Asian Pacific Journal of Reproduction

253-260

Authors: Mitasha Singh, Shipra Saini, Pooja Goyal, Ekta Gupta, Shweta Goswami

Objective: To identify the prevalence, determinants of reproductive tract infection, and healthcare seeking behavior among ever married women of reproductive age residing in an urban slum of Faridabad, Haryana, North India. Methods: This community based cross-sectional study was conducted among ever married women aged between 15 and 49 years insured under employees state insurance scheme and residing in an urban slum of Faridabad. Simple random sampling technique was used to interview 149 eligible women using a predesigned structured questionnaire. Study variables included sociodemographic profile, family planning methods, menstrual absorbent usage, and symptoms of reproductive tract infection. Binary logistic regression was used to investigate the determinants of reproductive tract infection. Results: Of the women, 46.3% had at least one reproductive tract infection or sexually transmitted infection symptom and 28.9% among them sought treatment for the symptom. Vaginal discharge, itching (14.1%) and lower abdominal pain (30.2%) were the major symptoms reported. Non-usage of condoms as contraceptive was significantly associated with a higher rate of symptoms (50.4% vs. 20.0%). Abortion had a significantly high odds of having reproductive tract infection symptoms (aOR 3.71, 95% CI 1.59-8.62; P<0.01). Less frequent change in absorbent during menstruation was also reported to have a higher rate of symptoms. The majority of those who took treatment sought it from government or employees state insurance dispensary. 2% also went to faith healers. Conclusions: Nearly half of the study population have reproductive tract infection symptom. Abortions and non-usage of condom increase the risk of reproductive tract infection. Menstrual hygiene and condom usage are the significant interventions, which may reduce the prevalence of these symptoms.

269-275

Authors: Sedighe Valipour, Fatemeh Estebsari, Maliheh Nasiri, Parvaneh Vasli

Objective: To determine the predictive role of stress, self-efficacy, and perceived social support on readiness for discharge in mothers of preterm infants. Methods: The present cross-sectional, descriptive-analytical study was conducted on 120 mothers of preterm infants admitted to hospitals affiliated to Lorestan University of Medical Sciences, Iran in 2019. Participants were selected by a convenience sampling method and based on inclusion criteria. Data collection tools included the demographic questionnaire of mothers and infants, parent perceptions of their child's hospital discharge, parental stressor scale: neonatal intensive care unit, perceived maternal parenting, and multidimensional scale of perceived social support. Data were analyzed using Pearson correlation and stepwise regression at the significance level of 0.05. Results: Infant behavior and appearance, situational belief, and family support achieved the highest mean score from parents' stress, self-efficacy, and perceived social support dimensions, respectively. There was a significant relationship between stress, self-efficacy, and perceived social support with readiness for discharge in mothers of preterm infants (P<0.001). The score of mothers' readiness for discharge decreased by 0.07 per 1-point increase in stress score, and the score of readiness for discharge in mothers of preterm infants rose by 0.35 and 0.43, respectively, for a unit increase in the scores of self-efficacy and perceived social support. Conclusions: Stress, self-efficacy, and perceived social support can be considered as predictors of readiness for discharge in mothers of preterm infants. It is suggested that nurses in neonatal intensive care units provide a better platform for the readiness for discharge in mothers of preterm infants by reducing stressors and increasing maternal self-efficacy and social support.

285-291

Authors: Jibanjyoti Nayak, Anil Kumar Nahak, Purna Chandra Mishra, Dillip Kumar Karna, Chinmoy Mishra, Perumal Ponraj

Objective: To assess the effect of exogenous gonadotropin releasing hormone (GnRH) in libido, scrotal and testicular biometrics, endocrinological and heamatological profiles of Ganjam goat buck during winter and pre-monsoon seasons. Methods: Forty eight healty Ganjam goat bucks of 3-4 years old were equally divided into the control and treatment groups. The control group received distilled water as placebo, while the treatment group received GnRH injection (4 µg Buserelin acetate/mL) once a week for four months. Body weight, scrotal circumference and testicular parameters (testicular volume, testicular weight and testis index), endocrinological profiles [follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone], sex behavioural profiles (libido score, mating ability score, and sex behavioural score) and heamatological profiles (red blood cells, white blood cells, haemoglobin, and packed cell volume) were estimated. Results: The libido, scrotal and testicular biometrics, and endocrinological profiles significantly differed between the control and GnRH-treated bucks within and between the seasons within the two groups (P<0.05). Body weight, scrotal circumference, testicular volume, testicular weight, testis index, FSH, LH, testosterone, libido score, mating ability score, sex behavioural score, red blood cells, haemoglobin and packed cell volume were significantly higher in the GnRH-treated bucks compared to the control bucks in pre-monsoon and winter seasons (P<0.05). Body weight, scrotal circumference, testicular volume, testicular weight, testis index, FSH, LH, testosterone, libido score, mating ability score, sex behavioural score, red blood cell counts (in treatment), and haemoglobin were significantly higher in pre-monsoon compared to winter season in the experimental groups (P<0.05). The white blood cell counts neither differed between seasons nor between the two groups. Conclusions: Exogenous GnRH supplementation and pre- monsoon season have higher beneficial effects in improvement of endocrinological profiles with cascading beneficial effects on scrotal circumference, testicular volume, testicular weight, and sex behavioural profiles, which in turn will improve the sperm production and its cryo-survivability and fertility rate in Ganjam goat.

208-216

Authors: Mohammed M. Laqqan, Maged M. Yassin

Objective: To speculate which of the following parameters: antral follicle count (AFC), anti-Müllerian hormone (AMH), follicle- stimulating hormone (FSH) and age can be used as a predictor of ovarian response to gonadotropin-releasing hormone (GnRH) antagonist stimulation multiple-dose protocol in women under 45 years, and to determine the cutoff value of these parameters and their correlations for predicting low and high ovarian response. Methods: This prospective study included 462 women with the mean age of (29.3±6.5) years. All women were subjected to the GnRH antagonist stimulation multiple-dose protocol. On the second day of the menstrual cycle, ultrasonography was conducted to determine AFC in both ovaries. Peripheral blood samples were collected to evaluate the level of estradiol, FSH, luteinizing hormone, prolactin, thyroid-stimulating hormone, and AMH. The women were divided into three groups: low response (AHH<1 ng/mL, n=173), normal response (AMH=1.0-3.5 ng/mL, n=175), and high response (AMH >3.5 ng/mL, n=114). Results: A significant decrease was found in the age and FSH level in the high response group compared to other groups (P<0.001). Conversely, a significant increase was shown in AMH, estradiol on human chorionic gonadotropin (hCG) day, AFC, mature oocytes, fertilized oocytes, and embryos transferred in the high response group compared to the other two groups (P<0.001). The receiver operating characteristic (ROC) curves demonstrated that AFC and AMH had the highest accuracy, followed by basal FSH level and age in the prediction of low ovarian reserves (P<0.001) with cutoff values of ≤4.50 and ≤0.95 for AFC and AMH, respectively. Moreover, the ROC analysis showed that AFC had the highest accuracy, followed by AMH level and age in the prediction of high ovarian reserves with a cutoff value of ≥14.50, ≥3.63, and ≤27.50 years, respectively (P<0.01). A significant decrease was observed in women's age, estradiol level, and oocyte fertilization rate in pregnant women compared to non-pregnant women (P<0.001). Additionally, significant negative correlations were found between the AFC, the number of mature oocytes, fertilized oocytes, embryos transferred, and the age of pregnant women (P<0.001). Conclusions: AFC and AMH predict low and high ovarian response to GnRH antagonist stimulation multiple-dose protocol in women under 45 years.

223-230

Authors: Mohamed G. Hedia, Amr S. El-Shalofy

Objective: To investigate the effects of a single oxytocin injection on plasma steroid concentrations, testicular blood flow measures (resistive and pulsatility indexes), and testicular echogenicity in Baladi goats. Methods: Twelve Baladi goat bucks were randomly allocated into 2 groups and received an intravenous injection of either 0.7 IU/kg oxytocin or normal saline 0.9%. Venous blood samples were collected, and testicular blood flow Doppler parameters (i.e., peak systolic velocity, end-diastolic velocity, time average maximum velocity, resistive index, and pulsatility index) were assessed for supratesticular arteries in the left and right testes immediately before (0), and at 5, 30, 60, and 120 min after injection. Results: Plasma concentrations of testosterone significantly decreased in the oxytocin group at 60 min post-treatment compared to the control group, whereas plasma concentrations of estradiol-17β were not affected (P>0.05). Both resistive index and pulsatility index declined in the oxytocin group at 60 min post- treatment compared to the control group (P<0.05). Testicular pixel intensity increased at 30 min post-treatment in the oxytocin group compared to the control group (P<0.05). Conclusions: Oxytocin treatment significantly increases testicular blood flow and decreases plasma testosterone concentrations in male Baladi goats.

236-242

Authors: Avijit Kumar Modak, Md Nuronnabi Islam, Asma Khatun, Md Hasanur Alam, Ireen Akter, AKM Ahsan Kabir, Md Abul Hashem, Mohammad Moniruzzaman

Objective: To investigate the effect of L-carnitine on in vitro maturation and subsequent in vitro embryo production of buffalo oocytes. Methods: Cumulus oocyte complexes (COCs) were aspirated from ovaries of slaughtered buffaloes. COCs were classified into good and fair qualities based on morphological observation of numbers and integrity of cumulus cells surrounding the oocyte. Both categories of COCs were placed in in vitro maturation medium with supplementation of different concentrations (0, 0.250, 0.375 or 0.500 mg/mL) of L-carnitine. Oocytes from both qualities were in vitro fertilized and in vitro cultured for 7 days, to examine the developmental competence. Results: Supplementation of L-carnitine to in vitro maturation medium increased the cumulus cell expansion rate of COCs to grade A, and reduced the cumulus cell expansion of COCs to grade B and grade C in both good and fair quality oocytes. Similarly, L-carnitine induced the in vitro meiotic progression of buffalo oocytes to metaphase 栻 in both good and fair quality oocytes. Additionally, L-carnitine reduced the rate of oocyte degeneration in both good and fair quality oocytes. L-carnitine increased the rate of cleaved formation at day 2 and blastocyst formation at day 7 during in vitro culture in both qualities of oocytes. Moreover, a higher rate of blastocyst production was observed in L-carnitine-treated fair quality oocytes, which was higher than the results in the untreated good quality oocytes. Conclusions: L-carnitine enhances meiotic maturation and subsequent embryo development from both good and fair quality buffalo oocytes.

155-157

Authors: Md. Anwer Hossain

Though the global population has been growing for hundreds of years at a rate that increased or decreased with unprecedented booms or busts and consecutive rebounds, the ongoing COVID-19 pandemic has led to population alarmism that might put individual or couples’ rights and choices at stake. This paper draws on historical as well as contemporary shreds of evidence and argues that whether the countries of the world face a COVID-19-induced short-term baby boom or baby bust, the solution lies in prioritizing the reproductive health and rights of all people, and thereby, calls for a global recognition that there is no effective alternative other than upholding the rights and the choices of individuals in shifting fertility rates as per the need of each country.

165-174

Authors: Farida Fitriana, Phoebe Pallotti

Objective: To investigate effect of iron supplementation on the risk of hypertensive disorders in pregnancy in non-anaemic pregnant women. Methods: A literature search was conducted using three categories of terms with its synonyms or related words: "iron", "supplement", “hypertensive disorders in pregnancy” through MEDLINE (OVID), CINAHL, PubMed, Cochrane Library, Scopus, Web of Science, ICTRP, and ClinicalTrials.gov, and manual search of references was used in seven potential resources. The inclusion criteria were randomized control trials (RCTs), published in English, full-text available, having healthy pregnant women without anaemia for study participants, and having hypertensive disorders in pregnancy at the end of pregnancy as the outcome. The risk of bias assessment tool was used for quality appraisal. Meta-analysis was conducted by calculating the fixed and random effects of the odds ratio (OR) for iron supplementation among non-anaemic pregnant women compared with the incidence of hypertensive disorders in pregnancy. The range of the study’s estimation accuracy was reflected by a 95% confidence interval (CI). Results: Four RCTs were included in the meta-analysis. The pooled results showed that iron supplementation possibly had no effect on the incidence of hypertensive disorders in pregnancy (OR 0.93, 95% CI 0.81-1.07; P=0.30), gestational hypertension (OR 1.37, 95% CI 0.69-2.73; P=0.36) as well as on the development of preeclampsia (OR 1.45, 95% CI 0.71-2.97; P=0.31). Conclusions: Iron supplementation has no effect on the incidence of hypertension in non-anaemic pregnant women. In general, there is a lack of evidence for the association between iron supplementation and the incidence of hypertensive disorders in pregnancy among non-anaemic pregnant women, and further studies are needed.

183-192

Authors: Perumal Ponraj, Jai Sunder, Arun Kumar De, Rafeeque Rahman Alyethodi, Purna Chandra Mishra, Sneha Bhowmick, Debasis Bhattacharya

Objective: To measure the seasonal effect on endocrinological profiles and sex behavioural profiles during rainy and dry summer seasons in male Andaman local goat in Andaman and Nicobar Islands, India. Methods: Ten adult male Andaman local goats were selected from the goat breeding farm, ICAR-Central Island Agricultural Research Institute, Port Blair, Andaman and Nicobar Islands, India. Endocrinological profiles such as follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), cortisol and prolactin were analysed with enzyme-linked immunosorbent assay kits. Sex behavioural profiles such as libido score, mating ability score and sex behavioural score were measured during rainy and dry summer seasons in male Andaman local goat. Results: Endocrinological profiles as well as sex behavioural profiles differed significantly between rainy season and dry summer season (P<0.05). The levels of FSH, LH, testosterone, TSH, T3, and T4 were significantly higher in rainy season than in dry summer season whereas cortisol and prolactin were significantly higher in dry summer season than in rainy season (P<0.05). The ratio of T3:T4 was significantly higher in rainy season than in dry summer season. Similarly, libido score, mating ability score and sex behavioural score were significantly higher in rainy season than in dry summer season (P<0.05). Conclusions: Rainy season has significantly higher beneficial effects than summer season on reproduction and artificial breeding programmes in semi-intensive management of goat under the tropical humid island ecosystem in Andaman and Nicobar Islands.

107-116

Authors: Kalaivani Manokaran, Pavithra Bhat, Deepak Nayak, Ravisankar Baskaran, Prabu Paramasivam, Shiek Fareeth Ahmed, Keerthi Priya, Karkala Sreedhara Ranganath Pai, Vignesh Balaji E

Oxidative stress arises from an imbalance between the body’s pro- oxidants and antioxidants. Recently, oxidative stress has been proven a contributing factor to many female reproductive disorders including infertility, preeclampsia, endometriosis and polycystic ovarian syndrome. Herein, we review the mechanistic role of oxidative stress in inducing the most common female reproductive disorders. The current review has also highlighted the protective role of vitamin C, necessary for certain female reproductive hormone secretion by the antral follicle and corpus luteum and also essential for collagen production in ovarian tissue remodeling after ovulation, in alleviating oxidative stress and thus improving female reproductive outcomes.

125-131

Authors: Deepthi Repalle, Saritha K.V., Shilpa Bhandari

Objective: To know whether sperm DNA fragmentation (SDF) affects the clinical outcomes in the cumulative transfers of an intracytoplasmic sperm injection (ICSI) cycle along with blastocyst transfers in couples with normozoospermic males. Methods: The study included 252 couples who underwent their first ICSI cycles along with blastocyst transfer and whose male partner semen samples were normozoospermic according to the World Health Organization 2010 criteria. All the couples were classified into two groups based on the SDF: the low SDF group (SDF≤30%, n=162) and the high SDF group (SDF>30%, n=90). Clinical as well as laboratory outcomes were correlated between the two groups. Sperm DNA fragmentation was assessed on the post-wash semen samples by acridine orange test. The main outcome measures were the live birth rate and miscarriage rate. Results: A significant decrease in the live birth rates was observed in the high SDF group compared to the low SDF group in fresh embryo transfer cycles (P<0.05). However, no significant difference was observed in the clinical outcomes either in the frozen embryo transfer cycles or in the overall cumulative transfer cycles (P>0.05). No significant difference was observed in the laboratory outcomes between the two SDF groups. A remarkable decrease in sperm motility was observed in the high SDF group compared to the low SDF group (P<0.05). Conclusions: Sperm DNA fragmentation does not affect the clinical outcomes in the cumulative transfers of an ICSI cycle along with blastocyst transfers in couples with normozoospermic males.

138-145

Authors: Mazen Alomar

Objective: To investigate antioxidant potential of pentoxifylline on spermatozoa of small ruminants including rams and bucks. Methods: The levels of hydrogen peroxide (H 2 O 2 ) production in ram and buck spermatozoa incubated with 0 (control), 4 and 8 mM of pentoxifylline were measured after 45-min incubation. Then, the motility parameters of ram and buck spermatozoa incubated with 0 (control), 1 mM of H 2 O 2 , 1 mM of H 2 O 2 plus 4 mM of pentoxifylline, and 1 mM of H 2 O 2 plus 8 mM of pentoxifylline were analysed. H 2 O 2 was estimated using a fluorometric assay and spermatozoa motility characteristics were analyzed using computer aided sperm analyzer. Results: Pentoxifylline significantly decreased the levels of H 2 O 2 produced from both ram and buck spermatozoa (P<0.05), and significant lower rates of H 2 O 2 formation were noted when 8 mM of pentoxifylline was added (P<0.05). The values of all sperm motility parameters for the two species significantly decreased after incubation with H 2 O 2 (P<0.05). In contrast, when the spermatozoa were incubated with both H 2 O 2 and two concentrations of pentoxifylline, the motility values rose significantly compared to those incubated with H 2 O 2 alone (P<0.05). For both ram and buck sperm samples, the rapid and static subpopulation motility parameters were the most affected categories by pentoxifylline addition compared to the medium and slow categories. Conclusions: Pentoxifylline possesses an antioxidant capacity proved by its ability of reducing H 2 O 2 levels as well as by increasing motility values of stressed spermatozoa. Therefore, pentoxifylline could be recommended as antioxidant additive for spermatozoa of small ruminants under stress conditions.

62-69

Authors: Md. Rahman Mahfuzur, Md. Rashed Alam, Md Arif Billah

Objective: To examine the determinants of emergency contraceptive pill use in Bangladesh. Methods: Data for this cross-sectional study came from 2017-2018 Bangladesh Demographic and Health Survey. Characteristics of 906 reproductive age women who were potential candidates for using emergency contraceptive pill were analysed in this study. Data were analysed using univariate and multivariate analyses. Stepwise binary logistic regression was employed as multivariate analysis. Results: Only 10.9% candidates were found to ever use emergency contraceptive pill. The odds of using emergency contraceptive pill for women visited by family planning field worker was significantly higher than that for those who were not visited by family planning field worker [odds ratio (OR) 1.94; 95% confidence interval (CI) 1.19–3.17; P=0.008], while the odds of using emergency contraceptive pill for women with high socioeconomic status was higher than that for those with low socioeconomic status (OR 3.10; 95% CI 1.61–5.97; P=0.001). Additionally, having some media access was linked to an increase in the odds of using emergency contraceptive pill (OR 3.01; 95% CI 1.33–6.83; P=0.008). Women empowerment related factors did not show any significant effect on emergency contraceptive pill use. Conclusions: The findings indicate that family planning programme has a great opportunity of playing an important role in increasing emergency contraceptive pill use in Bangladesh by increasing the knowledge and awareness of women about emergency contraceptive pill.

77-83

Authors: Zouhir Djerrou, Houria Benyezzar-Kenana, Zineb Maameri, Louiza Benhamza

Objective: To summarize medicinal plants used in the treatment of couple fertility disorders. Methods: An ethnopharmacological survey was conducted with 30 traditional healers from some localities of Skikda region in eastern Algeria. A standard questionnaire was used in the interview which focused mainly: the treated fertility disorders, the used medicinal plants species, parts used, and preparation methods. The relative frequency of citation and percentages of infertility troubles were calculated and analyzed. Results: The most important treated disorders in men were dysfunction of libido (44.22%), low sperm concentration and motility (25.33%), low semen volume (17.67%) and prostate disorders (5.66%). Women were treated mainly for menstruation disorders (35.32%), breast problems (29.53%) and sexual asthenia (25.82%). The survey identified 28 plant species belonging to 15 families, used by different ethnic groups, particularly women (58.00%), to address different fertility disorders. Three plant families were largely used viz Lamiaceae, Asteraceae, and Apiaceae. In term of relative frequency citation, ten dominated plant species were: Zingiber officinalis L. (0.96), Nigella sativa L. (0.83), Lepidium sativum L. (0.80), Capsicum annuum L. (0.60), Cuminum cyminum L. (0.56), Origanum vulgare L. (0.55), Allium sativum L. (0.50), Petroselinum sativum L. (0.43), Salvia officinalis L. (0.42), and Foeniculum vulgare L. (0.40). A number of investigated plants were scientifically confirmed by phytochemical and pharmacological studies to have one or more significant effects on couple fertility. However, much controversy was found in literature concerning the efficacy of some cited plants. Conclusions: The study highlights the important use of medicinal plants in management of couple infertility in eastern Algeria. More experimental studies are recommended to confirm or to refute these traditional uses and to ascertain the safety of these medicinal plants to consumers.

93-99

Authors: Zeinab Maleki, Abbas Farshad, Jalal Rostamzadeh

Objective: To evaluate antioxidant effects of Scrophularia (S.) striata ethanol extract, trehalose and cysteine added to diluents on cryopreserved goat epididymal sperms. Methods: Motility and standard motion parameters of sperm were assessed by using computer assisted sperm motility analysis system. Sperm viability was evaluated by eosin-nigrosin staining method. Hypo-osmotic swelling test was used to evaluate membrane health. Thiobarbituric acid testing was used to measure malondialdehyde (MDA) concentrations. To assess DNA fragmentation, sperm chromatin dispersion test was used. In Experiment 1, treatments consisting of basal Tris diluent supplemented with 25, 50 or 100 µg/mL of S. striata ethanol extract gave the best concentration to the freezing diluents. Experiment 2 was carried out to compare the best concentration of S. striata ethanol extract (50 µg/mL) resulting from the first experiment with 150 mM trehalose and/or 5 mM cysteine alone or in combination. Results: S. striata ethanol extract (50 µg/mL) significantly increased sperm viability, motility and progressive motility and at the same time decreased MDA concentration and DNA fragmentation compared to other treatments (P<0.05). In addition, all treatment groups resulted in viability, membrane health, total motility, progressive motility, curvilinear velocity, straight- line velocity higher and MDA lower compared to the control group (P<0.05). Acrosome integrity was significantly higher in 50 µg/mL of S. striata ethanol extract combined with cysteine, trehalose, or cysteine+trehalose groups than those in the control, trehalose, cysteine, and 50 µg/mL of S. striata ethanol extract groups (P<0.05). Regarding DNA, extenders supplemented with 50 µg/mL of S. striata ethanol extract, 50 µg/mL of S. striata ethanol extract+trehalose, and 50 µg/mL of S. striata ethanol extract+trehalose+cysteine were superior to other treatments. Conclusions: Adding 50 µg/mL of S. striata ethanol extract alone or in combination with trehalose and cysteine can improve the quality of cryopreserved epididymal sperms of goats.