International Journal of Fertility and Sterility

155-160

Authors: Firoozeh Ahmadi , Shiva Siahbazi , Farnaz Akhbari , Bita Eslami , Ahmad Vosough

Destruction of the endometrium due to trauma to the basal layer of endometrium may cause intra uterine adhesions, known as Asherman’s syndrome (AS). There are various types of imaging method for diagnosis of the intra uterine adhesion such as hysterosalpingography, sonohysterography, ultrasonography, and hysteroscopy which is considered as the gold standard approach. Hysterosalpingogram may suggest the presence of intrauterine adhesions, and may reveal the extent of the scar formation. Knowing different images in each technique is helpful in detection of intra uterine adhesion.

169-174

Authors: Nosrat Bahrami , Masoumeh Simbar , Somayeh Bahrami

Background: Antenatal educations provide information regarding pregnancy, birth, infant care and early parenthood. The purpose of this study was to determine effect of prenatal education on mother’s quality of life during first year after childbirth among Iranian women. Materials and Methods: This single-blind randomized control trial study was performed on 160 first-time pregnant women; with a singleton fetus; aged 18 to 35; without history of medical, psychological, and infertility diseases; as well as with at least eight prenatal visits during pregnancy. Participants were invited into two groups of intervention (n=80) and control (n=80). The antenatal education classes were consisted of eight sessions, and then, mother’s quality of life was evaluated during first year after childbirth. Data was analyzed using t test, chi-square, and Mann-Withney. Results: The interventional group demonstrated higher scores of quality of life domains than the control group (p<0.05). The interventional group (at one year postpartum) demonstrated significantly higher scores for quality of life in the physical health, psychological health, and environmental health domains compared to the control group. In addition, the interventional group showed a significant increase in the mean scores for the domains of physical, psychological, and environmental health from 6-8 weeks to 1 year postpartum. Conclusion: The study showed that women receiving prenatal education had higher level of happiness and satisfaction in their overall quality of life and health, respectively (Registration Number: IRCT201101115571N2).

181-186

Authors: Shabnam Abdi , Mojdeh Salehnia , Saman Hosseinkhani

Background: The aim of this study was to investigate follicular growth and steroid production in neonatal mouse ovary during in vitro culture. Materials and Methods: In this experimental study, 7-day-old mouse whole ovaries were cultured in α-MEM (medium supplemented with 100 mIU/ml recombinant follicle stimulating hormone, 1% insulin, transferrin and selenium (ITS), 5% fetal bovine serum (FBS), 100 IU/ml penicillin and 50 μg/ml streptomycin for 7 days. The size of whole ovary was determined as mean area during culture. The survival rates of isolated preantral follicles after culture were assessed using trypan blue staining after being mechanically isolated. Histological evaluation of whole ovary was done by hematoxylin and eosin staining. 17-β estradiol, progesterone and dehydroepiandrosterone concentrations in the medium were measured during culture. Results: The mean area of ovary increased after culture (1.47 vs. 0.21 mm2). The survival rate of isolated follicles in ovary after culture was 99.2%. There was a significant decline in the percentage of primordial follicles after seven days of culture (91.8 ± 0.2% vs. 65.1 ± 1.1%), whereas the rate of preantral follicles increased significantly (4.6 ± 0.4% vs. 29.2 ± 0.5%). The levels of estradiol, progesterone and dehydroepiandrosterone also increased significantly after culture (p<0.001). Conclusion: These results show that the growth and development of primordial follicles in contrast with hormonal production decreased during in vitro culture of neonatal mouse ovaries.

193-198

Authors: Farzaneh Bassiri , Marziyeh Tavalaee , Mohammad Hossein Nasr Esfahani

Background: Sperm membrane integrity is not only important as a barrier between intraand extra-cellular spaces, but also it can be considered as a sign of DNA integrity. Hypoosmotic swelling test reflects membrane integrity and has been used to evaluate sperm quality. Intracytoplasmic sperm injection (ICSI) in adjunct with hypo-osmotic swelling test (HOST) has been used for treatment of males with asthenozoospermia. Therefore, this study aims to evaluate correlation of different pattern of HOST with sperm parameters, protamine deficiency and apoptosis. Materials and Methods: In this case-control study, sixteen semen samples were randomly collected from infertile normozospermic men. Semen samples were divided into two portions as follows: one portion was assessed for sperm parameters according toWorld Health Organization (WHO)-2010, while the other portion, after applying HOST procedure, was used for assessment of sperm morphology, protamine deficiency and late or early apoptosis. Statistical analysis was carried out using the Statistical Package for the Social Studies (SPSS 11.5). Results: Our results showed that, the lowest odds ratio (OR) of abnormal sperm head morphology and abnormal acrosome was in d-sperm as compared to a-pattern or nonviable spermatozoa (p=0.00, p=0.01). In addition, a significant correlation was observed between d-sperm with sperm concentration and percentage of DNA damage (p=0.03 and p=0.04, respectively). A significant correlation was observed between percentage of sperm motility and DNA fragmentation (r=-0.56; p=0.01). Furthermore, significant correlations were observed between percentages of early apoptotic sperm with protamine deficiency and sperm concentration (p=0.009 and p=0.01, respectively). Conclusion: Significant correlations exist between d-pattern and sperm DNA integrity. Semen samples with low sperm concentration have low percentage of d-sperm which are mature and intact sperms.

207-216

Authors: Anne Oppenheimer , Marcos Ballester , Emmanuelle Mathieu d’Argent , Karine Morcel , Jean-Marie Antoine , Emile Daraï

Background: To evaluate the impact of the association of endometrioma with or without deep infiltrating endometriosis (DIE) after a first intra cytoplasmic sperm injection- in vitro fertilization (ICSI-IVF) cycle on pregnancy rate. Materials and Methods: In this retrospective study, women with endometrioma who underwent a first ICSI-IVF cycle from January 2007 to June 2010 were reviewed for pregnancy rate. The main outcome measure was the clinical pregnancy rate. A multiple logistic regression (MLR) was performed; including all variables that were correlated to the conception rate. Only independent factors of pregnancy rate were included in a Recursive Partitioning (RP) model. Results: The study population consisted of 104 patients (37 without DIE and 67 patients with associated DIE). Using multivariable analysis, a lower pregnancy rate was associated with the presence of DIE (OR=0.24 (95% CI: 0.085-0.7); p=0.009) and the use of ICSI (OR=0.23 (95% CI: 0.07-0.8); p=0.02). A higher pregnancy rate was associated with an anti-mullerian hormone (AMH) serum level over 1 ng/ml (OR=4.3 (95% CI: 1.1-19); p=0.049). A RP was built to predict pregnancy rate with good calibration [ROC AUC (95% CI) of 0.70 (0.65-0.75)]. Conclusion: Our data support that DIE associated with endometrioma in infertile patients has a negative impact on pregnancy rate after first ICSI-IVF cycle. Furthermore, our predictive model gives couples better information about the likelihood of conceiving.

225-238

Authors: Mrinalini Kumari , Poonam Singh

Background: Metronidazole (MTZ) is commonly used as an antibacterial and antiprotozoal drug. Various doses of MTZ have been reported to inhibit spermatogenic activity and sperm indices. Materials and Methods: In this experimental study, dose-dependent effects of MTZ on the structural and functional integrity of the testis and accessory reproductive organs have been investigated. Adult male mice of Swiss strain were administered orally with MTZ at the doses of 250 mg/kgBW/day and 500 mg/kgBW/day for 28 consecutive days to study the changes in the testis, epididymis, seminal vesicle, sperm indices and fertility. Reversal effects of the drug were also studied on the same mice, 42 days after cessation of the treatment. Results: Therapeutic dose of MTZ (250 mg/kgBW/day) neither altered the weights of the testis, epididymis and seminal vesicle nor their histoarchitecture and sperm indices. The drug at the high dose (500 mg/kg BW/day) caused significant reductions in the weights of the testis and epididymis. Histoarchitecture of the testis and epididymis at the high dose revealed marked regressive changes while that of seminal vesicle remained unaffected. Significant reductions were noticed in the motility, viability and count of epididymal spermatozoa while the concentrations of epididymal sialic acid and seminal vesicular fructose remained unaltered after the treatment. No significant changes were noticed in the mating ability as well as in the level of serum testosterone in the treated mice. Fertility of the male mice treated with high dose of MTZ declined markedly leading to an increase in pre- and postimplantation loss while a significant decrease was noticed in the number of live blastocysts in females impregnated with such males. MTZinduced changes in the male reproductive organs and fertility were reinstated 42 days after cessation of the treatment. Conclusion: High dose of MTZ induced reversible deleterious effects on the male reproduction and fertility.

243-244

Authors: Firoozeh Ahmadi , Hadieh Haghighi

Recent advances in reproductive medicine have created a demand for more accurate and safe imaging modalities before assisted reproductive treatment (ART) (1). Gradually, the important role of three-dimensional (3D) ultrasonography in the diagnosis of uterine congenital anomalies has been proved (2-4). The aim of this article is to evaluate a communicated uterus through 3D image, while to compare this result with quite similar images of this patient with hysterosalpingography (Fig1).The patient’s past medical history indicated three first -trimester miscarriages. Therefore, she underwent a hysterosalpingogram (HSG), and was also referred to 3D ultrasound as part of her infertility treatment (before ART). Figure 2 shows an image taken through a 3DXI (ACCUVIX XQ, Medison, South Korea) ultrasound with a 6.5-MHz transvaginal probe equipped with three-dimensional imaging. The uterus was examined systematically .On the coronal view, a long septum divides the cavity and cervix into two parts, and between the divided parts, a connection in isthmus can easily be identified. Congenital malformation of uterus is caused by a numerous anomalies during embryogenesis. The American Society for Reproductive Medicine (ASRM) has classified müllerian duct anomalies (MDAs) to provide substantial assistance in the clinical application of infertility and preoperative decision (5). A communicating uterus, as a rare type of müllerian duct anomaly, does not fall into the classification system of ASRM (6). An alternative embryological deficiency, reviewed by Musset’s classification, describes this anomaly (6). According to this theory, fusion first occurs at the level of the uterine isthmus, and simultaneously, proceeds into the both directions of caudal and cephalad. Later, uterine corpus and cervix are formed by midline resorption initiating at the isthmus, followed by rapid cellular bidirectional resorption of septum. It is not clear whether this is the mechanism for normal müllerian development, or a developmental failure which is unique to other rare anatomical divergence (7). Recent developments in three-dimensional ultrasonography can greatly strengthen diagnostic potential of female reproductive tract anomalies, and also, should be considered as first-line examination. It has the advantages of an easy, inexpensive, reproducible and noninvasive tool for analyzing of morphologic anatomy, which deserves more attention by gynecologists (2). In certain cases, MRI, hysteroscopy and laparoscopy are more effective techniques than others. (3).