International Journal of Fertility and Sterility

161-170

Authors: Azizollah Bakhtari; Saeedeh Nazari; Sanaz Alaee; Elias Kargar-Abarghouei; Fakhroddin Mesbah; Esmaeil Mirzaei; Mohammad Jafar Molaei

Background: Although application of superparamagnetic iron oxide nanoparticles (SPIONs) in industry and medicine has increased, their potential toxicity in reproductive cells remains a controversial issue. This study was undertaken to address the response of sperm, oocyte, and resultant blastocyst to dextran-coated SPIONs (D-SPIONs) treatment during murine in vitro fertilization (IVF). Materials and Methods: In this experimental study, murine mature oocytes were randomly divided into three groups: control, and low- and high-dose groups in which fertilization medium was mixed with 0, 50 and 250 μg/ml of DSPIONs, respectively. Sperm and/or cumulus oocyte complexes (COCs) were cultured for 4 h in this medium for electron microscopic analysis of sperm and COCs, and assessment of developmental competence and genes expression of Gpx1, Sod1, catalase, Bcl2l1 and Bax in the resultant blastocysts. Results: Ultrastructural study of sperm, oocyte, and granulosa showed destructed mitochondria and membranes in spermatozoa, vacuolated mitochondria and distorted cristae in oocytes, and disrupted nuclei and disorganized cell membranes in granulosa in a dose-dependent manner. Data showed that cleavage and blastocyst rates in the 250 μg/ml of D-SPIONs were significantly lower than in the control group (P<0.05). Gene expression of GPx1, Sod1, catalase, Bcl2l1 and Bax in resultant blastocysts of the high-dose group and catalase and Bax in resultant blastocysts of the low-dose group, was higher than the controls. Conclusion: There is considerable concern regarding D-SPIONs toxic effects on IVF, and mitochondrial and cell membrane damage in mouse spermatozoa and oocytes, which may be related to oxidative stress and apoptotic events.

176-184

Authors: Maryam Adib; Seyed Morteza Seifati; Mahmood Dehghani Ashkezari; Fatemeh Akyash; Arezoo Khoradmehr; Behrouz Aflatoonian

Background: Testicular cell conditioned medium (TCCM) has been shown to induce female germ cell development in vitro from embryonic stem cells (ESCs). Testicular cells (TCs) secrete a variety of growth factors such as growth differentiation factor-9 (GDF-9), bone morphogenetic protein 4 (BMP-4), stem cell factor (SCF), leukemia inhibitory factor (LIF), and other, that could improve oocyte maturation. Here we have investigated the effect of human TCCM (hTCCM) on in vitro maturation (IVM) and morphology of mouse oocytes. Materials and Methods: In this experimental study, 360 germinal vesicle (GV) oocytes were obtained from NMRI mice, aged 4-6 weeks that had received 5 IU pregnant mare's serum gonadotropin (PMSG) 48 hours before. GV oocytes were subjected to IVM. 120 GV oocytes were cultured in each medium; hTCCM as the test group, DMEM + 20%FBS as the control group and Ham’s F10 + HFF medium as the sham group. The rates of the IVM and perivitelline space (PVS) changes were recorded at 8, 16 and 24 hours after culture. The metaphase II (MII) oocytes were subjected for in vitro fertilization (IVF) and the fertilization rate was evaluated after 1, 2, and 3 days. Results: There was a significant difference between the maturation rates in hTCCM (31.67% MII) and the control [0% MII, P<0.05, (7.5% MI, 52.5% deg. and 40%GV)] groups but there was not a significant difference between the maturation rates in hTCCM and the sham group (53.33% MII, P>0.05). IVF success rate for MII oocytes obtained from IVM in the hTCCM group was 28.94% (n=11). Our data showed that hTCCM is an effective medium for GV oocyte growth and maturation compared to the control medium. Conclusion: Our findings show that TCCM supports oocyte IVM in mice and affect oocyte morphology

193-200

Authors: Mahnaz Ashrafi; Nadia Jahangiri; Shahideh Jahanian Sadatmahalleh; Fatemeh Aliani; Mohammadreza Akhoond

Background: Endometriosis is one of the most common pelvic diseases associated with dyspareunia, pelvic pain, and infertility. The primary aim of this study is to evaluate the role of diet on the risk of endometriosis among Iranian women. Materials and Methods: This case-control study was conducted in two health research centres between 2015 and 2016. There were 207 women with endometriosis (case) and 206 women without endometriosis (control) who were evaluated by laparoscopy. The women were asked about their frequency of consumption per week of portions of selected dietary items in the Iranian diet in the year before the interview. Results: The results indicated that intake of green vegetables (odds ratio [OR]=0.39, 95% confidence interval [CI]=0.21–0.74, Ptrend=0.004), red meat (OR=0.61, 95% CI=0.41–0.91, Ptrend=0.015) and dairy products (milk [OR=0.65, 95% CI=0.47–0.92, Ptrend=0.014], cheese [OR=0.53, 95% CI=0.37–0.76, Ptrend<0.001]), fresh fruit (OR=0.68, 95% CI=0.50–0.93, Ptrend=0.015) and grain legumes (OR=0.59, 95% CI=0.47–0.77; Ptrend<0.001) had a significant association with lower risk of endometriosis. Consumption of carrots, green tea, fish, eggs and oil was not significantly related to the risk of endometriosis. Conclusion: This study suggests that certain types of dietary components may be related to the risk of endometriosis.

209-212

Authors: Firoozeh Ahmadi; Amirhossein Maghari; Fattaneh Pahlavan

Background: The purpose of this study to determine the relationship between endometrial length and positive pregnancy test in patients who underwent assisted reproductive technology (ART). Materials and Methods: This cross-sectional study included patients who were referred for in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) therapy from 2013 to 2016. All nulliparous women who met the inclusion criteria were between 20-38 years of age and presented for ultrasound measurements prior to fresh embryo transfer (ET). Endometrial length was measured by transvaginal ultrasound (TVS) with a Medison Accuvix device on the day of human chorionic gonadotropin (hCG) administration. The relationship between endometrial length and treatment success was assessed. The independent sample t test, receiver operating characteristic (ROC) curve and the area under the curve (AUC) index and chi-square test were used for data analysis. P values <0.05 were statistically significant. Results: There was a significant relationship between endometrial length (41.5%) and treatment success (P<0.05). The endometrial length of 41.5(mm) with a sensitivity of 66.7%, specificity of 50.6%, positive predictive value of 46.8%, negative predictive value of 69.4%, and efficiency of 56.62% can be used as a proper cut-off point with an AUC of 0.63. Conclusion: The value of 41.5(mm) for endometrial length can be used as a proper cut-off point for prediction of a higher ART success rate. We recommend TVS as the first step for assessment of uterine and endometrium receptivity in the ART cycle.

218-222

Authors: Ronak Zarei; Parvaneh Nikpour; Bahman Rashidi; Nahid Eskandari; Roshanak Aboutorabi

Background: Mucin-1(Muc1) is one of the first molecules in the endometrium that confronts implanting embryos. There is insufficient knowledge about the impacts of diabetes and drugs developed for diabetes treatment on expression of this molecule at the time of implantation. Therefore, this study aimed to investigate the impacts of diabetes and insulin, metformin and pioglitazone on Muc1 expression at the time of implantation. Materials and Methods: This experimental study was conducted on a total of 63 female Wistar rats divided into 9 groups. To induce type 1diabetes, streptozotocin (STZ) and for induction of type 2 diabetes, nicotinamide (NA) and STZ were injected intraperitoneally. For superovulation, human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) were used. Insulin, metformin and pioglitazone were administered for two weeks. Finally, the endometrial expression of Muc1 was evaluated by quantitative real-time reverse transcription–polymerase chain reaction (RT-PCR). Results: Muc1 expression was non-significantly increased in type 1 and type 2 diabetic groups compared to the control group (P=0.61 and 0.13, respectively); also, it increased in insulin-treated type 1 diabetic group compared to the control group (P=0.0001). Its expression was increased in insulin-treated type 1 diabetic group compared to untreated diabetic group (P=0.001). The expression level of Muc1 was significantly reduced in superovulated and insulin-treated type 1 diabetic group compared to the insulin-treated type 1 diabetic group (P=0.001). Conclusion: One of the causes of fertility problems in diabetes, is changes in Muc1 expression during implantation. On the other hand, the use of insulin in these patients can even lead to overexpression of this gene and worsen the condition. However, these changes can be partially mitigated by assisted reproductive technology (ART) such as superovulation. Also, treatment with metformin and pioglitazone can restore Muc1 expression to near normal levels and has beneficial effects on implantation.

228-233

Authors: Hossein Azizi; Amirreza Niazi Tabar; Thomas Skutella; Mostafa Govahi

Background: The glial cell-derived neurotrophic factor (GDNF) family plays essential roles in the maintenance, growth, regulatory and signalling pathways of spermatogonial stem cells (SSCs). In this study, we analysed the expression of anti-GDNF family receptor alpha 1 antibody (GFRa1) by immunohistochemistry (IHC), immunocytochemistry (ICC), Fluidigm real-time polymerase chain reaction (RT-PCR) and flow cytometry analyses. Materials and Methods: In this experiment study, ICC, IHC, Fluidigm RT-PCR and flow cytometry were used to analyse the expression of the germ cell marker GFRa1 in testis tissue and SSC culture. Results: IHC analysis showed that there were two groups of GFRa1 positive cells in the seminiferous tubules based on their location and expression shape - a small round punctuated shape on the basal compartment donut shape and a C-shaped expression located between the basal and the luminal compartments of the seminiferous tubules. OCT4 and PLZF positive cells may have similar patterns of expression as the first group. Assessment of the seminiferous tubule sections demonstrated that about 27% of the SSCs were positive for GFRa1. Fluidigm RT-PCR confirmed the significant expression (P<0.001) of GFRa1 in the SSCs compared to testicular stromal cells (TSCs). Flow cytometry analysis demonstrated that about 75% of the isolated SSCs colonies were positive for GFRa1. Conclusion: The results indicated that GFRa1 had a specific expression pattern both in vivo and in vitro. This finding could be helpful for understanding the proliferation, maintenance and signalling pathways of SSCs, and differentiation of meiotic and haploid germ cells.

240-246

Authors: Fatemeh Hadizadeh-Talasaz; Masoumeh Simbar; Robab Latifnejad- Roudsari

Background: Despite significant advances in reproductive technology, using donor assisted reproductive technology is a double-edged sword that has numerous challenges. One of the most challenging issues for couples is whether or not to disclose this information to donor offspring. This study, therefore, explored infertile couples’ decision to disclose donor conception to their future child. Materials and Methods: This qualitative study was conducted using content analysis approach in 2012 in the Milad Infertility Centre, Mashhad, Iran. Data were collected through semi-structured interviews with 32 infertile persons including nine couples and 14 women who were selected by purposive sampling. Data were analysed by conventional qualitative content analysis adopted by Graneheim and Lundman using MAXQDA 2010 software. Results: Two categories were emerged: ‘not to disclose information to the child’ and ‘to disclose information to the child’. The first category consisted of three subcategories: 1. child support from probable harms; 2.to maintain healthy family relationships; and 3. lack of a compelling reason to disclose this information. The second category embraced four subcategories: 1. awareness of the others; 2. emergence of new living conditions; 3. appreciation for the donor; and 4. honesty among family members. The main reason for not disclosing information was to protect the child from probable harm. Conclusion: Although protecting children from possible harms was a major reason for infertile couples' secrecy, keeping this secret would not be always easy. Therefore, increasing public awareness about the donation process in order to change the beliefs of community and eliminate the infertile couples’ concerns would help them to overcome this problem. Additionally, long-term psychological counselling during and after the donation process is highly recommended.

256-259

Authors: Hossein Ghorbani; Mohammad Ranaee; Zeinab Vosough

The most common mesenchymal tumours of the uterine corpus originate from smooth muscle cells. Leiomyomas are commonly found in women of child bearing age; however, leiomyosarcomas occur later in life (50-55 years of age). Most uterine leiomyosarcomas occur de novo, but rare cases of leiomyosarcomas that arise from leiomyomas have been reported. We present two cases of fertile women with submucosal leiomyomas that became malignant and discuss their pathologic features and immunohistochemistry studies for P16, P53 and Ki67.

262-263

Authors: Soodeh Mahdian; Maryam Shahhoseini; Ashraf Moini

Coronavirus disease 2019 (COVID-19) prevalence has caused many problems in society and disrupted many regular aspects of life. COVID-19 contains major structural proteins that among them, S protein can promote fusion of the viral and cellular membranes and facilitate the entry of coronavirus into the host cells. Basigin (BSG) is one of the most important receptors for COVID-19 that mediates its entry to host cells. Also, Basigin has an important role in male and female reproduction. Basigin is expressed in the uterus and plays an important role during embryo implantation and needed for successful implantation. Therefore, disruption or inhibition of Basigin causes to a weakness in embryo implantation. Therefore, if a woman or a man is infected with COVID-19, it is recommended that they do not attempt to conception until their treatment is complete. It is also recommended tests for COVID-19 be performed on infertile couples before using assisted reproductive technology (ART).