International Journal of Fertility and Sterility

169-177

Authors: Milad Azami, Zahra Jaafari, Ali Soleymani, Gholamreza Badfar, Shamsi Abbasalizadeh

Rubella infection within the first trimester of pregnancy may lead to adverse pregnancy outcomes. The present study was conducted to evaluate the immunity against rubella among the pregnant Iranian women. The steps of meta-analyses were conducted based on the MOOSE protocol and results were reported according to the PRISMA guideline. To review the associated English and Persian literature, a comprehensive search was conducted among the international databases such as Scopus, PubMed/Medline, Science Direct, Embase, Cochrane library, Web of Science and Google Scholar search engine as well as Iranian databases, until April 1, 2018 using the following medical subject headings (MeSH) keywords: ‘Pregnant’, ‘Gestational’, ‘Prenatal care’, ‘Complications of pregnancy’, ‘Pregnancy’, ‘Rubella infection’, ‘Prevalence, ‘Epidemiology’, ‘Immunity’, ‘Immunization’, ‘Antibody’, ‘Immunogenicity’ and ‘Iran’. Cochran’s Q test and I2 index were used to investigate heterogeneity in the studies. Random effects model was used to estimate the rate of rubella immunity. The obtained data were analyzed using Comprehensive Meta-Analysis Ver.2. Fifteen studies constituting 7,601 pregnant Iranian women met the inclusion criteria. The overall pooled rubella immunity rate was 90.1% [95% confidence interval (CI): 86.1-93.1]. Rubella immunity rates were respectively 88.6% (95% CI: 80.6-93.6) and 91.5% (95% CI: 88.1-93.9) before and after national vaccine program. Rubella immunity rates were 91.4% (95% CI: 87.8-94.0) and 87.2% (95% CI: 74.3-94.1) based on the enzyme-linked immunosorbent assay (ELISA) and haemagglutination-inhibition (HAI) methods, respectively. There was no significant association between rubella immunity and vaccination program (P=0.398), diagnostic methods (P=0.355), geographic regions (P=0.286), quality of the studies (P=0.751), occupation (P=0.639), residence (P=0.801), and year of the studies (P=0.164), but it was significantly associated with age (P<0.001). Despite high rubella immunity among the pregnant Iranian women, anti-rubella antibody screening is recommended for all women of childbearing age.

184-189

Authors: Farnaz Kheirandish, Behrouz Ezatpour, Shirzad Fallahi, Mohammad Javad Tarahi, Pardis Hosseini, Arian Karimi Rouzbahani, Seyyed Javad Seyyed Tabaei, Soheila Akbari

Background Toxoplasma gondii is one of the major causes of abortion in pregnant women. Most cases of abortion occur in the acute phase of infection and early pregnancy. The purpose of this study was to investigate the association between spontaneous abortion and seropositive status of toxoplasmosis in women with first-time spontaneous abor- tion. Materials and Methods This research is a case-control study on 240 serum samples from women experiencing spon- taneous abortion for the first time as the case group, and 240 serum samples from women who had a normal delivery with no history of abortion as the control group. The level of anti-Toxoplasma gondii IgM and IgG antibodies were assessed in serum samples using ELISA. To separate the acute and chronic infections, all IgM-positive samples in both groups and IgG-positive samples of the case group were examined using IgG avidity. Results The Toxoplasma IgM antibody was detected in 3.3% (8/240) of the case group and 0.4% (1/240) of the con- trol group, which was a statistically significant difference between the two groups [P=0.019, odds ratio (OR)=10.266]. Of all samples 47.5% and 46.3% of the case and control groups were positive for Toxoplasma IgG antibody, respec- tively. Seven out of 8 (87.5%) IgM-positive serum samples from the case group had low IgG avidity, indicating acute infections, whereas all IgG-positive sera and 1 IgM-positive serum, which was related to the control group, showed a high IgG avidity, indicating chronic infections. Conclusion Maternal acute toxoplasmosis during pregnancy is raised as one of the factors that increase the chance of spontaneous abortion. The necessary health training, especially on the parasite transmission ways to women before marriage, as well as the serological test in women before and during pregnancy is recommended. Polymerase chain reaction (PCR) and IgG avidity assays should be performed in the medical diagnostic laboratories for accurate distin- guishing of the initial infection of toxoplasmosis in the pregnant women.

196-202

Authors: Sam Zarbakhsh, Robabeh Safari, Hamid Reza Sameni, Behpour Yousefi, Manouchehr Safari, Nasrin Khanmohammadi, Parisa Hayat

Background L-carnitine (Lc) as a type of flavonoid antioxidants and bone marrow stromal cells (BMSCs) as a type of mesenchymal stem cells may recover damaged ovaries. It seems that Lc has favorable effects on differentiation, increasing lifespan and decreasing apoptosis in BMSCs. The aim of this study was to investigate effects of co-ad- ministration of BMSC+Lc on damaged ovaries after creating a chemotherapy model with cyclophosphamide in rats. Materials and Methods In this experimental study, cyclophosphamide was intraperitoneally (IP) injected to forty female wistar rats for 14 days, in terms of chemotherapy-induced ovarian destruction. The rats were then randomly divided into four groups: control, Lc, BMSCs and co-administration of BMSC+Lc. Injection of BMSCs into bilateral ovaries and intraperitoneal injection of Lc were performed individually and together. Four weeks later, levels of se- rum estradiol (E2) and follicle-stimulating hormone (FSH) using enzyme-linked immunosorbent assay (ELISA) kit, number of ovarian follicles at different stages using hematoxylin and eosin (H&E) staining and expression of ovarian Bcl-2 and Bax proteins using western blot were assessed. Results Co-administration of BMSC+Lc increased E2 and decreased FSH levels compared to the control group (P<0.001). The number of follicles was higher in the co-administrated group compared to the control group (P<0.001). Co-administration of BMSC+Lc increased Bcl-2 protein level, decreased Bax protein level and increased Bcl-2/Bax ratio (P<0.001). Conclusion The effect of co-administration of BMSC+Lc is probably more effective than the effect of their separate administration on the recovery of damaged ovaries by chemotherapy.

209-214

Authors: Maryam Zamanian, Farzaneh Zolala, Ali Akbar Haghdoost, Mohammad Reza Baneshi

Background Abortion is a sensitive issue surrounded by social, cultural and religious stigmata. Therefore, estimation of its prevalence involves methodological challenges. The aim of this manuscript is to estimate the abortion prevalence, stratified by type, using a direct and two indirect methods. Materials and Methods This cross-sectional study was done in 2016, we recruited 1020 women aging 18-49 years. Three methods were applied to estimate the abortion prevalence: direct question, network scale-up (NSU), and single sample count (SSC). In the direct method, to guarantee anonymity, data were collected by means of a self-administered questionnaire. In other methods, data were collected through gender-matched street-based inter- views. Results The annual rate of abortion estimated by direct and NSU methods were respectively 29 (10 intentional, 4 therapeutic and 15 spontaneous) and 23 (9 intentional, 3 therapeutic, and 11 spontaneous) per 1000 women aging 18-49 years. The annual rate of intentional abortion estimated based on SSC method was higher (15 per 1000 women) than other methods. Conclusion The present estimates are higher than previously reported ones. The results of three methods more or less supported each other confirming the internal validity of our estimates.

225-229

Authors: Fataneh Mokhtari, Firoozeh Akbari asbagh, Ozra Azmoodeh, Mahmood Bakhtiyari, Amir Almasi-Hashiani

Background Oxidative stress as a potential cause of poor oocyte quality can influence a female’s reproductive system. This study aimed to investigate the effects of melatonin on chemical pregnancy rates of a significant number of polycystic ovary syndrome (PCOS) patients undergoing intrauterine insemination (IUI). Materials and Methods In this double-blinded randomized clinical trial (RCT) study, the samples included 198 PCOS patients fulfilling the inclusion criteria and undergoing the IUI treatment. On the third day of menstruation, a 3-mg melatonin tablet or its placebo was given to the patients according to the randomized study protocol; this prescription was continued until the day of human chorionic gonadotropin (hCG) administration. The current study attempted primarily to scrutinize the effect of melatonin administration on the rate of chemical pregnancy and mature follicles during the IUI treatment cycle, and secondarily to determine the endometrial thickness (ET) on the day of IUI. Results The mean age of the participants in the study was 28.9 ± 5.5 years. The chemical pregnancy rate in the group receiving melatonin was about 32%, when it was 18% in the control group (P=0.012). Furthermore, it was concluded that the addition of melatonin to the treatment cycle of PCOS individuals could significantly improve the ET after the treatment (P<0.001). Conclusion The results of this study demonstrated that the treatment of PCOS patients undergoing IUI with mela- tonin significantly improves the rate of chemical pregnancy (Registration number: IRCT2017021132489N1).

236-239

Authors: Nayyereh Khadem, Mahsa Mansouri, Matin Attaran, Armin Attaranzadeh, Elnaz Zohdi

Background In this work, we have determined the levels of interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α), which function as cytokines in endometrial receptivity, through the endometrial secretion within the eligible individuals and thus studied their relationships with the success or failure of pregnancy in in vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) cycles. Materials and Methods In this prospective study, 76 women were selected for their first IVF/ICSI and met the study inclusion criteria. All of the patients have undergone the endometrial secretion aspiration prior to performing the oocyte collection. The levels of IL-1and TNF-α were analyzed by the means of enzyme-linked immunosorbent assay method, using special standard kits. The patients were requested to undergo the serum human chorionic gonadotropin measurements and ultrasound evaluation for the purpose of detecting successful implantations and pregnancies. Results Among the 76 subjects of the study, 33 (43.4%) patients had a positive beta-human chorionic gonadotropin (β-hCG) and 44 (56.6%) resulted in a negative β-hCG. It should be also noted that through the patients with positive β-hCG, 23 (30.3%) of them displayed fetal heart rate in their transvaginal sonography (TVS). Compared to the group with failed pregnancies and their cytokine levels, we perceived a higher concentration of IL-1 in the group containing successful chemical pregnancies (P=0.00). However, there was no significant difference in terms of clinical pregnancy in the IL-1 levels between the two groups (P=0.06). In addition, there was not any notable difference in the levels of TNF-α between the two groups, neither in terms of chemical nor clinical pregnancy (P=0.8 and P=0.6, respectively). Conclusion The current study suggests that higher concentrations of IL-1 in endometrial secretions could be as- sociated with improved endometrial receptivity and IVF outcome. With regards to TNF-α, no statistically significant difference was observed between the groups of with and without successful pregnancies.

245-249

Authors: Hiromitsu Tanaka, Yasushi Miyagawa, Akira Tsujimura, Morimasa Wada

Actins play essential roles in cellular morphogenesis. In mice, the T-actin1 and 2 genes, which encode actin-like proteins, are specifically expressed in haploid germ cells. Both T-ACTIN1/ACTLB and T-ACTIN2/ACTL7A have also been cloned and studied. The orthologous genes in humans are present on chromosome 9q31.3 as intronless genes. Defects of germ cell-specific genes can introduce infertility without somatic function impairment. We determined T- ACTIN1 and 2, specifically expressed in the testis using reverse-transcription polymerase chain reaction (RT-PCR). To examine whether genetic polymorphisms of the T-ACTIN1 and 2 genes are associated with male infertility, we screened for T-ACTIN1 and 2 polymorphisms by direct sequencing of DNA from 282 sterile and 89 fertile Japanese men. We identified five and six single nucleotide polymorphisms (SNPs) in the T-ACTIN1 and 2 regions of the sterile and fertile subjects respectively. Among these genetic polymorphisms was a novel SNP that was not in the National Center for Biotechnology Information SNP database. Although we could not determine whether these SNPs cause infertility, the prevalence of these genetic polymorphisms may be useful for analyzing polymorphisms in future large- scale genetic analyses.