International Journal of Fertility and Sterility

251-255

Authors: Soghra Hosseini Aghdam; Alyeh Ghasemzadeh; Laya Farzadi; Kobra Hamdi; Nazli Navali; Parvin Hakimi; Marayam Baradaran-Binazir; Mohammad Nouri; Amir Fattahi; Ralf Dttrich

Background: Growth hormone (GH) is a potential treatment in the assisted reproductive technology (ART) to improve endometrial receptivity and thickness. In the current study, we investigated the effect of the intrauterine administration of GH on the endometrial thickness (EMT) and ART outcomes in the patients with refractory thin endometrium. Materials and Methods: In this clinical trial study, women with a refractory thin endometrium and a history of one or more frozen embryo transfer (FET) cancellation who were referred to the infertility center of the Tabriz Al-Zahra hospital (Tabriz, Iran) and Milad Infertility Clinic (Tabriz, Iran) received intrauterine injections of GH every other day from day 14 of the menstrual cycle until the EMT reached ≥7 mm in addition to the routine endometrium preparation protocol. EMT was evaluated during the treatment and in the cases with EMT ≥7 mm, biochemical/clinical pregnancy was evaluated after embryo transfer. Results: Thirty-one women aged 35.29 ± 6.21 years were included in this study. The mean amount of EMT was significantly increased following the GH treatment (7.03 ± 1.23 mm) vs. before treatment (5.14 ± 1.1 mm, P<0.001). The EMT reached ≥7 mm in the 65% patients (20/31). Also, the embryo transfer resulted in pregnancy in the patients, biochemical pregnancy: 9/20 (45%) and clinical pregnancy: 7/20 (35%). There was a positive correlation between EMT on the day 13 of cycle (before the treatment) and the maximum EMT (r=0.577 and P=0.001). The EMT was statistically different on the embryo transfer day between clinically pregnant and non-pregnant women (7.18 ± 0.56 vs. 6.21 ± 0.72 mm, P=0.007). Conclusion: The intrauterine administration of GH could be an appropriate therapeutic strategy for patients with refractory thin endometrium. This treatment could significantly increase the EMT as well as implantation and pregnancy rates in these patients (registration number: IRCT20210220050429N1).

263-267

Authors: Zahra Asgari; Sara Farzadi; Reihaneh Hosseini; Alireza Hadizadeh; Masoud Mortezazadeh

Background: Deep infiltrating endometriosis (DIE) is described as an endometriotic tissue that penetrates more than 5 mm under the peritoneal surface. It’s suggested that trans vaginal sonography (TVS) is 79% sensitive and 94% specific in the assessment of intestinal DIE. Considering the possibility that DIE ultrasonography (rectal and\or vaginal ultrasonography) might be more accurate, we designed this study to assess this study to evaluate the accuracy of DIE ultrasonography. Materials and Methods: In this retrospective cross-sectional study, we designed and conducted this study from 2019 to 2020 on patients suspected of severe endometriosis. Our patients underwent ultrasonographic imaging and based on the results became candidates for surgery. We compared histopathological results with sonographic findings using crosstabulation and chi-square tests were used to measure accuracy. P<0.05 were considered statistically significant. Results: Following pathological assessments of 109 cases, 97 cases had ovarian endometrioma, 42 cases had intestinal involvement and 56 cases had uterosacral DIE. The results for accuracy were as the following; uterosacral ligament (USL) involvement SE: 96.4% and SP: 59.1%; intestinal involvement SE: 97.6% and SP: 73.8%; and Cul de sac involvement with SE: 100% and SP: 50.8%. With regards to ovarian endometrioma, ultrasonographic imaging was 99.0% sensitive and 84.6% specific. With regards to intestinal involvement, ultrasonography performed a reliable overall diagnosis (97.6% sensitive and 73.8% specific). However, the results showed lower accuracy regarding the level of intestinal involvement. The accuracy for other sites and cavities was low except for ovarian endometrioma. Conclusion: The results of the present study demonstrated that pre-operative TVS and Transrectal ultrasound (TRUS) can be a helpful paraclinical tool in the assessment and diagnosis of DIE and endometriosis in general and particularly with adnexal and bowel lesions, it can have some shortcomings with respect to cul de sac and USLs.

275-280

Authors: Fahimeh Monirian; Batul Khodakarami; Leili Tapak; Fatemeh Kimiaei Asadi; Soodabeh Aghababaei

Background: The aim of this study was to determine the effect of couples coping enhancement counseling (CCEC) on stress and dyadic coping of infertile couples. Materials and Methods: In this parallel randomized controlled trial study in 2020, seventy infertile couples were randomly divided into case and control groups. The intervention was performed in 7 sessions of couple counseling based on CCEC for the intervention group, no intervention was performed in the control group. Fertility Problem Inventory, Dyadic Coping Inventory and demographics questionnaires were completed by both couples separately before the intervention and 4 weeks after the last consultation session. Data were analyzed using IBM SPSS statistics 24 and statistical tests such as mean ± SD, frequency, percentage, Independent t test, Mann-Whitney test, Chi-square test or Fisher’s exact test and Analysis of covariance. Significant level was considered less than 0.05. Results: The mean stress scores of women in the intervention group before and after intervention decreased from (156.83 ± 23.57) to (139.43 ± 22.39) and the mean scores of dyadic coping increased from (126.83 ± 19.89) to (138.26 ± 16.92), these differences were statistically significant (P<0.001), also the mean stress scores of men in the intervention group before and after the intervention decreased from (143.80 ± 23.40) to (128.03 ± 22.24), the mean scores of dyadic coping increased (131.34 ± 20.67) to (136.40 ± 19.38), these differences were statistically significant (P<0.001). Conclusion: Positive effects of CCEC were observed in reducing infertility stress and increasing dyadic coping in both women and men after the intervention, the effect of the intervention on women was greater than that of men. As a result, this intervention can play an important role in reducing stress and increasing the solidarity and support of infertile couples for infertility treatments (registration number: IRCT20120215009014N367).

286-291

Authors: Nader Namvarsigaroudi; Zahra Tahmasebi Fard

Background: Impaired expression of genes which act on hormone signaling pathways is one of the factors affecting miscarriage. In this study, the expression levels of insulin receptor (INSR) and insulin receptor substrates-1 (IRS-1) genes in endometrial tissue of infertile women and fertile women with miscarriage in less than twenty weeks gestation for unknown reasons were evaluated. Materials and Methods: In this case-control study, forty-two fertile women with children and 42 infertile women, who underwent in vitro fertilization (IVF), were selected. Both groups had abortions under twenty weeks gestation for unknown reasons. The endometrial tissue of all patients was prepared to evaluate the expression of INSR and IRS-1 genes by quantitative real-time polymerase chain reaction (PCR) method after RNA extraction. Results: There was a statistically significant relationship between the expressions of INSR and IRS-1 genes in the endometrial tissue of the infertile women compared with the fertile women (P=0.002 and P=0.008, respectively). The expression level of genes was decreased in both groups by age and increasing body mass index (BMI). Comparison of genes expression levels in healthy and diabetic participants in each group showed a significant difference (P<0.0001), but no meaningful difference was indicated between diabetic infertile and fertile groups in terms of gene expression. INSR gene expression levels showed an increase in the fertile group in the second 10 weeks and a decrease in IRS-1 gene expression. But in the infertile group, both genes showed a slight increase in expression. Conclusion: It seems a decreased expression of insulin signaling pathway genes in the endometrial tissue of infertile women can be one of reasons for unspecified abortion. These genes may be strong molecular markers for infertility

299-305

Authors: Zeynab Mohammadi; Seyedmostafa Hosseinianvari; Negin Ghazalian; Masoumeh Fani; Azam sadat Mahmudian; Balal Brazvan; Majid Shokoohi; Seyd-Hosein Abtahi-Evari; Maryam Moghimian

Background: The ovarian Ischemia/reperfusion is one of the gynecological emergency concerns that may lead to the ovary damage and folliculogenesis. The present research aimed to evaluate the impact of the Chrysin (CH) on the ischemia-reperfusion (I/R) injury in the rat model. Materials and Methods: In this experimental research, 48 adult female rats, 8 weeks age and 180-200 g weight, have been categorized into 6 equal groups (n=8) including one sham and 5 ovarian torsion groups (OT+CH groups) that received different treatments. Each group has been treated 30 min before detorsion with gavage of CH or normal saline for 1 week and pregnant mare serum gonadotropin (PMSG) has been injected on the day 5 for initiating folliculogenesis. Finally, bio-chemical, molecular, histopathological, apoptotic and hormonal evaluations were performed. Results: The anti-oxidant enzyme, superoxide dismutase and glutathione peroxidase, ameliorated in the ovarian tissues of the OT+CH groups in comparison with the OT group (P<0.001). Moreover, the level of serum Luteinizing hormone considerably declined and estradiol level (P<0.001), partly enhanced in the rats treated with CH in comparison with the ones in the OT group (P<0.05). In addition, histopathological scores of the OT+CH groups ameliorated in comparison with the OT group scores (P<0.05). Furthermore, the expression Caspase-3 and Bax genes were significantly increased while the expression of Bcl-2 was notably decreased in the OT group in comparison with the sham group (P<0.05). Conclusion: Here, it seems that CH is possibly beneficial for the protection of ovaries against reperfusion injury and ischemia.

310-319

Authors: Mehran Nouri; Nooshin Abdollahi; Kimia Leilami; Mahsa Shirani

Background: Infertility is a major clinical problem that affects people psychologically and medically. For the past 40 years, studies have linked nearly 50% of childlessness to male infertility. It is worth noting that unlike other factors contributing to infertility, diet is a tunable factor and can be applied in counseling infertile men. The goal of this study was to determine the relationship between plant diet index (PDI) and semen parameters in Iranian infertile men. Materials and Methods: In this cross-sectional study, dietary intake was determined by a valid 168-item questionnaire (FFQ). In this study, four dependent semen parameters, including total sperm motility (TSM), sperm concentration (SC), normal sperm morphology (NSM), and semen volume (SV) were measured. Results: Results of this study stated that greater adherence to the healthful plant-based diet index (hPDI), can significantly increase sperm density and motility in men, as well as greater adherence to the PDI dietary pattern is related to a lower risk of sperm volume deficiency, and ultimately more adherence to the unhealthful plant-based diet index (uPDI), can reduce the risk of sperm motility. Conclusion: In this study, for the first time, the relationship between PDI, hPDI, uPDI and male infertility was evaluated. Altogether, this study demonstrated that nutrition has an impact on semen quality and fertility of men.

132-139

Authors: Maryam Jazayeri; Alireza Alizadeh; Mohammadali Sadighi; Poopak Eftekhari-Yazdi; Mohsen Sharafi; Abdolhossein Shahverdi

Infertility is a complex multifactorial problem that affects about 7% of men and 15% of couples worldwide. Many molecular mechanisms involved in male infertility. Destructive effects of infertility on the next generations are not well understood. Approximately 60-75% of male infertility cases have idiopathic causes, and there is a need for additional investigations other than routine examinations. Molecular factors that surround DNA, which are mitotically stable and independently regulate genome activity of DNA sequences, are known as epigenetics. The known epigenetic mechanisms are DNA methylation, histone modifications and non-coding RNAs. Prevalence of metabolic diseases has been increased dramatically because of changes in lifestyle and the current levels of inactivity. Metabolic disorders, such as obesity and diabetes, are prevalent reasons for male infertility; despite the association between metabolic diseases and male infertility, few studies have been conducted on the effects of epigenetic alterations associated with these diseases and sperm abnormalities. Diabetes can affect the reproductive system and testicular function at multiple levels; however, there are very few molecular and epigenetic studies related to sperm from males with diabetes. On the other hand, obesity has similar conditions, while male obesity is linked to notable alterations in the sperm molecular architecture affecting both function and embryo quality. Therefore, in this review article, we presented new and developed technologies to study different patterns of epigenetic changes, and explained the exact mechanisms of epigenetic changes linked to metabolic diseases and their relationship with male infertility.

152-155

Authors: Fattaneh Pahlavan; Fatemeh Niknejad; Hesamoddin Sajadi; Ahmad Vosough

Background: We aim to determine the prevalence of renal anomalies in patients with congenital vas deferens agenesis referred for infertility assessment. Materials and Methods: This cross-sectional study was carried out on eligible infertile men from 2016 to 2019. Infertile men who were suspected of obstructive azoospermia were referred to the Ultrasound ward and they were examined by abdominal ultrasound for detecting the genital and kidney anomalies. An informed consent form was filled out by patients. Data was entered into SPSS software 21. Patients were divided into two groups in terms of congenital bilateral absence of vas deferens (CBAVD) or congenital unilateral absence of the vas deferens (CUAVD). Using the Chi-square test kidney anomalies between groups were compared. The P<0.05 was considered significant. Results: The mean age of participants was 33.05 ± 6.35. The frequency of CBAVD was 66 and the frequency of left side VD and right side VD were 23 and 21, respectively. The percentage of other comorbidities was calculated. Out of 110 cases, 12 (11%) men had coexistence of vas deferens and kidney agenesis. Other studies are in agreement with our findings. Although the percentage of CBAVD and CUAVD were 9.1% and 1.8% respectively, the difference was not significant (P=0.07). Conclusion: Considering the fact that kidney agenesis is a remarkable congenital anomaly that coexists with the majority of vas deferens agenesis cases and could not be detected by routine laboratory tests or transrectal ultrasound examination, it should be ruled out with transabdominal ultrasound examination after detection of vas deferens agenesis.

162-166

Authors: Soheila Ansaripour; Nayereh Tamizi; Mohammad Reza Sadeghi; Azam Mohammad-Akbari

Background: Few studies have so far been done about the role of follicle stimulating hormone (FSH) in final oocyte maturation. However, none of these studies have been performed solely on normoresponder patients. This study aimed to determine whether oocyte maturation, as well as fertilization and pregnancy rates, could be improved in normoresponder women with concomitant FSH and human chorionic gonadotropin (hCG) trigger compared to those with the hCG trigger alone. Materials and Methods: In this prospective randomized clinical trial, 117 normoresponder women, aged 19-40 years who were candidates for the gonadotropin-releasing hormone (GnRH) antagonist protocol at Avicenna Infertility treatment Center, were enrolled and claasified in two groups. Final oocyte maturation was triggered using 10000 IU of hCG plus 450 IU of FSH in the first group (59 subjects) and 10000 IU of hCG alone in the second group (58 subjects). The primary outcome was clinical pregnancy rate. Results: Mean age of the patients was 33.21 ± 4.41 years. There was no difference in clinical pregnancy among the two groups (30.9% vs. 25.5%, P=0.525). There was no statistically significant difference in fertilization rate (80.0% vs. 74.1%, P=0.106), implantation rates (18.9% vs. 16.7%, P=0.352), and chemical pregnancy rates (38.2% vs. 32.7%, P=0.550). Oocyte maturation rate (84.2% vs. 73.6%, P<0.001), 2 pronuclei (2PNs) (6.53 ± 2.54 vs. 5.36 ± 2.85, P=0.021) and total embryos (5.85 ± 2.43 vs. 4.91 ± 2.58, P=0.046) were significantly higher in the first group. Conclusion: Adding FSH to hCG for oocyte triggering, significantly improved oocyte maturation rates and total embryos. While there was no significant difference in the clinical and chemical pregnancy rates, between these two groups (registration number: IRCT20190108042285N1).

172-179

Authors: Azam Kouhkan; Roya Hosseini; Hamid Reza Baradaran; Arezoo Arabipoor; Rezvan Cheraghi; Ashraf Moini; Farideh Malekzadeh; Mohammad Khamseh

Background: This study aimed to determine the prevalence of postpartum metabolic syndrome (MetS), glucose intolerance, and the determinants, 6-12 weeks postpartum in women with assisted reproduction technology conception gestational diabetes mellitus diagnosis (ART-GDM) compared to women with spontaneous conception and GDM diagnosis (SC-GDM). Materials and Methods: In this prospective cohort study, two groups consisting of 62 ART-GDM and 64 SC-GDM singleton pregnant women were followed 6-12 weeks after delivery for postpartum MetS. Fasting glucose, 75-g 2-h OGTT, and lipid profile were assessed. Waist and hip circumference, and systolic and diastolic blood pressures (BP) were measured at postpartum. Clinical, paraclinical, and obstetric data were recorded from registry offices. The prevalence of MetS and glucose intolerance were determined. Predictors of MetS and glucose intolerance were evaluated by logistic regression. Results: The prevalence of postpartum MetS was 20.8% in ART-GDM women and 10.9% in SC-GDM (P=0.123). Mean postpartum BMI and systolic BP were significantly higher in the ART-GDM group (P=0.016 and P=0.027 respectively). Adverse pregnancy outcomes were significantly higher in the ART-GDM group. Postpartum glucose intolerance prevalence did not vary significantly between the groups. Family history of diabetes was a predictive factor for postpartum MetS and glucose intolerance 6-12 weeks after delivery. Conclusion: Early postpartum MetS and glucose intolerance prevalence after assisted conception did not vary significantly; however, postpartum body mass index (BMI) and systolic BP were significantly higher in the ART-GDM group. Lifestyle modification programs and long-term health care of ART women with GDM diagnosis can be recommended. Further studies with larger sample size and longer follow-up are necessary to verify our findings.

184-191

Authors: Zahra Kokabiyan; Parichehreh Yaghmaei; Seyed Behnamedin Jameie; Zahra Hajebrahimi

Background: Polycystic ovary syndrome (PCOS) is a common type of endocrinopathy in women which is accompanied by androgens elevation, insulin resistance, and metabolic dysfunction. Eugenol is a phenolic component of clove oil that has an antioxidant, anti-inflammatory, and anti-diabetic activity. The present study aimed to evaluate the therapeutic effects of eugenol on the PCOS models of rats. Materials and Methods: In this experimental study, thirty adults female Wistar rats weighing between 180 and 200 g were used. Estradiol valerate-induced PCOS rats (4 mg/rat) were treated with eugenol (12 and 24 mg/kg) for 28 days. The effects of eugenol were studied on levels of glucose, lipid profile, liver enzymes, reproductive hormones, oxidative stress, and the expression of cyclooxygenase-2 (Cox-2) and peroxisome proliferator-activated receptor alpha (Ppar-α) genes, using biochemical analysis of blood and histopathological evaluation of ovaries. Results: Estradiol valerate-induced PCOS resulted in the formation of cystic follicles in the ovaries, hyperinsulinemia, hyperglycemia, hyperlipidemia, hyperandrogenism, and anovulation. It altered the Cox-2 and Ppar-α gene expression and increased oxidative stress and activities of liver enzymes. Eugenol treatment improved the PCOS-associated endocrine and metabolic disorder and histopathological alterations, mostly through antioxidant, anti-diabetic, anti-hyperlipidemic, and anti-androgenic properties. It showed beneficial effects on serum glucose, serum insulin, fat profile, reproductive hormones, liver activity, oxidative stress, expression of Cox-2 and Ppar-α genes, as well as restoration of normal ovulation in the PCOS animals. Conclusion: Eugenol could represent a promising natural product to prevent PCOS or reduce its symptoms.

200-205

Authors: Nargeskhatoon Shoaibinobarian; Ghazaleh Eslamian; Morvarid Noormohammadi; Shirin Malek; Shayesteh Rouhani; Seyedeh Nooshan Mirmohammadali

Background: Among multiple factors that affect the etiology of polycystic ovary syndrome (PCOS), diet has an important contribution. Chronic oxidative stress has also been implicated in the development of PCOS. The present study is an attempt to evaluate dietary total antioxidant capacity (TAC) and its relationship with odds of PCOS in Iran. Materials and Methods: The study was carried out as a case-control study in hospital outpatient clinics, Tehran, Iran. Totally, 310 female participants with a history of PCOS and 602 age-matched controls took part in this study between June 2015 and December 2018. A reproducible and valid 168-item semi-quantitative food frequency inventory was utilized to determine the entire antioxidants of the usual diet in order to calculate dietary TAC. The relationship of dietary TAC with odds of PCOS were assessed adjusting for potential confounders through an estimation of two multivariable conditional regression models. The first tertile was presented as a reference category. Results: In a fully adjusted model, the highest tertile of dietary TAC was associated with a reduced odds of PCOS [odds ratio (OR): 0.81, 95% confidence interval (95% CI): 0.59, 0.96, P for trend: 0.038). In addition, PCOS odds decreased in the highest tertile of α-tocopherol intake (OR: 0.73, 95% CI: 0.56, 0.88, P for trend: 0.023). The adjusted ORs in the highest tertile of vitamin C, β-carotene and magnesium were 0.79 (95% CI: 0.83-0.97), 0.81 (95% CI: 0.67-0.98) and 0.91 (95% CI: 0.55-0.9 8) respectively, with a significant trend. Conclusion: Our results provide evidence that there was a relationship between high TAC diets and lower odds of PCOS.

211-219

Authors: Zahra Basirat; Farzan Kheirkhah; Mahbobeh Faramarzi; Sedigheh Esmaeilzadeh; sorraya khafri; Zahra Tajali

Background: Recurrent pregnancy loss (RPL) and infertility are associated with significant psychiatric complications. The study aimed to investigate the effectiveness of cognitive behavioral therapy (CBT) and sertraline in the treatment of in depression, anxiety, and infertility stress of depressed infertile women with RPL in comparison with usual care. Materials and Methods: A triple-arm randomized controlled trial was carried out on the 60 depressed infertile women with RPL, a population of Infertility Center of Babol city, Iran, who were randomly assigned into three groups: pharmacotherapy with sertraline (n=20), psychotherapy with CBT (n=20), and a usual care as control group (n=20). The participants of psychotherapy received CBT sessions (90 minutes each) over 10 weeks. The participants in the pharmacotherapy group took 50 mg/day sertraline daily for 22 weeks. Outcomes were assessed using the Beck Depression Inventory (BDI-II), fertility problem inventory (FPI), and State-Trait Anxiety Inventory Form Y (STAI-Y) at the beginning of the trial, 10-weeks post-trial, and three months of follow-up. Using statistical package for the social sciences (SPSS) software, data were analyzed. Results: CBT considerably reduced the depression symptoms more than sertraline with a moderate effect size at the post-trial (g=0.11, 95% CI: -0.03 to -0.50). Sertraline showed reduced the scores of state-anxiety more considerably in comparison with control group by a large effect size of post-trial (g=-1.04, 95% CI: -1.70 to -0.38). CBT reduced the total scores of FPI more considerably than sertraline, with a large, small size at follow up-trial [95% CI=-0.03(-0.65, -0.58)]. Both CBT and sertraline were superior to the control group in reducing depression and infertility stress. Conclusion: Depression and infertility stress diminished under CBT and sertraline in depressed infertile women with RPL, with a significant advantage of CBT. Sertraline was superior to CBT in reduction of anxiety (registration number: IRCT201304045931N3).

224-229

Authors: Hajar Adib-Rad; Farzan Kheirkhah; Mahbobeh Faramarzi; Shabnam Omidvar; Zahra Basirat; Mahmoud Haji Ahmadi

Background: Primary dysmenorrhea is the usual medical status in medical students that are defined as pain during the menstrual period. This study was done to evaluate the psychological problems associated with dysmenorrhea. Materials and Methods: Three hundred forty students aged 18 to 20 years participated in this cross‑sectional study (194 with dysmenorrhea and 150 without dysmenorrhea). In this cross‑sectional study, data were collected through the sociodemographic checklist, the verbal multidimensional scoring system (VMS), and the revised version of the Symptom Checklist-90 (SCL-90-R) questionnaire using the convenience sampling method. This questionnaire includes 9 Subscale and a GSI index. We considered psychological distress to be equivalent to the Global Severity İndex (GSI), which is obtained by dividing 90 questions by 90. The significance level of the tests was considered 0.05. Results: The GSI of the SCL-90 score in the 194 students with dysmenorrhea and 150 students without dysmenorrhea was 1.02 ± 0.42 and 0.34 ± 0.15 respectively (P<0.001). In the group with dysmenorrhea, the severity of dysmenorrhea was significantly associated with a family history of dysmenorrhea and mother's education (P=0.012 and P=0.037, respectively). The strongest predictors of GSI>1 were a family history of dysmenorrhea and mother’s education [odds ratio (OR)=2.33, 95% confidence interval (CI), 1.43-4.15 and OR=0.45, 95% CI, 0.24-0.87, respectively]. Conclusion: According to the result, dysmenorrhea is associated with psychological distress. Psychological interventions and counseling in addition to drug treatment are suggested for treatment of primary dysmenorrhea. Therefore, it is necessary to formulate strategies and health policies to recover psychological issues of menstrual health.

237-243

Authors: Amirsaleh Abdollahi; Iman Naseh; Fatemeh Kalroozi; Mohammad Hassan Kazemi-Galougahi; Maryam Nezamzadeh; Shayan Sabeti Billandi; Mojtaba Yousefi Zoshk

Background: Present study assessed whether Sinopharm, AstraZeneca, Sputnik V, and Covaxin’s vaccinated women reveal a distinct incidence of menstruation disturbances, hirsutism, and metrorrhagia. Materials and Methods: Data collection was performed from June to August 2021, and 427 women working in seven selected hospitals in Tehran were studied in this descriptive-analytical cross-sectional study. All of these women had received one or both doses of the vaccines with one of the assessed vaccines. Required data was collected via questionnaire and imported to SPSS 16 for further assessment and analysis. Fisher’s Exact Test and Chi-Squared test were main statistical tests used to understand whether any significant relation exists or not. Results: The participant’s mean age and body mass index (BMI) were 29.78 ± 10.55 and 23.27 ± 3.82, respectively. Three hundred ninety-five cases (92.4%) had received both doses of the vaccines. Also, 154 cases (36.1%) had a history of COVID-19. A total of 38 cases (8.8%) of menstruation disturbances, 20 cases (4.6%) of metrorrhagia, and 7 cases (1.6%) of hirsutism were reported after receiving the vaccines. There was a significant difference among the vaccinated groups with the vaccines as mentioned earlier in terms of menstruation disturbances (hypermenorrhea, dysmenorrhea, Amenorrhea) (P=0.01). The highest and the lowest incidence of menstruation disturbances were recorded in the group vaccinated with Covaxin (17.6%) and Sputnik V (5%), respectively. There was also no significant difference amongst the vaccinated groups with the four vaccines regarding the incidence of metrorrhagia and hirsutism (P=0.10 and P=0.12, respectively). There was no significant relationship between all three complications incidence with the previous infection concerning all vaccines (coefficient=0.46, 1.27, -0.15 respectively for menstruation disturbances, metrorrhagia, and, hirsutism). Conclusion: Seemingly, Covaxin revealed the most side effects in terms of menstruation disturbances. As a result, professionals must carry out several studies with reasonable samples to recommend the vaccine to those women confidently

247-251

Authors: Sara Khalife; Regina Geitani

Recurrent pregnancy loss (RPL) complication is a challenge of reproductive medicine due to its often unknown etiology. A case-control study was carried out between June 2019 and April 2020 to examine the correlation between RPL and inherited thrombophilia (IT), namely mutations in factor V Leiden (FVL G1691A), prothrombin (FII G20210A), and methylenetetrahydrofolate reductase (MTHFR C677T). A total of 120 Lebanese women with RPL was studied and compared, for the frequency of these mutations, to 100 healthy reproductive Lebanese women. The association between the zygosity status of the three tested mutations, the existence of more than one prothrombotic single nucleotide polymorphisms (SNPs), and the increased risk of RPL were examined using Chi-square or two-tailed fisher exact test, and the student t test. The predictive factors of RPL were analyzed using a multiple logistic regression model. P<0.05 was considered to be statistically significant. Our results showed statistically significant higher frequencies of FVL G1691A and FII G20210A mutations among the cases with RPL compared to the control group. Thus, RPL is associated with FVL G1691A and FII G20210A mutations. These mutations seem to increase the risk of RPL in the Lebanese women. Therefore, we suggest thrombophilia screening and adequate genetic counseling for women with RPL and at high-risk to plan for primary prevention, avoiding thromboembolic or obstetric accidents, and reducing the associated morbidity and mortality among Lebanese women. no

64-69

Authors: Babak Sayad, Zeinab Mohseni Afshar, Feizollah Mansouri, Mehdi Salimi, Ronak Miladi, Somayeh Rahimi, Zohreh Rahimi, Maria Shirvani

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells through angiotensin converting enzyme 2 (ACE2), which expression of its gene increases during pregnancy that is resulted in an enhanced level of the ACE2 enzyme. It might enhance the risk of SARS-CoV-2 infection and its complications in the pregnant women. Although, pregnancy hypertensive disorders and severe infection with SARS-CoV-2 are correlated with high comorbidity, these two entities should be discriminated from each other. Also, there is a concern about the risk of preeclampsia and consequently severe coronavirus disease 2019 (COVID-19) development in the pregnant women. So, to answer these questions, in the present review the literature was surveyed. It seems there is higher severity of COVID-19 among pregnant women than non-pregnant women and more adverse pregnancy outcomes among pregnant women infected with SARS-CoV-2. In addition, an association between COVID-19 with preeclampsia and the role of preeclampsia and gestational hypertension as risk factors for SARS-CoV-2 infection and its complications is suggested. However, infection of the placenta and the SARS-CoV-2 vertical transmission is rare. Various mechanisms could explain the role of COVID-19 in the risk of preeclampsia and association between preeclampsia and COVID-19. Suggested mechanisms are included decreased ACE2 activity and imbalance between Ang II and Ang-(1-7) in preeclampsia, association of both of severe forms of COVID-19 and pregnancy hypertensive disorders with comorbidity, and interaction between immune system, inflammatory cytokines and the renin angiotensin aldosterone system and its contribution to the hypertension pathogenesis. It is concluded that preeclampsia and gestational hypertension might be risk factors for SARS-CoV-2 infection and its complications.

76-84

Authors: Radin Dabbagh Rezaeiyeh, Arian Mehrara, Amin Mohammad Ali Pour, Jafar Fallahi, Sedighe Forouhari

A woman who is infertile is defined as a woman who is unable to conceive after having unprotected sex for more than one year. 20-25% of couples worldwide suffer from infertility each year (60 to 80 million couples). In vitro fertilization (IVF) plays a significant role in the treatment of various types of infertility, including fallopian tube defects, endometriosis, immunity, and male causes. IVF is a complex procedure that can be used to aid fertility or prevent genetic problems in the fetus. The objective of this review is to investigate factors that affect IVF failure and success rates. Need for this review is predicated on the different results obtained from previous studies, the high prevalence of infertility, and the lack of a similar study in this field. Articles were regarded as suitable if they evaluated the association between any factor and IVF outcome. A comprehensive search of databases was completed from their inception until March 2021. Our search resulted in 1278 articles. After assessing the titles and abstracts, we selected 70 articles for further reading. Our review shows that the effectiveness of IVF treatment depends on many factors. These include the physical environment, genetics, psychological factors, serum levels of certain hormones, sperm characteristics, as well as the age and body mass index of couples. Based on the results of our study, nutrient supplementation maybe beneficial for the enhancement of semen quality. For better IVF outcome, it is better for obese women to balance their body mass index (BMI) before IVF procedure initiation.

90-94

Authors: Nazli Navali, Leila Sadeghi, Laya Farzadi, Aliyeh Ghasemzadeh, Kobra Hamdi, Parvin Hakimi, Behrouz Niknafs

Background: Advanced age is associated with a decline in the natural oocytes, low oocyte yield, and also increases the assisted reproductive technology (ART) failure rate, and consequently resulted in a pregnancy rate decrease. Platelet-rich plasma (PRP) is one of the proposed therapeutic strategies for women with poor ovarian response (POR). Because of the autologous source of PRP, the lowest risks of disease transmission, immunogenic and allergic reactions have been expected. This study aimed to evaluate the single-dose intraovarian injection of autologous PRP in poor ovarian reserve. Materials and Methods: We conducted a clinical trial study in the Al-Zahra hospital and Milad Infertility Clinic, Tabriz, Iran (April and May, 2021). A total of thirty-five women with a POR and mean age 40.68 ± 0.34 enrolled in this study. After injection of autologous PRP into the ovaries, the number of oocytes, antral follicles, and level of estradiol, anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteal hormone (LH), FSH/LH ratio also were evaluated while, these parameters were evaluated before PRP administration. Results: At the 2-month follow-up, women treated with PRP showed a significant elevation in the number of oocytes (3.68 ± 0.24, P=0.0043) and embryos (3.17 ± 0.14, P=0.0001), as well as in the estradiol levels (404.1 ± 16.76 vs. 237.7 ± 13.14, P=0.0003). Conclusion: Single PRP injection is effective and might be a promising therapeutic approach in the patients with POR to conceive with their own oocytes, although further evidence is required to assess the influence of PRP on the live birth rate.

102-107

Authors: Sima Janati, Mohammad Amin Behmanesh, Hosein Najafzadehvarzi, Aziz Kassani, Nasim Athari, Seyedeh Mahsa Poormoosavi

Background: Hyperhomocysteinemia plays an important role in the anovulation in infertile women suffering from polycystic ovary syndrome (PCOS). However, long-term metformin therapy elevated homocysteine (Hcy) concentration in these individuals. Inositol increases serum insulin levels and improves ovulation. The aim of this study was to compare the effect of metformin and inofolic on the level of serum Hcy and oxidative markers in the infertile patients with PCOS. Materials and Methods: Eighty PCOS infertile women undergoing in vitro fertilization in the Umm-al-Banin clinical center, Dezful, Iran from December 2018 to September 2019 were invited to participate in this double blind randomized clinical trial. They were divided into two groups; group A who received metformin (1000 mg twice/day) and folic acid (400 μg /day) and group B who used inofolic (inositol+ olic acid 200 μg twice/day) for 3 months. Results: The mean Hcy levels increased significantly by metformin (P=0.02), but not by inofolic. There was a decrease in the total antioxidant capacity (TAC) after metformin administration (P=0.01). In both groups, a significant increase in folic acid levels was observed after treatment (P=0.04). Also, no significant change in vitamin B12 and malondialdehyde levels was observed in both groups (P=0.08). Conclusion: These findings indicate an increase in the serum Hcy levels as well as a remarkable decrease in TAC following metformin treatment. Given the rise in blood Hcy in PCOS patients, inofolic and other medications containing inositol can be prescribed instead of metformin (registration number: IRCT20190508043516N1).

115-121

Authors: Maryam Homayouni-Meymandi, Fattah Sotoodehnejadnematalahi, Mohammad Hossein Nasr-Esfahani

Background: Today, vitamin D deficiency (VDD) is one of the major health issues around the world and VDD is associated with several diseases. This study was conducted to find the relationship between vitamin D status in male’s serum with sperm function and clinical outcomes in infertile men candidate for intracytoplasmic sperm injection (ICSI). Materials and Methods: In this cohort study, different parameters of male fertility such as sperm parameters, oxidative stress, and sperm chromatin status were evaluated in sperm samples of 30 infertile couples candidate for ICSI. Clinical outcomes like fertilization, embryo quality, and implantation were also assessed. Data were analyzed using SPSS Statistics 25.0 software. Besides, assessment of the correlation between aforementioned parameters with the level of serum vitamin D, in this study, ICSI candidates were divided into three groups [individuals with sufficient vitamin D levels (>30 ng/ml), insufficient vitamin D levels (between 20-29 ng/ml), and VDD (<20 ng/ml)]. The aforementioned parametesr were also compared between these study groups. Results: Analysis of all the data revealed a significant correlation between the level of vitamin D with sperm concentration (P=0.000, r=0.5), sperm count (P=0.03, r=0.31) and sperm reactive oxygen species (ROS) level (P=0.000, r=-0.77). Moreover, comparing clinical outcomes within study groups showed a significant difference in implantation rate between sufficient and other groups (insufficient and deficient) (P=0.02). Conclusion: Considering the association between sperm concentration and level of ROS with vitamin D and, higher implantation rate in individuals with vitamin D sufficient group compared to other two groups, our data call for vitamin D supplementation as part of male infertility treatment. But considering our sample size, further research is needed to verify these findings.

128-131

Authors: Collin L. Jones, Christopher P. Houk, Ubirajara Barroso, Jr, Peter A. Lee

Current guidelines for gender assignment for all 46,XX congenital adrenal hyperplasia (CAH) continue to be female. This decision is most challenging for individuals with a 46,XX karyotype born with (CAH) having severely masculinized genitalia (Prader 4 or 5). They may be at significant risk for quality of life (QoL) and psychological health. More outcome information currently exists for such individuals assigned male than female. Most available data for those raised females do not indicate the extent of masculinization at birth, so there are minimal outcome data to compare with those raised males. Gender dissatisfaction among those raised females may be related to the degree of prenatal androgen excess in the brain evidenced by external genital masculinization. Also, additional brain maturation after birth, especially during puberty, is impacted by postnatal androgen excess resulting from inadequate androgen suppression. The purpose of this perspective is to suggest that both female and male assignment be considered. Most who have been raised male at birth have positive adult outcomes. This consideration should occur after discussions with full disclosure to the parents. The lack of more outcome data highlights the need for further information. This perspective also suggests that surgery should be deferred whether assigned female or male at least until gender identity is apparent to preserve the potential for male sexual function and prevent irrevocable loss of sensitive erotic tissue. While the gender fluidity is recognized, it is important to consider potential subsequent need for gender reassignment and extent of masculinization, particularly at the time of gender determination.

1-9

Authors: Eisa Tahmasbpour Marzouni, Hanieh Ilkhani, Asghar Beigi Harchegani, Hossein Shafaghatian, Issa Layali, Alireza Shahriary

Recent studies have indicated that epigenetic alterations are critical for normal function and development of spermatozoa during the fertilization process. This review will focus on the latest advances in epigenome profiling of the chromatin modifications during sperm development, as well as the potential roles of epigenetic mechanisms in the context of male infertility. In this review, all data were collected from published studies that considered the effect of epigenetic abnormalities on human spermatogenesis, sperm parameters quality, fertilization process, embryo development and live births. The database PubMed was searched for all experimental and clinical studies using the Keywords “epigenetic modifications”, “male infertility”, “spermatogenesis”, “embryo development” and “reproductive function”. Post-translational modifications of histone, DNA methylations and chromatin remodeling are among the most common forms of epigenetic modifications that regulate all stages of spermatogenesis and fertilization process. Incorrect epigenetic modifications of certain genes involved in the spermatogenesis and sperm maturation may be a main reason of male reproductive disorder and infertility. Most importantly, abnormal patterns of epigenetic modifications or transgenerational phenotypes and miRNAs expression may be transmitted from one generation to the next through assisted reproductive techniques (ART) and cause an increased risk of birth defects, infertility and congenital anomalies in children. Epigenetic modifications must be considered as a one of the main factors of unexplained male infertility etiology. Due to high risk of transmitting incorrect primary imprints to offspring, there is a need for more research into epigenetic alterations in couples who benefit of ART support.

17-22

Authors: Marziyeh Norozi-Hafshejani, Marziyeh Tavalaee, Mohammad Hassan Najafi, Farnaz Shapouri, Maryam Arbabian, Mohammad Hossein Nasr-Esfahani

Background: Implementation of sperm preparation techniques based on cellular and molecular characteristics can improve the clinical outcomes of couples with male factor infertility. These methods attempt to select better sperm compared to classical methods of preparation such as swim-up and density gradient centrifugation (DGC). In this view, the aim of this study was the comparison of clinical outcomes of magnetic-activated cell separation (MACS) followed by DGC or DGC alone in infertile men undergoing intracytoplasmic sperm injection (ICSI). Materials and Methods: For this prospective single parallel blind clinical trial study, 206 infertile couples with male factor infertility and having abnormal sperm morphology higher than 96% were included. 106 and 100 couples were considered for the study (MACS-DGC) and control group (DGC), respectively. Clinical outcomes of ICSI; fertilization, embryo quality, and implantation, pregnancy rates were compared between two groups. Results: Mean of fertilization (80.19 ± 1.88 vs. 75.63 ± 2.06, P=0.1), top embryo quality on the day 3 (30.22 ± 3.59 vs. 17.96 ± 2.9, P=0.009), clinical pregnancy (30.76% vs. 22.22%, P=0.19), and implantation rate (18.12% vs. 10.42%, P=0.04) were higher in the study group compared to the control group. Conclusion: Sperm preparation by MACS followed by DGC in teratozoospermic men could improve the clinical outcomes after ICSI (Registration number: IRCT201610317223N8).

30-35

Authors: Mohammad Khaje Roshanaee, Seyed-Hosein Abtahi-Eivary, Majid Shokoohi, Masoumeh Fani, Azamsadat Mahmoudian, Maryam Moghimian

Background: Minocycline is a widely used bacteriostatic antibiotic with various functions. The aim of this study was to investigate impact of apoptotic genes in ovary of the torsion/detorsion treated rat model by minocycline. Materials and Methods: This experimental study was performed in 32 female Wistar rats classified in four groups, including: i. sham, ii. TD: torsion/detorsion group received normal saline, iii. TDM: torsion/detorsion group treated with 40 mg/kg Minocycline, and iv. MC: healthy group received 40 mg/kg Minocycline. After treatment period (7 days), histoplogical parameters, oxidative stress markers and hormone profile of serum as well as the expression of Bax and Bcl-2 genes were measured in the ovary of rats. Results: Levels of superoxide dismutase (SOD), glutathione peroxidase (GPX) and estrogen were decreased in the TD group and significantly increased in the treated groups (P=0.001). Levels of malondialdehyde (MDA) and testosterone were increased in the TD group and decreased in the treated groups (P=0.001). Expression level of Bax was elevated in the TD group, while it was attenuated in the treated groups (P=0.001). Expression level of Bcl-2 was significantly increased in treated groups (P=0.001). Conclusion: Minocycline can repair oxidative damage in ovarian tissue and regulate apoptotic-related gene expressions.

42-48

Authors: Parisa Mostafaei, Firouzeh Ghaffari, Zahra Zolfaghari, Samira Vesali

Background: The aim of our study was to detect the rate of unexplained total fertilization failure (TFF) after intracytoplasmic sperm injection (ICSI) and identify its risk factors and retreatment prognosis. Materials and Methods: In this retrospective case-control study, we searched the computerized database of the Royan Institute (Tehran, Iran) from March 2015 to March 2019 and retrieved all cases diagnosed with TFF after ICSI. TFF cases that did not have any recognized risk factors were classified as unexplained (subgroup A). Cases with recognized risk factors were classified as subgroup B. The control group was randomly selected from infertile couples who underwent ICSI cycles with fertilization of at least one oocyte during the same time interval. Characteristics and treatment outcomes of the cases with unexplained TFF (subgroup A) were compared to the control group, and to the other TFF cases (subgroup B). Results: Out of 18,750 couples who underwent ICSI cycles, 296 (1.58%) experienced TFF for the first time. Of these, 49 (16.5%) couples were diagnosed as unexplained TFF (subgroup A) and 247 (83.5%) were placed in subgroup B, TFF with expected risk factors. Multivariable logistic regression analysis showed that the total number of mature oocytes (P<0.001), duration of infertility (P=0.043), and women’s body mass index (BMI, P<0.001) were significant predictive factors for unexplained TFF. In the ICSI cycle after TFF, clinical pregnancy and live birth rates in subgroup A were higher than subgroup B. Although differences between these groups were not statistically significant (P=0.14 and P=0.07, respectively), this finding could be clinically important. Conclusion: Unexplained TFF following ICSI is a rare event significantly related to a lower number of mature oocytes, longer duration of infertility and higher female BMI. It has a good prognosis in retreatment cycles in comparison with expected TFF cases. Clinicians should take this into consideration for patient counseling and management.

55-59

Authors: Smriti Dharuman, Supraja Ajith Kumar, Subbusamy Kanakasabapathy Balaji, Usha Vishwanath, Royapuram Parthasarathy Parameshwari, Muthukumar Santhanakrishnan

Polycystic ovary syndrome (PCOS) is a common condition with a multifactorial aetiology. Chronic periodontitis (CP) is an immunoinflammatory disease that is linked to PCOS via the excessive production of reactive oxygen species (ROS), which leads to an imbalance in the antioxidant system. However, limited studies have evaluated the relationship between these diseases. The current study aims to evaluate the levels of advanced oxidation protein products (AOPP) in patients with periodontitis and PCOS. Four groups, each consisting of 12 patients, with both PCOS and CP (PCOSCP), systemically healthy women with CP, periodontally healthy women with PCOS (PCOSPH), and periodontally and systemically healthy women (PH) were included in the study. Clinical parameters such as clinical attachment loss, bleeding on probing (BOP), and periodontal inflamed surface area (PISA) index were noted. AOPP were evaluated in the saliva and serum samples by spectrophotometric detection. Salivary and serum AOPP levels were highest in the PCOSCP group (75.16 ± 7.50 μmol/l, 97.92 ± 6.50 μmol/l, respectively). Statistical significance (P<0.05) was noted between the salivary AOPP levels of the PCOSCP group and PCOS group. PISA was greatest in the PCOSCP group (1338.40 ± 285.96 mm2) followed by the PCOS group (680.33 ± 79.49 mm2), which showed the impact of PCOS on gingival inflammation. According to the results of this study, increased levels of advanced oxidative protein products appeared to show the effect of CP on worsening PCOS.