International Journal of Fertility and Sterility

1-9

Authors: Juan José Espinós, Ivan Sola, Claudia Valli, Ana Polo, Lucja Ziolkowska, M Jose Martinez-Zapata

Obesity has been associated with negative effects on natural fertility and poor prognosis when assisted reproductive technologies (ART) are performed. Patients attending for fertility treatments are often advised to optimize their weights to improve the outcomes. There is lack of enough information on how weight-loss would be effective for improving fertility in women who are overweight or obese. We conducted a systematic review to evaluate whether weight-loss achieved by lifestyle program improves natural or assisted reproduction in obese infertile women. We searched CENTRAL, MEDLINE, and EMBASE up to March 2018. Two reviews were selected as randomised trials assessing a lifestyle intervention in women with obesity before receiving treatments for infertility and appraised their risk of bias. We extracted data on pregnancy, birth, and miscarriage rates as the primary outcomes and pooled effect estimates using a random effects model. The primary outcome was the live birth rate. We reported summary measures as the relative risk (RR), 95% confidence interval (CI), and percentage of heterogeneity (I2). We included eight randomised trials with 1175 women. Lifestyle programmes, improved pregnancy rates (RR: 1.43, CI: 95% 1.02 to 2.01; I2=60%; 8 RCTs; N=1098) but had no impact on live births (RR: 1.39, CI: 95% 0.90 to 2.14; I2=64%; 7RCTs; N=1034). Our findings suggest that women participating in lifestyle interventions had an increased risk of miscarriage (RR: 1.50, CI: 95% 1.04 to 2.16; I2=0; 6RCTs; N=543). We rated the quality of evidence for these outcomes as the moderate-to-low. Lifestyle interventions slightly increased the pregnancy rate, while it would be uncertain whether it can improve the live birth. Lifestyle interventions can increase the risk of miscarriage. More research is needed to further explore lifestyle interventions on reproductive outcomes in obese infertile women.

17-22

Authors: Mehran Nouri, Mohammad Hossein Nasr-Esfahani, Mohammad Javad Tarrahi, Reza Aman

Background: Infertility is a major worldwide problem which is caused by several factors such as environmental, physiological, and genetic conditions. Lycopene is considered to be one of the most important antioxidants that can contribute to reducing or preventing the psychological damage that leads to infertility. Thus, the aim of this study was to evaluate the effect of lycopene supplementation on depression, anxiety and stress scales and quality of life in infertile men. Materials and Methods: In this randomized clinical trial, 44 infertile men with oligozoospermia were randomly divided into the following two groups: the experimental group was supplemented with 25 mg lycopene, once per day for 12 weeks, and the control group received a placebo, for 12 weeks. Anthropometric and dietary data, physical activity, mood status, including depression, anxiety, stress, and quality of life scores were recorded pre- and post-intervention. Depression, anxiety and stress were assessed using a 21-item questionnaire (DASS-21) and quality of life was examined using the WHO 26-qustion questionnaire (WHOQOL). Results: The baseline age and body mass index (BMI) were not significantly different between the two groups (age: 31.89 ± 2.51 and 32.15 ± 2.16 years old for intervention and placebo, respectively; P=0.732 and BMI: 27.20 ± 1.68 and 26.53 ± 1.53; for intervention and placebo, respectively; P=0.206). There were no significant differences in depression, anxiety and stress values between the two groups; however, depression score significantly decreased in both groups compared to the baseline levels (P=0.028 and P=0.031). No significant differences were observed in four domains of quality of life, except for psychological domain that was improved in the lycopene group compared to the baseline values (P=0.049). Conclusion: Short term supplementation of lycopene had no effect on mood status and quality of life, except for psychological status in infertile men (Registration number: IRCT20171105037249N1).

27-33

Authors: Mozhgan Kohzadi, Mohammad Rasool Khazaei, Farzaneh Choobsaz, Mozafar Khazaei

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Anti-Mullerian hormone (AMH) is a valid indicator of ovarian function and is used for PCOS diagnosis. Some studies have shown that adipokines affect the synthesis of AMH, and therefore they are somehow related in function. The aim of the present study was to determine the relationship between serum levels of AMH, adiponectin and oxidative stress markers in PCOS patients. Materials and Methods: In this cross-sectional study, PCOS patients and healthy women (80 cases in total) were investigated. Serum levels of AMH, adiponectin, gonadotropins, androgens, total antioxidant capacity (TAC), nitric oxide (NO) and insulin resistance (IR) were measured by standard methods. An independent t test was used to compare the two groups and Pearson correlation coefficient was used to determine the relationship between variables. Results: There was a significant difference between the means of AMH (5.16 ± 5.3 vs. 2.44 ± 2.5 ng/mL) (P=0.007) and adiponectin (24.55 ± 9.41 vs. 30.57 ± 14.2 μg/L) (P=0.029) among the PCOS and control groups, respectively. The correlation between AMH and adiponectin in the control group was statistically significant and negative (P=0.028, r=-0.35), while in the PCOS group it was not significant (P=0.11, r=-0.25). Conclusion: Various biochemical and hormonal factors differ between PCOS and healthy women. Different factors can influence AMH and adiponectin levels independently of PCOS in women of reproductive age.

41-45

Authors: Rana Niktalab, Zeinab Piravar, Roudabeh Behzadi

Background: Pre-eclampsia (PE) is a pregnancy complication and one of the leading causes of maternal and neonatal morbidity and mortality in the world. PE is characterized by high blood pressure and signs of damage to the other organs, most often the liver and kidneys. Given the importance of mutation in the vascular endothelial growth factor (VEGF) gene and its correlation with the incidence of PE, the relationship of VEGF encoding gene polymorphisms rs922583280, rs3025040 and rs10434 with the incidence of PE in the population of Iranian women was studied, in this research. Materials and Methods: In this case-control study, 100 pregnant women with PE diagnosis and 50 healthy pregnant women were evaluated using Sanger sequencing method to determine genotypes rs922583280, rs3025040 and rs10434. Results: There was no significant difference in the allele frequency of rs922583280 and rs3025040 polymorphisms between case and control groups (P>0.05), while frequency of the recessive allele (G) for rs10434 polymorphism was significantly higher in the case group compared to the control group (P=0.014, case=24%, control=12%). Frequency of the allele A in the control group was higher than the patient group (case=76%, control=88%). Frequency of AG genotype in the patient group was also higher than the control group. In addition, frequency of AA genotype in the control group was higher than the patient group (case=57%, control=78). Conclusion: The results of this study demonstrated a significant difference between patient and control groups for the VEGF coding gene polymorphism rs10434 and it can affect the incidence of PE among Iranian women.

51-56

Authors: Razieh Ghorbani-sini, Tayebeh Izadi, Marziyeh Tavalaee, Leila Azadi, Mehdi Hajian, Mahshid Rahimi Zamani, Mohammad Hossein Nasr-Esfahani

Background: Telomeres are particular sequences of DNA located at the end of the eukaryotic chromosomes that are essential for genome integrity. Telomere length in spermatozoa differs among males, as well as spermatozoa. Also, decreased telomere length in spermatozoa of infertile men is associated with the reduction of fertility potential and embryo quality. Density gradient centrifugation (DGC) and swim-up are useful techniques for separation of spermatozoa with longer telomeres. Also, the selection of sperm based on surface negative electric charge or “Zeta potential”, can separate high percentage of spermatozoa with intact chromatin compared to DGC alone, and also the combination of DGC-Zeta can improve clinical outcomes of infertile men candidate for intracytoplasmic sperm injection (ICSI). Therefore, we compared sperm telomere length and DNA fragmentation between two sperm preparation procedures, namely DGC and zeta potential. Materials and Methods: In this experimental study, we assessed sperm telomere length and DNA fragmentation by quantitative real-time polymerase chain reaction (PCR) and TUNEL assay methods, respectively. The spermatozoa were obtained from infertile men with normozoospermia between September 2017 and December 2017 and prepared either by DGC or zeta potential methods. Sperm telomere length was expressed as relative and absolute units. Results: Compared with washed semen samples or control, no significant (P>0.05) difference was observed in the mean relative or absolute sperm telomere length when the two methods DGC or zeta potential were compared. However, the mean percentage of DNA fragmentation was significantly (P<0.05) lower in spermatozoa prepared by DGC or zeta potential methods than spermatozoa obtained from control samples. Conclusion: This is the first study that compared the effect of DGC and zeta potential as the sperm preparation methods on sperm telomere length. It seems that both methods can select sperm population with high DNA integrity and the same sperm telomeres length.

63-67

Authors: Dimitra Korakaki, Spyros Mouroutsos, Gregory Tripsianis, Nikos Nikolettos, Byron Asimakopoulos

Background: In embryological culture dishes, there is a temperature decline when they are removed outside incubators. This study aimed at investigating the effects of this temperature decline within a certain time frame, the type of culture dish with or without the use of laminar air flow and whether it is possible to achieve a sufficient thermal control with the use of a heating stage. Materials and Methods: In this experimental study, the temperatures of four different types of polystyrene dishes [50 mm intracytoplasmic sperm injection (ICSI), 35 mm, 60 mm, 90 mm], filled with culture medium and oil were recorded for a period of 10 minutes outside the incubator. Temperature was measured with an infrared thermographic camera. The reference temperature was 37°C. Four parameters were analyzed: the type of dishes, air flow, a heating stage at 37°C and 38.5°C. Results: There was a time-dependant significant temperature decline outside the incubator in all types of dishes and under all experimental conditions. Under air flow temperature decline increased compared to the no air flow condition. The use of a heating stage at either 37°C or 38.5°C slightly improved the situation in most cases. After three minutes out of the incubator without a heating stage and air flow, the temperature was <34°C; with air flow and without a heating stage the temperature was <33°C. When a heating stage was used, the temperature was <36°C, except when using ICSI dishes. When ICSI dishes were on a heating stage they maintained a temperature close to 37°C with or without air flow. In all experimental conditions the highest decline was recorded with the 90 mm dishes. Conclusion: Time is crucial for managing the temperature decline in culture dishes when out of the incubator. Under air laminar flow, the heat loss is greater, when with a heating stage at 37°C or better at 38.5°C this loss decreases but still exists. ICSI flat bottom dishes give the best results when heated stages are used. Flat bottom dishes maintain the temperature rather efficiently. Based on our findings, the use of flat bottom dishes should become a universal practice in in vitro fertilization (IVF).

72-75

Authors: Alejandro Gonzalez, Santiago Artazcoz, Francisco Elorriaga, Douglas Timmons, Jose Carugno

Endometriosis is a common condition that occurs in 6-10% of all reproductive age women. This number increases to approximately 40% in women with infertility and nearly 75% in women with complaints of chronic pelvic pain. Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity. The most common complaints associated with endometriosis are dysmenorrhea and pelvic pain; however, patients often present with a variety of symptoms and on occasion are asymptomatic. When presenting with haemorrhagic ascites, endometriosis mimics ovarian malignancy. Conservative medical treatment is a feasible management option, especially in young patients who desire to preserve fertility. This article aims to present an extremely rare presentation of endometriosis, haemorrhagic ascites, and a review of the associated literature.

78-78

Authors: Elias E. Mazokopakis

I read with great interest the manuscript entitled "Association between sexual activity during menstruation and endometriosis: a case-control study" published in the International Journal of Fertility and Sterility (1). According to the findings of this study, there was an association between sexual activities leading to orgasm during menstruation and endometriosis (1). These findings revealed the medical value and health benefit of the restriction of sexual contact during menstruation by major religions of the world. Particularly, in the third Book of the Pentateuch or Torah, known as Leviticus, it states that a woman undergoing menstruation is perceived as unclean for seven days and whoever touches her shall be unclean until evening (Leviticus 15:19)....