International Journal of Fertility and Sterility

167-177

Authors: Cyrus Jalili; Fuzieh Khani Hemmatabadi; Mehrdad Bakhtiyari; Amir Abdolmaleki; Fatemeh Moradi

Background: Prior to chemotherapy interventions, in vitro maturation (IVM) of folliclesthrough vitrification can be used to help young people conserve their fertility. Materials and Methods: This experimental study was conducted on immature female BALB/c mice (12-14 days). Follicles were gathered mechanically and placed in α-Minimal Essential Medium (α-MEM) containing 5% fetal bovine serum (FBS). Some pre-antral follicles were frozen. The fresh and vitrified follicles were cultured in different concentrations of sodium alginate (0.25%, 0.5%, and 1%) and two dimensional (2D) medium for 12 days. The samples were evaluated for viability percentage, the number of MII-phase oocytes and reactive oxygen specious (ROS) level. Additionally, Gdf9, Bmp15, Bmp7, Bmp4, Gpx, mnSOD and Gcs gene expressions were assessed in the samples. Results: The highest and lowest percentages of follicle viability and maturation in the fresh and vitrified groups were respectively 0.5% concentration and 2D culture. There was no significant difference among the concentrations of 0.25% and 1%. Viability and maturation of follicles showed a significant increase in the fresh groups in comparison with the vitrified groups. ROS levels in the both fresh and vitrified groups with different concentrations of alginate showed a significant decrease compared to the control group. ROS levels in follicles showed a significant decrease in the fresh groups in comparison with the vitrified groups (P≤0.0001). The highest gene expression levels were observed in the 0.5% alginate (P≤0.0001). Moreover, the viability percentage, follicle maturation, and gene expression levels were higher in the fresh groupsthan the vitrified groups (P≤0.0001). Conclusion: Alginate hydrogel at a proper concentration of 5%, not only helps follicle get mature, but also promotes the expression of developmental genes and reducesthe level of intracellular ROS. Follicular vitrification decreases quality of the follicles, which are partially compensated using a three dimensional (3D) cell culture medium.

189-196

Authors: Mahboubeh Taebi; Nourossadat Kariman; Ali Montazeri; Hamid Alavi Majd

Background: Infertility stigma is a phenomenon associated with various psychological and social tensions especially for women. The stigma is associated with a feeling of shame and secrecy. The present study was aimed to explore the concept of infertility stigma based on the experiences and perceptions of infertile women. Materials and Methods: This qualitative conventional content analysis study was conducted in Isfahan Fertility and Infertility Center, Iran. Data were collected through in-depth interviews with 17 women who had primary infertility. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The Standards for Reporting Qualitative Research (SRQR) checklist was followed for this research. Results: Eight hundred thirty-six initial codes were extracted from the interviews and divided into 25 sub-categories, 10 categories, and four themes. The themes included “stigma profile, self-stigma, defensive mechanism and balancing”. Stigma profile was perceived in the form of verbal, social and same sex stigma. Self-stigma was experienced as negative feelings and devaluation. Defensive mechanism was formed from three categories of escaping from the stigma, acceptance and infertility behind the mask. Two categories; empowered women and pressure levers, created a balancing theme against the infertility stigma. Conclusion: Infertile women face social and self-stigma which threatenstheir psychosocial wellbeing and self-esteem. They use defensive response mechanisms and social support to mitigate these effects. Education focused on coping strategies might be helpful against infertility stigma.

202-209

Authors: saeed Azizollahi; Maryam Bagheri; Fedyeh Haghollahi; Seyyede Momeneh Mohamadi; Batool Hosein Rashidi

Background: Gonadotropin-releasing hormone (GnRH) analogues have been extensively utilized in the ovarian stimulation cycle for suppression of endogenous rapid enhancement of luteinizing hormone (LH surge). Exclusive properties and functional mechanisms of GnRH analogues in in vitro fertilization (IVF) cycles are clearly described. This randomized clinical trial was performed to evaluate clinical and molecular impacts of the GnRH agonist and antagonist protocols in IVF cycles. For this purpose, gene expression of cumulus cells (CCs) as well as clinical and embryological parameters were evaluated and compared between two groups (GnRH agonist and antagonist) during the IVF cycle. Materials and Methods: Twenty-one infertile individuals were enrolled in this double-blind randomized clinical study. Subjects were randomly allocated into two groups of GnRH agonist (n=10) treated patients and GnRH antagonist (n=11) treated individuals. The defined clinical embryological parameters were compared between the two groups. Expression of BAX, BCL-2, SURVIVIN, ALCAM, and VCAN genes were assessed in the CCs of the participants using the real-time polymerase chain reaction (PCR) technique. Results: The mean number of cumulus oocyte complex (COC), percentage of metaphase II (MII) oocytes, grade A embryo and clinical parameters did not show noticeable differences between the two groups. BAX gene expression in the CCs of the group treated with GnRH agonist was remarkably higher than those received GnRH antagonist treatment (p <0.001). The mRNA expression of BCL-2 and ALCM genes were considerably greater in the CCs of patients who underwent antagonist protocol in comparison to the group that received agonist protocol (p <0.001). Conclusion: Despite no considerable difference in the oocyte quality, embryo development, and clinical outcomes between the group treated with GnRH agonist and the one treated with antagonist protocol, the GnRH antagonist protocol was slightly more favorable. However, further clinical studies using molecular assessments are required to elucidate this controversial subject (Registration number: IRCT20101115005181N16).

219-225

Authors: Induja Manikandan; Sushmita Bora; Prashant Adole; Chitra Thyagaraju; Rajesh Ganesh

Background: Because of the widespread use of organophosphate (OP) pesticides in agriculture, they are major environmental contaminants in developing countries. OP pesticides decrease sperm concentration and affect its quality, viability, and motility. Studies have demonstrated the association between abnormal semen analysis and OP pesticides exposure among the high-risk population. Asthere is limited data on the percentage of OP pesticides exposure, the study aimed to determine the OP pesticides exposure in Southern Indian men with idiopathic abnormal semen analysis and find the possible source of their OP pesticides exposure. Materials and Methods: In this cross-sectional pilot study, fifty men with idiopathic abnormal semen analysis as cases and fifty men with normal semen analysis as controls were recruited. Detailed history wastaken and general and systemic examinations were carried out. OP pesticides exposure was determined by assessment of pseudocholinesterase and acetylcholinesterase levels and urinary OP pesticides metabolites dialkyl phosphate (DAP) consisting of dimethyl phosphate (DMP), diethyl thiophosphate (DETP), and diethyl dithiophosphate (DEDTP). Results: Cases had statistically significantly lower levels of pseudocholinesterase (5792.07 ± 1969.89 vs. 10267.01 ± 3258.58 IU/L) (P=0.006) and acetylcholinesterase [102.90 (45.88-262.74) vs. 570.31 (200.24-975.30) IU/L] (P=0.001) as compared to controls. Cases had a statistically significantly higher percentage of urinary DAP positivity as compared to controls (80 vs. 38%) (p <0.0001). Hence, cases had a significantly higher percentage of OP pesticides exposure as compared to controls (20 vs. 4 %) (P=0.015). OP-exposed cases had significantly higher urinary DETP and DEDTP levels as compared to OP non-exposed cases. Also, urinary DETP and DEDTP levels were significantly negatively associated with sperm concentration, motility, and normal morphology among OP-exposed cases. Conclusion: Southern Indian men with idiopathic abnormal semen analysis had a significantly higher percentage of OP pesticides exposure as compared to men with a normal semen analysis.

234-240

Authors: Arezoo Bagheri; Mahsa Saadati

Background: Total fertility rate (TFR) in Iran decreased from the year 2000 and recently Iran has experienced fertility rates below replacement level. Birth interval is one of the most important determinants of fertility levels and plays a vital role in population growth rate. Due to the importance of this subject, the aim of this study was analyzing three birth intervals using three Survival Recurrent Event (SRE) models. Materials and Methods: In a 2017 cross-sectional fertility survey in Tehran, 610 married women, age 15-49 years, were selected by multi-stage stratified random sampling and interviewed using a structured questionnaire. The effects of selected covariates on first, second and third birth intervals were fitted to the data using the Prentice-Williams- Peterson-Gap Time (PWP-GT) SRE model in SAS 9.4. Results: Calendar-period had a significant effect on all three birth intervals (p <0.01). The Hazard Rate (HR) for a short birth interval for women in the most recent calendar-period (2007-2017) was lower than for the other calendarperiods. Women’s migration influenced second (P=0.044) and third birth intervals (P=0.031). The HR for both birth intervals in migrant women was 1.298 and 1.404 times shorter, respectively than non-migrant women. Women’s employment (P=0.008) and place of residence (p <0.05) also had significant effects on second birth interval; employed women and those living in developed, completely-developed and semi-developed areas, compared to unemployed women and those living in developing regions, had longer second birth intervals. Older age at marriage age increased the HR for a short third birth interval (p <0.01). Conclusion: The analysis of birth interval patterns using an appropriate statistical method provides important information for health policymakers. Based on the results of this study, younger women delayed their childbearing more than older women. Migrant women, unemployed women and women who live in developing regions gave birth to their second child sooner than non-migrant employed women, and women who lived in more developed regions. The implementation of policies which change the economic and social conditions of families could prevent increasing birth intervals and influence the fertility rate.