International Journal of Fertility and Sterility

218-225

Authors: Shirin Azizidoost; Mahrokh Abouali Gale Dari; Farhoodeh Ghaedrahmati; Zahra Razani; Mona Keivan; Razieh Mohammad Jafari; Mahin Najafian; Maryam Farzaneh

Recurrent pregnancy loss (RPL) or recurrent miscarriage is the failure of pregnancy before 20-24 weeks that influences around 2-5% of couples. Several genetic, immunological, environmental and physical factors may influence RPL. Although various traditional methods have been used to treat post-implantation failures, identifying the mechanisms underlying RPL may improve an effective treatment. Recent evidence suggested that gene expression alterations presented essential roles in the occurrence of RPL. It has been found that long non-coding RNAs (lncRNAs) play functional roles in pregnancy pathologies, such as recurrent miscarriage. lncRNAs can function as dynamic scaffolds, modulate chromatin function, guide and bind to microRNAs (miRNAs) or transcription factors. lncRNAs, by targeting various miRNAs and mRNAs, play essential roles in the progression or suppression of RPL. Therefore, targeting lncRNAs and their downstream targets might be a suitable strategy for diagnosis and treatment of RPL. In this review, we summarized emerging roles of several lncRNAs in stimulation or suppression of RPL.

231-235

Authors: Salome Maghsudlu; Mohamad Ghazanfari Hashemi; Vahid Talebi; Elham Vahabi; Sanaz Sharifpour; Ramtin Hajibeygi; Farajolah Maleki

Human leukocyte antigen G (HLA-G) levels are among the biomarkers suggested for pre-eclampsia (PE). This study is aimed at determining the possible relationship between low soluble HLA-G (sHLA-G) levels in maternal blood at the beginning of pregnancy and subsequent PE. We searched the international scientific databases of Web of Science, Embase, PubMed, Cochrane, and Scopus. We extracted the studies investigating the relationship between the serum levels of HLA-G in the first trimester of pregnancy and the onset of PE using the appropriate keywords. The collected data were analyzed using the random-effects meta-analysis model and STATA (version 14). A total of 5 studies met the eligibility criteria, and the total sample size was 668 subjects. The mean and SD age of case subjects was 31.41 ± 4.16 years, while it was 30.56 ± 3.5 for control subjects. According to the findings, there was an inverse relationship between HLA-G serum level in the first trimester of pregnancy and the subsequent onset of PE, standard mean difference (SMD)=-1.51 [95% confidence interval (CI): -2.26, -0.75, I2=90.8%, P=0.000]. Based on these results, low sHLA-G level in early pregnancy has a positive correlation with subsequent PE, and the significant role of sHLA-G in the early stages of placentation can be proven.

242-247

Authors: Nadia Noghrehalipour; Reza Aflatoonian; Ali Rahimipour; Samaneh Aghajanpour; Aida Najafian; Zahra Chekini; Firouzeh Ghaffari; Faranak Kazerouni

Background: Ectopic pregnancy (EP) is defined as implantation and development of an embryo outside of the uterine tissue. Women undergoing assisted reproductive technologies (ART), particularly frozen embryo transfer (FET), are in high-risk populations for EP. Mucin1 (MUC1), fibroblast growth factor-2 (FGF2), and Heparin-binding epidermal growth factor (HBEGF) genes are involved in the endometrial receptivity pathway, leading to normal eutopic implantation; Although, their relevance in the tubal pregnancy after FET is unknown. We aimed evaluation of Mucin1, FGF2, and HBEGF expression fold as endometrial receptive markers in the EP patients following the FET cycle. Materials and Methods: A case-control study was conducted on ten patients (five EP patients and five women in the pseudo-pregnancy group, as the control samples). Pseudo-pregnancy group was established in women who were candidates for hysterectomy for benign diseases. Fallopian tube biopsies and corresponding endometrial tissues from these patients were taken during the hysterectomy. However, the fallopian tube and endometrial tissues of EP patients were obtained during salpingectomy. The mRNA expressions of MUC1, FGF2, and HBEGF genes in the fallopian tube and endometrial tissues were measured by real-time polymerase chain reaction (PCR) assay. Results: MUC1 mRNA expression level in the endometrium of the case group was higher than in the control group (P=0.04); however, its mRNA expression in the fallopian samples of the case group in comparison with the control group was significantly decreased (P=0.001). The HBEGF mRNA expression level was not significantly different between the case and control endometrium, whereas its expression was significantly increased in the case fallopian samples compared with the control ones (P=0.001). The same pattern was observed for FGF2 mRNA expression level in the fallopian samples of the case group but was significantly reduced in the endometrial samples in comparison with the control samples (P=0.03). Conclusion: MUC1, FGF2, and HBEGF gene mRNA expression changes may explain the embryo rejection from the uterus and the establishment of a receptive phenotype in fallopian cells.

254-258

Authors: Fira Azzahra; Mulyoto Pangestu; Silvia W Lestari; Gita Pratama

Background: Corona virus disease-19 (COVID-19) pandemic also led to a reduction or even the suspension of elective health services. These decisions affected in vitro fertilization (IVF) programs worldwide. Therefore, it is essential to map the readiness of IVF clinics in providing safety in this situation and in the future. Materials and Methods: This is a retrospective qualitative and quantitative research done in 2021 that involved three IVF clinics of Jakarta, Indonesia. Those three clinics were government-owned, private-owned, and educational and training center. The qualitative data of each clinic’s readiness towards COVID-19 was obtained from interviews with the clinics staff. The quantitative data were collected from the clinics patients’ number and demographic data from 2019-2021 as well as from COVID-19 databases. Both data sets were analysed descriptively and only for the quantitative analysis Stata version 16 was used. Results: There were changes in the domiciles and number of patients attending the three clinics. The ratio of patients from Jakarta increased while patients from outside Java Island decreased. There was a drop in annual patient numbers in 2020. However, from June 2020 to December 2021, the number of monthly IVF cycles increased significantly by 3.5 cycles per month (P=0.001). There was no association between IVF patients’ attendance numbers and COVID-19 cases (P=0.785). One of the clinics had a negative pressure operating theatre, which made them more confident in treating patients with COVID-19 positive and made them even had higher IVF cycles started than the pre-pandemic period. Conclusion: Those three clinics are prepared in facing COVID-19, as they complied with government regulations. As the COVID-19 pandemic progressed, the number of patients gradually returned to normal.

264-267

Authors: Budi Wiweko; Ervan Surya; Vita Silvana; Mila Maidarti; Achmad Kemal Harzif; Gita Pratama; Kanadi Sumapraja; R Muharam; Andon Hestiantoro

Background: In vitro fertilization (IVF) remains a main treatment for infertility cases. Post-injection human chorionic gonadotropin (hCG) level is an essential factor in determining oocyte maturation rate in IVF. This study aimed to determine the relationship between 12 hours post-injection serum hCG level and oocyte maturation rate among IVF participants. Materials and Methods: A cross-sectional study on IVF participants was done at a tertiary hospital in Indonesia from January 2020 to December 2021. Subjects were injected with 250 μg of recombinant-hCG (r-hCG) subcutaneously. Twelve hours post-injection serum hCG levels and oocyte maturation rate data were retrieved and analyzed accordingly. Results: Twenty-eight subjects were recruited into the study. Higher 12 hours post-injection serum hCG was related to oocyte maturation rate (P=0.046). The cut-off point of 12 hours post-injection serum hCG to predict better oocyte maturation rate was 90.15 mIU/mL (sensitivity 68.2%, specificity 83.3%). Oocyte maturation rate may be predicted using body mass index (BMI) and 12 hours post-injection serum hCG. Conclusion: Higher 12 hours post-injection serum hCG was associated with a higher oocyte maturation rate in IVF subjects.

276-280

Authors: Fereshteh Aliakbari; Neda Taghizabet; Fatemeh Rezaei-Tazangi; Hamid Kalantari; Ahmad Vosough Dizaj; Maryam Mohammadi; Hesamoddin Sajadi; Mohammad Ali Sadighi Gilani

Background: This study aimed to evaluate the predicting factors affecting sperm retrieval. We prospectively assessed the relationship between sonographic and microdissection testicular sperm extraction (mTESE) findings in Klinefelter syndrome (KS). Materials and Methods: In this prospective study, 44 azoospermic men with 47, XXY karyotypes participated in this study. In order to evaluate the amount of blood supply in different parts of testicular tissue, a doppler ultra-sonographic was performed. Also, for the detection of sperm in this group mTESE technique was performed. Results: The age average of positive mTESE and negative mTESE groups was 29.4 and 33.6 years, respectively. By comparing the testicle volume (based on the data obtained from the clinical examinations conducted by the urologist) it was determined that there is no significant difference between mTESE positive and negative groups. Folliclestimulating hormone (FSH) levels in men with negative mTESE (P=0.03) and testosterone levels in men with positive mTESE significantly increased (P=0.017). The overall rate of testis vascularity was significantly higher in the positive mTESE group than in the negative mTESE group. The clinical pregnancy rate in positive mTESE men was 9% per cycle, 16.6% per embryos were transferred (ET), and 12.5% per cycle. Conclusion: Totally, our observation indicated that there is not a significant relationship between sonographic and mTESE results in KS patients. However, more investigations with bigger sample Size can be useful to validate our results.

287-291

Authors: Shiva Roshankhah; Neda Barani; Mohammad Reza Salahshoor; Leila Rezakhani; Mozafar Khazaei

Background: Sperm chromatin abnormalities are defects in nuclear maturation and DNA integrity. These defects originated from defective spermatogenesis due to a lack of DNA repair during chromatin remodeling. Changes in semen elements can cause damage to chromatin. There is little information about the relationship between changes in trace metal elements and total antioxidant capacity (TAC) with sperm chromatin damage. The present study was conducted to determine the relationship between Selenium (Se), Iron (Fe), Zinc (Zn), Copper (Cu) and the TAC of semen with the status of human sperm chromatin. Materials and Methods: In this experimental study, semen samples (n=30) were collected from healthy men referred to Kermanshah Motazadi Hospital and stored in liquid nitrogen; after thawing and centrifugation, sperm were separated. The atomic absorption method was used to measure the concentration of metal elements. The TAC was evaluated using the ferric-reducing antioxidant capacity of the plasma method. Furthermore, the integrity of sperm chromatin was measured using the sperm DNA fragmentation (SDF) method. Results: The status of sperm chromatin had a non-significant correlation with body mass index (BMI, P=0.25, r=0.21) and a non-significant negative correlation with sperm count (P=0.71, r=-0.71) and motility (P=0.75, r=0.61). In addition, there was no significant relationship between sperm chromatin and the TAC of semen (P=0.92, r=0.01). Additionally, there was no significant correlation between Se, Zn, or Cu concentration (P>0.05) and Fe concentration, which had a partially positive relationship with the chromatin state of sperm (P=0.24, r=0.20). Conclusion: The trace metal elements in the seminal fluid did not play a significant role in the status of sperm chromatin.

299-305

Authors: Farideh Malekzadeh; Maryam Mohammadi; Behnaz Navid; Ashraf Moini; Reza Omani-Samani

Background: One of the most common endocrine disorders of reproductive age women is polycystic ovary syndrome (PCOS). Women with PCOS are at risk for infertility, endometrial cancer, metabolic disorders, and cardiovascular disease. Awareness of the signs and symptoms of PCOS can be effective in diagnosing early stage PCOS and promoting quality of life (QoL). This study assesses the awareness of PCOS in schoolgirls and their mothers. Materials and Methods: This cross-sectional study was carried out on 1580 high school girls and 480 of their mothers in Tehran (capital of Iran) in 2017 and 2018. We used the stratified sampling method and divided Tehran into five geographic regions: north, south, east, west, and central. Schools were randomly selected from each of these regions. Students and their mothers separately answered a self-administered questionnaire that pertained to their knowledge of PCOS. Statistical analyses were carried out with SPSS, version 22 (Inc. Chicago, IL, USA) and R version 3.2.1. Results: Students had an average age of 16.97 ± 0.84 years and their mothers’ average age was 45.19 ± 5.03 years. The average body mass index (BMI) of the students was 22.01 ± 5.54 kg/m2. The results of this study showed that only 48 students (3.2%) and 148 mothers (27%) had acceptable knowledge about PCOS. The knowledge of students about PCOS was positively related to their mothers’ knowledge about PCOS (P<0.001). Conclusion: The level of PCOS awareness in Iranian women is insufficient and this may affect their QoL. Therefore, the health authorities should implement educational programs to challenge women’s incorrect beliefs about PCOS and increase their awareness of this disease.

152-159

Authors: Atefeh Yas; Elaheh Mansouri Ghezelhesari; Elnaz Iranifard; Ali Taghipour; Malihe Mahmoudinia; Robab Latifnejad Roudsari

Infertility due to the male factor is one of the major problems of infertile couples. One of the factors contributing to male infertility could be the herpes simplex virus (HSV). The aim of this systematic review was to evaluate the impact of HSV on semen parameters. This systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Different English and Persian databases including Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, ProQuest as well as SID, Magiran and Iranmedex were searched by two researchers, independently, without time limit until April 15, 2022. Observational studies that reported the relationship between HSV and semen parameters in men with idiopathic infertility were included in this review. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment of the included studies. Out of 356 retrieved articles, 12 observational studies comprising a total of 1460 patients were reviewed. Four studies examined the effect of HSV1 virus, two studies examined the effect of HSV2 virus and five studies examined the effect of both viruses on semen parameters. Seven studies reported at least one significant association between HSV infection and semen parameters. Sperm count and sperm motility were semen parameters further affected by the virus. In conclusion, HSV can be one of the risk factors for male infertility and it can affect semen parameters. However, due to the dearth of studies, further research with more robust designs are recommended.

174-180

Authors: Shiva Shafierizi; Seddigheh Esmaelzadeh; Faezeh Ghofrani; Hemmat Gholinia; Mahbobeh Faramarzi

Background: Infertility is a stressful condition that can lead to either emotional disturbance or personal growth. Marital relationship is one of the factors affecting the consequences of infertility. This study aimed to explore the role of marital relationship quality in development of women's personal growth after experiencing infertility. Materials and Methods: In the cross-sectional study, 122 infertile women (mean age 28.79 ± 6.3) were invited to complete the survey, including ENRICH Marital Satisfaction Scale, Posttraumatic Growth, Fertility problem inventory, State-Trait Anxiety Inventory, and Beck Inventory Depression. Results: Higher scores of quality of marital relationships were a protective factor against infertility stress and state/ trait anxiety. Additionally, infertility stress was a strong negative predictor of personal growth. Furthermore, infertile women with a high level of marital relationships may have more chances to experience personal growth rather than stress in infertility treatments. Conclusion: The study suggests that high quality of marital relationships may provide positive opportunities for women’s personal growth after experiencing infertility.

187-194

Authors: Malihe Soltani; Maryam Moghimian; Seyd-Hosein Abtahi-Evari; Seyed-Alireza Esmaeili; Ramin Mahdipour; Majid Shokoohi

Background: This study aimed to determine whether syzygium aromaticum (clove) could help polycystic ovary syndrome (PCOS) rats. Materials and Methods: In this experimental study, forty adult female Wistar rats (weighing 250 ± 10 g) were divided randomly into five groups; G1: control, G2: PCOS group, G3: PCOS+clove (30 mg/kg/ orally/daily) group, G4: PCOS+clove (60 mg/kg/orally/daily) group, and G5: PCOS+gonadectomy group. The PCOS was induced by a single dose injection of estradiol valerate (16 mg/kg/IM). Following PCOS induction, the rats were treated for 14 days. Histological parameters, follicle apoptosis, mRNA expression of autophagy markers (Lc3, Beclin1), oxidative stress markers, insulin and blood glucose levels, as well as serum levels of aromatase and testosterone were evaluated in these rats. Finally, the ratio of serum luteinizing hormone (LH) to follicle-stimulating hormone (FSH) levels was also calculated. Results: The autophagy markers (Lc3, Beclin1), histological parameters, oxidative stress, insulin, and hormone levels changed significantly in the PCOS rats (G2). In G3 and G5 groups, it was observed that the levels of LH/FSH and testosterone decreased significantly in comparison to the PCOS group, and inhibition of autophagy was also observed in these groups. Treatment with cloves in the G3 group significantly improved oxidative stress, histological parameters, and insulin levels. Conclusion: These findings demonstrated that oxidative stress, apoptosis, and excessive autophagy could be improved by treatment with low doses of clove and gonadectomy. Cloves may help to improve these parameters by regulating and inhibiting excessive autophagy. However, discovering the direct role of this extract in regulating the parameters such as oxidative stress, insulin, and androgens requires further investigation. In the present study, P<0.05 was considered statistically significant.

201-207

Authors: Ali Mohammad Falahati; Soghra Fallahi; Zeinab Allamehzadeh; Maliheh Izadi Raieni; Kianoosh Malekzadeh

Background: Accumulating evidences suggest that date palm pollen (DPP) induces antioxidant activity and improves semen parameters in male rats. However, there is a few scientific evidences in support of the DPP effects on human male fertility. Hence, the effect of oral consumption of DPP on sperm parameters and expression pattern of Peroxiredoxin- 1 (PRDX1) and Peroxiredoxin-6 (PRDX6) genes was evaluated in men with infertility. Materials and Methods: The current controlled clinical trial included 40 men with infertility (DPP group) and 10 normospermic fertile men as controls. The DPP group received gelatinous capsules of DPP (400 mg/kg) for 74 days. Semen sampling was done before and after treatment in the both groups. Semen analysis and 8-isoprostane concentration assessments were performed by computer-assisted sperm analysis and ELISA methods, respectively. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) assays were employed to explore expression of PRDX1 and PRDX6 genes. Results: DPP consumption significantly improved semen volume (P=0.030), count (P<0.001) and morphology of sperm (P=0.023). Concentration of 8-isoprostane was significantly decreased after intervention in the DPP group (P<0.001). DPP consumption led to a significant elevation in the expression of PRDX1 and PRDX6 genes (P<0.001). Elevated gene expression of PRDX6 and PRDX1 was positively correlated with improved parameters of sperm including count, volume, motility and morphology. Conclusion: Taken together, DPP seems to promote sperm quality through a decrease in reactive oxygen species (ROS) by increasing expression of antioxidant genes. Further large-scale studies are required to challenge this hypothesis (registration number: IRCT2015021221014N2)

215-217

Authors: Mohamamdreza Zamanian; Hesam Sajadi; Masoomeh Tahsili; Parnaz Borjian Boroujeni; Navid Almadani

Ring chromosomes are the result of breakage and re-union of distal ends of chromosomal arms. They have a general frequency of 1 in 50,000 and 1 in 58,000 for chromosome 13. Ring chromosome 13 is usually presented as a syndromic situation stigmatized by particular features, including developmental delay, mental retardation and CNS, skeletal or organ anomalies. As an experimental study, here we report a 31 years old male with no major phenotypic manifestation who was evaluated for azoospermia, while his karyotype revealed presence of a mosaic ring chromosome 13. He had a history of bilateral varicocelectomy and no other major finding in his routine infertility work up was determined. Genetic counseling did not provide any clue for mental disability or dysmorphic features. Pathology examination of the testicular tissue revealed very scarce number of spermatid/spermatozoa within the tubules in conjunction with degrees of maturation arrest mostly in spermatocyte stage. In our knowledge, this is the first report of a ring chromosome 13, manifested by an isolated male infertility.

85-91

Authors: Kresna Mutia; Budi Wiweko; Abinawanto Abinawanto; Astari Dwiranti; Anom Bowolaksono

Embryo selection for in vitro fertilization (IVF) is an effort to increase the success rate of embryo implantation. Factors influencing the success of embryo implantation include embryo quality, endometrial receptivity, embryo characteristics, and maternal interactions. Some molecules have been found to influence these factors, but their regulatory mechanisms are unclear. MicroRNAs (miRNAs) are reported to play an essential role in the embryo implantation process. miRNAs are small non-coding RNAs consisting of only 20 nucleotides that play an essential role in the stability of gene expression regulation. Previous studies have reported that miRNAs have many roles and are released by cells into the extracellular environment for intracellular communication. In addition, miRNAs can provide information related to physiological and pathological conditions. These findings encourage research development in determining the quality of embryos in IVF to increase the implantation success rate. Moreover, miRNAs can provide an overview of embryo-maternal communication and potentially be noninvasive biological markers of embryo quality, which could increase assessment accuracy while reducing mechanical damage to the embryo itself. This review article summarizes the involvement of extracellular miRNAs and the potential applications of miRNAs in IVF.

99-106

Authors: Tayebeh Gharakhani Bahar; Seyedeh Zahra Masoumi; Shamim Pilehvari; Farideh Kazemi; Shirin Moradkhani; Shokoufeh Mahmoudi

Background: The aim of this study was to investigate the effects of the antioxidant supplement of CoQ10 and placebo in the male infertility treatment. Materials and Methods: The randomized controlled trial study was designed as a clinical trial. Samples in each group consisted of 30 members. The first group received 1 daily dose of 100 mg coenzyme Q10 capsules and the second group received a placebo treatment. Treatment in both groups lasted 12 weeks. Before and after the intervention of semen analysis, hormonal measurement of testosterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and thyroid stimulating hormone (TSH) were done. Sexual function was assessed before and after the intervention by using the International Index of Erectile Dysfunction questionnare. Results: The mean age of participants was 34.07 (5.26) years in the CoQ10 group and 34.83 (6.22) in the placebo one. Normal volume of semen (P=0.10), viscosity (P=0.55), sperm count (P=0.28), and sperm motility (P=0.33) in the CoQ10 group increased without statistically significant differences. But the normal sperm morphology increased with statistically significant differences in the CoQ10 group (P=0.01). There was an increase in normal FSH levels and testosterone levels in the CoQ10 group compared with the placebo patients, but these differences were not statistically significant (respectively P=0.58, P=0.61). The results also revealed that the scores of erectile function (P=0.95), orgasm (P=0.86), satisfaction with sexual intercourse (P=0.61), overall satisfaction (P=0.69) and the score of the International Index of Erectile Function (IIEF, P=0.82) were greater after the intervention in the CoQ10 group than in the placebo group although the difference was not statistically significant. Conclusion: The use of CoQ10 supplement can improve sperm morphology; however, in other sperm parameters and also in some hormones increased after the intervention, this was not statistically significant and therefore the result is not conclusive (registration number: IRCT20120215009014N322).

115-119

Authors: Khadije Rezaie Keikhaie; Maryam Moshfeghi; Leli Rezaie Kahkhaie; Mahya Eftekhari; Sanaz Ajami; Forough Forghani; Mahdi Afshari

Background: Non-invasive prenatal testing (NIPT), sometimes called noninvasive prenatal screening (NIPS), is a non-invasive prenatal genetic test using cell-free DNA in maternal blood. This method is used to diagnose fetal aneuploidy disorders such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13), which causes disability disorders or significant postpartum defects. The aim of this study was to investigate the relationship between high and low fetal fraction (FF) and prognosis of maternal pregnancy. Materials and Methods: In this prospective study, after obtaining informed consent, 10 ml of blood was collected from 450 mothers with singleton pregnancies with gestational age above 11 weeks (11-16) at the request of NIPT for cell-free DNA BCT test. After obtaining the test results, maternal and embryonic results were evaluated based on the amount of non-cellular DNA FF. Data analysis was performed by using SPSS software version 21 and independent t test, chi-square statistical tests. Results: Based on test results, 20.5% of women were nulli par. The mean FF index in the studied women was 8.3% with a standard deviation of 4.6. The minimum and maximum values were 0 and 27, respectively. The frequency of normal, low and high FFs was 73.2, 17.3 and 9.5%, respectively. Conclusion: High FF has fewer risks to the mother and fetus than low FF. The use of FF level (high or low) can help us determining the prognosis of pregnancy and using it to better manage the pregnancy.

127-132

Authors: Neda Emami; Ashraf Moini; Mohammad Reza Bakhtiarizadeh; Parichehreh Yaghmaei; Maryam Shahhoseini; Alireza Alizadeh

Background: The qualitative analysis of adipose tissue (AT) is an exciting area for research and clinical applications in several diseases and it is emerging along with the quantitative approach to research on overweight and obese people. While the importance of steroid metabolism in women with polycystic ovary syndrome (PCOS) has been reported, limited data exists on the effective roles of AT in pregnant women suffering from PCOS. The aim of this study was to determine association of fatty acid (FA) profiles with expression of 14 steroid genes in abdominal subcutaneous AT of PCOS vs. non-PCOS pregnant women. Materials and Methods: In this case-control study, the AT samples of 36 non-PCOS pregnant women and 12 pregnant women with PCOS (3:1 ratio control: case) who underwent cesarean section were collected. Relationship of expressing gene targets and different features were performed using Pearson correlation analysis on the R 3.6.2 software. The ggplot2 package in R tool was used to draw the plots. Results: Age (31.4 and 31.5 years, P=0.99), body mass index (BMI) (prior pregnancy 26 and 26.5 kg.m-2, P=0.62) and at delivery day (30.1 and 31, P=0.94), gestational period (264 and 267 days, P=0.70) and parity (1.4 and 1.4, P=0.42) of non-PCOS and PCOS pregnant women were similar. Expression of steroidogenic acute regulator (STAR) and 11β-Hydroxysteroid dehydrogenase (11BHSD2) in non-PCOS pregnant women showed the highest association with eicosapentaenoic acid (EPA, C20:5 n-3, r=0.59, P=0.001) and (r=0.66, P=0.001), respectively. In the all participants, STAR mRNA level showed the greatest association with the EPA fatty acid concentration (P=0.001, r=0.51). Conclusion: Our results showed a link between the genes involved in steroid metabolism and fatty acids in AT of pregnant women, especially for omega-3 FA and the gene involved in the first step of steroidogenesis in subcutaneous AT. These findings warrant further studies.

140-144

Authors: Seyed Mohsen Miresmaeili; Farzaneh Fesahat; Negar Kazemi; Hossein Ansariniya; Fateme Zare

Background: Despite of long-lasting efforts, in more than 50% of cases, the etiology of recurrent spontaneous abortion (RSA) remains unknown. Leukemia inhibitory factor (LIF) has an essential role in the reproductive process, such as modulating inflammatory responses. This study aimed to evaluate the relationship between the LIF gene expression as well as serum levels of inflammatory cytokines and occurrence of RSA in infertile women with a history of RSA. Materials and Methods: In this case-control study, the relative gene expression levels of LIF, concentrations of tumor necrosis factor-alpha (TNF-α), and interleukin (IL)-17 were measured in peripheral blood and serum of women with a history of RSA (N=40) compared with non-pregnant and fertile women as the control group (N=40) using quantitative real-time polymerase chain reaction and the enzyme-linked immunosorbent assay, respectively. Results: The mean age of patients and controls was 30.1 ± 4.28 and 30.03 ± 4.23, respectively. Patients had a history of at least 2 and at most 6 abortions. The mRNA levels of LIF were significantly lower in the women with RSA in comparison with the healthy participant (P=0.003). Regarding cytokine levels, no significant difference was seen between the two groups (P≥0.05). There was no correlation - between the LIF mRNA levels and TNF-α and IL-17 serum concentrations. The U-Mann-Whitney test and the Pearson correlation coefficient were applied to comparison variables between groups as well as a correlation between LIF mRNA and cytokine levels in serum. Conclusion: Despite a significant reduction in the LIF gene mRNA level in patients with RSA, it was not associated with increases in inflammatory cytokines. Dysfunction in the production of LIF protein may be involved in the onset of RSA disorder.

151-151

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

In this article published in Int J Fertil Steril, Vol 16, No 2, April-June 2022, Pages: 90-94, the authors found that this sentence “Also, AMH level was not statistically significantly different after PRP treatment (0.38 ± 0.039) in comparison with before of treatment (0.39 ± 0.04, Fig.1C)” was incorrect. The corrected one is “Also, AMH level was not significantly different before PRP treatment (0.38 ± 0.039) in comparison with after of treatment (0.39 ± 0.04, Fig.1C)” in the first paragraph of the result section. The authors would like to apologies for any inconvenience caused.

1-6

Authors: Sanaz Mollazadeh; Khadijeh Mirzaii Najmabadi; Mojgan Mirghafourvand; Robab Latifnejad Roudsari

Up to now, limited studies have been done to evaluate the effect of sexual activity during menstruation on the endometriosis. However, due to the menstrual-related symptoms of endometriosis, this study aimed to systematically review the published articles on the association between sexual activity through menstruation and endometriosis. This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). This study examined all published observational studies on the association between sexual activity during menstruation and endometriosis, on the basis of the PICOS from conception until September 2021. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of the articles. Also, Meta-analysis was conducted using Review Manager (RevMan 5.3). Out of the 1,905 retrieved articles of related databases, four studies comprised a total of 3641 patients (2251 cases and 1390 controls), which fulfilled the inclusion criteria, and equally encompassed high (2/4) and low (2/4) methodological quality, were reviewed. The results of all pooled studies showed that the probability of having sexual activity during menstruation is approximately two times higher in the women with endometriosis compared to women without endometriosis [odds ratio (OR)=1.80, 95% confidence interval (CI): 1.12 to 2.90, P=0.02, I2=78%, Tau=0.17, Chi2=13.72, P=0.003]. In this review, the sexual activity during menstruation was found to be an influencing factor for endometriosis. Due to the importance and complexity of endometriosis and the dearth of evidence on this topic, further studies with more robust designs are recommended.

12-21

Authors: Farzaneh Soltani; Rafat Bakht; Mansoureh Refaei; Laya Hemmati; Soodabeh Aghababaei

Background: It seems pandemics may have a notable potential adverse effect on the pregnant women. The important biological COVID-19 aspect of the pregnancy has been led to the neglect of its psychological aspect of the pregnant women, especially COVID-19 affected. The present qualitative study aims to explore the experiences of Iranian pregnant women who were recovered from the COVID-19 pandemics. Materials and Methods: This qualitative study designed based on a semi-structured interview with 9 pregnant women who had developed COVID-19 during pregnancy and had recovered. Results: Data analysis revealed five themes including: anxiety and helplessness, stigma, confront disease, apprehension in the heart of desire, and seeking calmness. Rrecovered pregnant women from COVID-19 spoke of their mixed feelings; being happy with their survival and that of their fetus, despite getting the disease, along with anxiety and fear of the future, which had resulted in the continuation of pregnancy in the limbo of ambiguity and expectation. Recovered pregnant women during unknown pandemics, despite being saved from disease, continue to tolerate concerns about their unborn child. Conclusion: Recovered pregnant women during unknown pandemics, despite being saved from disease, continue to tolerate concerns about their fetus. Therefore, they require comprehensive and complete management approaches that require familiarity with the psychological challenges of this group of patients.

28-33

Authors: Raden Muharam; Ririn Rahmala Febri; Kresna Mutia; Pritta Ameilia Iffanolida; Mila Maidarti; Budi Wiweko; Andon Hestiantoro

Background: Endometriosis is identified as presence of the endometrium outside the uterine cavity. Retrograde menstruation contributes to the endometrial tissue implantation and the establishment of endometriotic lesions at ectopic sites. It has been suggested that the endometriotic lesions are rich in angiogenic growth factors, while they have an essential role in survival and invasion of these cells. We investigated regulation of microRNA-93 (miR-93) and its involvement with vascular endothelial growth factor A (VEGFA) and matrix metalloproteinase (MMP) 3 expression in women with endometriosis. Materials and Methods: This was a cross-sectional study at Central Surgical Installation, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, between October 2020 and November 2021. Eutopic and ectopic endometrial tissues were collected from 30 subjects with laparoscopically-confirmed endometriotic women. Normal endometrial cells of non-endometriosis women served as controls. Total RNA was isolated from all samples and a quantitative reverse-transcription polymerase chain reaction (qRT-PCR) was used to analyze the expression of miR-93, VEGFA and MMP3. Results: There was no significant difference in the expression levels of VEGFA (2.14 ± 0.50, P=0.719) and MMP3 (2.99 ± 0.42, P=0.583) between endometriotic lesions of endometriosis women and the healthy endometrium. Expression of miR-93 was significantly lower in the eutopic endometrium (16.7 fold) and ectopic endometriotic lesion (20 fold) compared to the normal endometrium (P<0.001). Furthermore, we also observed a significant correlation between miR-93 and VEGFA expression in eutopic endometrium obtained from women with endometriosis (r=-0.544, P=0.029). Expression of the miR-93 was also negatively correlated with MMP3 expression in both eutopic (r=-0.412, P=0.01) and ectopic (r=-0.539, P=0.03) endometrial cells of women with endometriosis. Conclusion: VEGFA and MMP3 expression levels trended to be increased in both eutopic and ectopic endometrial tissues of endometriosis women, while down-regulation of miR-93 might be involved in the alteration of VEGFA and MMP3 in endometriosis.

40-46

Authors: Clara Q. Wu; Molly Campbell; Doron Shmorgun; Samantha Torrance; Jenna Gale; Marie-Claude Leveille

Background: Past studies have shown that culturing slow-growing embryos from day 5 to day 6 may increase vitrification yield. This study aims to evaluate if the proportion of embryos eligible for vitrification increases by growing embryos not vitrified by day 5 to day 6. Materials and Methods: In this retrospective cohort study, a Canadian tertiary-care clinic-based cohort was identified between August 2019 and December 2020. In vitro fertilization (IVF) cycles involving autologous oocytes with at least one viable day 5 embryo were selected for inclusion. We compared embryo developmental outcomes of IVF cycles performed before and after an embryo cryopreservation policy change. Prior to March 2020, good-quality day 5 blastocysts of any stage were eligible for vitrification, and after that date, good-quality expanded blastocysts on either day 5 or day 6 were eligible. The primary outcome is the comparative proportion of embryos eligible for vitrification. The secondary outcome is to identify embryo, maternal and cycle factors that are predictive of day 6 vitrification. Results: A total of 3,438 viable embryos across 679 consecutive IVF cycles were included in this study. After the policy change, we found similar mean proportions of blastocysts eligible for cryopreservation (46.9% per IVF cycle in group 2 vs. 44.4% in group 1, mean difference 0.025, 95% confidence interval -0.021 to 0.071, P=0.28). The mean number of cryopreserved embryos were significantly higher in group 2 (mean 2.2 vs. 1.7 embryos, P=0.007). Factors that predicated an embryo’s progression to day 6 included: younger age of egg provider, presence of an early blastocyst on day 5, and cycles involving surgically-retrieved sperm. Conclusion: A cryopreservation policy change to include good-quality full and expanded day 6 blastocysts while avoiding to vitrify early blastocysts on day 5 yielded comparable proportions of embryos eligible for vitrification per IVF cycle.

52-56

Authors: Mahboobeh Shirazi; Mehnoosh Torkzaban; Margan Ghaemi; Maryam Moshfeghi; Mahmood Shirazi; Maryam Emadzadeh; Lida Ahmadi; Zahra Khazaeipoor; Sara Mirzaeian

Background: Fetal exposure to maternal anxiety is associated with low birth weight and maternal stress may be led to constriction of uterine arteries. This study compared the relation of anxiety and uterine artery doppler flow indices in pregnant women with the high and low-risk of Down syndrome. Materials and Methods: This prospective cohort study was conducted among pregnant women in the second trimester that were classified as having a high or low risk according to their prenatal aneuploidy screening outcome. The high risk group underwent amniocentesis. Anxiety was initially assessed using the Spielberger State-Anxiety Inventory (STAI) and uterine artery blood flow indices were evaluated 2 times for the both groups. For the high-risk group first: immediately before amniocentesis and second: after two weeks follow up, when receiving the karyotype results and for the low-risk group in the first admission and two weeks later. Results: Totally, 375 pregnant women participated in our study that sorted into 2 risk populations based on the aneuploidy screening test, low-risk=176 and high-risk women=199. The high-risk group for Down syndrome amniocentesis showed abnormal results in the 23 cases (23/199). The mean state (P=0.003) and trait (P=0.033) of the Anxiety Inventory scores were significantly different between the groups. Baseline uterine artery indices were no significant difference between the groups. Baseline Uterine artery indices in the high-risk group was significantly different with follow-up (in both positive-amniocentesis and negative amniocentesis sub-groups) indices. Also, there was a weak and significant correlation in the uterine resistance index and STAI scores (P=0.008, r=0.137) during the follow-up period. Conclusion: All pregnant women experienced high level anxiety, especially in the high-risk group that may reduce after confirmation of prenatal aneuploidy screening test and also affects the Doppler indices. For all pregnant women; Stress management and emotional support training is recommended before and during pregnancy.

61-66

Authors: Zohre Nateghian; Mohammad Hossein Nasr-Esfahani; Tahereh Talaei-Khozani; Marziyeh Tavalaee; Elham Aliabadi

Background: In infertility clinics, preserving high-quality spermatozoa for a long time is a necessity. Pentoxifylline (PT) and L-carnitine (LC) are effective in improving sperm motility as well as protecting the sperm membrane. The present study aimed to investigate the protective impacts of PT and LC on the quality of the normal sperm motility, protamine content, and viability on prolonged storage for 12 days at 4-6°C. Materials and Methods: The present experimental work included 26 samples, which were first prepared based on the swim-up technique, of normozoospermic men. They were divided into three aliquots as untreated control, LC-treated, and PT-treated groups and incubated for up to 12 days at 4-6°C. Thereafter, chromatin maturity, sperm viability, and motility were assessed on 0, 1, 2, 5, 7, and 12 days. Data were analyzed using a one-way analysis of variance. Results: The obtained data revealed that PT supplementation increased the percentage of motile spermatozoa in comparison with control and LC-treated specimens. On the other hand, LC supplementation increased the percentage of viable spermatozoa in comparison with the PT-treated and control samples. During the 12-day storage, the percentage of spermatozoa with a normal protamine content was nearly unchanged in the three groups (P>0.05). Conclusion: Although LC supplementation can be considered a better alternative than PT for preserving sperm viability, PT could better preserve sperm motility compared to LC during 12 days at 4-6°C.

75-79

Authors: Ali Hajb; Zeynab Salehpour; Roghayyeh Aghaei; Aida Najafian; Masoumeh Mahmoodi; Masoomeh Latifi; Soghra Fallahi

Background: Nowadays, using medicinal properties is a good alternative for infertility treatment to use them is increasing in the world. The aim of this study was to determine the effects of Herbal oral capsules included palm pollen extract (DPP) and Nigella Sativa extract (NS) on sex hormones in adult infertile men. Materials and Methods: In this a single-blind, placebo-controlled clinical trial study, a total of 62 infertile men between 22 and 42 years of age were randomly selected and tested for sex hormones and prolactin. Thirty people in the case group received two 500 mg/kg capsules on a daily basis containing an herbal composition of palm pollen extract (350 mg) and black seed powder extract (250 mg) and the 20 in the control group received a placebo in the morning and at night for 3 months. The herbal composition capsules were manufactured by the Golbadistan Company. At the end of the three -month period, blood and semen tests were performed before and after the intervention in the case group that was compared with the control group. Hormonal assays were performed by Immunoradiometric Assay (IRMA) method. The data entered SPSS statistical software and the level of significance was set at P≤0.05. Results: The spermiogram test results showed significant changes in the sperm count, progressive motility and rapid progressivity of the case group at the end of a quarterly period after consuming plant composition except for morphology (P=0.001, P=0.001, P=0.02, P=0.23). In addition, in the case group, the concentration of testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH) was significantly increased compared to the control group (P=0.000, P=0.004, P=0.012). Conclusion: It seems that taking one 500 mg/kg capsule of DPP and NS extract can significantly increase sperm parameters and testosterone (registration number: IRCT2015020120895N1).