated diabetic rats and metformin-treated diabetic rats. Streptozotocin (STZ) and nicotinamide (NA) were used to induce type 2 diabetes (T2D). During the implantation window, the endometrium was removed and the expression of Opn was analysed by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Results Opn expression was significantly higher (30.70 fold-changes) in the diabetic group in comparison with the control group (P=0.04). Furthermore, the expression of Opn was significantly lower in the diabetic group treated with pioglitazone when compared with the diabetic group (P=0.04). Conclusion According to the high Opn expression and the possibility of increased adhesion of endometrial epithelial cells, the invasion of blastocyst may be affected and thus reduced. As pioglitazone significantly reversed the upregulation of Opn in diabetic rats, it may be considered as a therapeutic compound for treating T2D.

303-305

Authors: Hesamoddin Sajadi, Jalil Hosseini, Faramarz Farrahi, Farid Dadkhah, Mahdi Sepidarkish, Marjan Sabbaghian, Poopak Eftekhari-Yazdi, Mohammad Ali Sadighi Gilani

Background Assessing the net-results of microsurgical varicocelectomy in infertile men with non-obstructive azoosper- mic (NOA) and clinical varicocele in five years at Royan Institute. Materials and Methods This is a descriptive retrospective cohort study. A backward-looking review of patients treated for NOA and varicocele from march 2011 to march 2016 was performed. In addition, MDTESE results of 57 patients with NOA and clinical varicocele, with 537 NOA patients without varicocele were compared. Results Of 57 patients who underwent varicocelectomy, eight patients (14%) had sperm on sperm analysis post-opera- tively. One of the eight patients was single, and one of them had spontaneous pregnancy (1/7) 14%, and one had a child by microinjection (1/7) 14%. Out of these 8 patients, 6 had hypospermatogenesis pathology. Of 38 patients who under- went MDTESE, 14 patients (36%) had sperm on their testis tissues, but one of them had no egg fertilization. Therefore, the fertilization rate was (92%). Of the remaining 13 patients, 3 had live child birth (3/13) 23%. Sperm retrieval rate (SRR) in NOA men without clinical varicocele was lower from those who had varicocele and NOA (22 vs. 36%). Also live birth rate in NOA men with varicocelectomy was higher than NOA men without varicocele (23 vs. 11%). Conclusion Microsurgical varicocelectomy in NOA men may have positive effects on post-operative sperm in ejacu- late and natural or assisted pregnancies, but it seems that the effect is more significant on MDTESE results and follow- ing successful microinjection. Meanwhile, SRR and live birth rate was higher in our patients compare to NOA men without clinical varicocele.

310-315

Authors: Fatemeh Hassani, Shahrbanoo Oryan, Poopak Eftekhari-Yazdi, Masood Bazrgar, Ashraf Moini, Nahid Nasiri, Azadeh Ghaheri

Background The objective of this study was to describe the association between luteinizing hormone (LH)/ follicle-stimulating hormone (FSH) ratio and demographic variables and maturation stage of oocytes in insulin- resistant and insulin-sensitive patients with polycystic ovary syndrome (PCOS) in comparison with control group. Materials and Methods In this case-control study, 60 patients with in vitro fertilization (IVF)/intracytoplas- mic sperm injection (ICSI) indication were subdivided into 3 groups as follow: 20 subjects were assigned to control (fertile women with male infertility history) group, 20 subjects with PCOS were insulin resistant (IR) and 20 subjects with PCOS were insulin sensitive (IS). After puncture, retrieved oocytes were classified into metaphase II (MII) as mature and in metaphase I (MI) or germinal vesicle stage (GV) as immature. Regression analyses were used to explore the association between MII oocyte number and demographic and clinical variables. Results LH/FSH ratio was significantly higher in PCOS-IR women compared to controls but not significantly different from that of PCOS-IS group. PCOS-IR women had lower MII oocyte number compared with that of controls. According to multiple regression analysis, the number of previous assisted reproductive technology (ART) cycles was negatively associated with the number of MII oocytes. Conclusion Insulin resistance can be associated with reductions in MII oocyte number in patients with PCOS.

324-328

Authors: Zahra Ezabadi, Fahimeh Mollaahmadi, Saeideh Sazvar, Samira Vesali, Reza Omani-Samani

Background Potentially modifiable factors, such as the appropriate informing process given to infertile patients, can affect their infertility knowledge and information. This study aims to assess infertility information provided to Iranians who undergo assisted reproductive treatment. Materials and Methods In this cross-sectional study, participants recruited were a convenience sample of all infertile patients who received assisted reproductive treatments from Royan Institute, Tehran, Iran. Inclusion criteria consisted of: patient’s first time visit, no previous infertility treatment failures, and referral to the centre between January and March 2015. A 20-item tool designed by researchers measured patient satisfaction with the infertility informing process. This tool included cause of infertility, type of recommended treatment, diagnostic procedures, approximate treatment duration, success rate of the treatment, approximate cost of treatment, and non-therapeutic factors in treatment success. Results A total of 235 infertile patients were invited to participate in the study, from which 200 (100 men and 100 women) participants completely responded to the questionnaire with a response rate of approximately 85%. The mean age of participants was 30.93 ± 5.56 years. In terms of satisfaction with information provided about the cause of infertility, male responders reported the lowest mean score of 3.59 ± 1.05 compared to female responders (3.82 ± 0.85, P=0.078). Infertile women had a greater mean score of 3.85 ± 0.78 than infertile men (3.58 ± 1.29) in satisfaction with information provided about the type of recommended treatment (P=0.037). There was a statistically significant difference between males (3.26 ± 1.04) and females (3.58 ± 0.93) in satisfaction with approximate treatment duration (P=0.031). Conclusion According to the results, most infertile patients were satisfied with the informing process related to the cause of infertility and recommended therapies. Information about infertility should be provided more systematically to all treated patients by medical staff, especially in terms of success rate of treatment and financial cost of therapy.

335-338

Authors: Matias Angel Sirini, Juan Patricio Anchordoquy, Silvina Quintana, Cecilia Furnus, Alejandro Enrique Relling, Juan Mateo Anchordoquy

Energy balance is regulated by ghrelin which is a neuroendocrine modulator. Ghrelin is expressed in reproductive organs. However, the role of ghrelin during in vitro maturation (IVM) and bovine preimplantational development is limited. The purpose of this study was to measure the expression of ghrelin (GHRL) and its receptor growth hormone secretagogue receptor 1A (GHS-R1A) mRNA, and determine cumulus oocyte complex (COC) viability after IVM with 0, 20, 40 and 60 pM of ghrelin. Also, pronuclear formation was recorded after in vitro fertilization (IVF). GHRL and GHS-R1A mRNA expression in oocyte and cumulus cells (CCs) was assessed using reverse transcription-polymerase chain reaction (PCR). Oocyte and CC viability were analyzed with the fluorescein diacetate fluorochrome-trypan blue technique. Pronuclear formation was determined 18 hours after IVF with Hoechst 33342. The results demonstrated that ghrelin mRNA is present in oocyte and CCs before and after 24 hours IVM with all treatments. Ghrelin receptor, GHS-R1A, was only detected in oocytes and CCs after 24 hours IVM with 20, 40 and 60 pM of ghrelin. Oocyte viability was not significantly different (P=0.77) among treatments. However, CC viability was significantly lower (P=0.04) when COCs were matured with ghrelin (77.65, 72.10, 66.32 and 46.86% for 0, 20, 40, and 60 pM of ghrelin, respectively). The chance of two pronuclei forming were higher (P=0.03) when ghrelin was not be added to the IVM medium. We found that ghrelin negatively impacts CC viability and pronuclear formation.