International Journal of Fertility and Sterility

224-231

Authors: Daniel M.Campagne

Background: Women in particular suffer from psychological stress when diagnosed with infertility. Psychosocial interventions are known to not only prevent and lessen various mental problems, but also to play a positive role in physical health and pregnancy rates. The aim of this study is to determine the unique impact of spiritual psychotherapy on concerns about infertility and their perceived psychological stresses. Materials and Methods: This study was a randomized clinical trial. The study population included nearly 800 infertile couples who attended the Maternity and Gynecology Clinic of Jahrom University of Medical Sciences, Jahrom, Iran. We enrolled65 people who were randomly divided into two groups, experimental (n=33)and control (n=32). The experimental group received spiritual group psychotherapy counseling for 12 sessions, 2 hours per week for a 3 months period. The control group did not receive any intervention, but due to ethical considerations, we gave a presentation (one session) about infertility treatment for this group after the research process was completed. We used two questionnaires to obtain data, the Penn State Worry Questionnaire (PSWQ) and Perceived Stress Scale (PSS). Data analysis was done by descriptive and analytic statistics using SPSS 16 software. Results: Psychological intervention in the treatment group significantly decreased the PSWQ (p=0.004). There were significant differences in the mean score of the PSWQ in both groups as determined by analysis of covariance (ANCOVA; p=0.009). Psychological intervention in the treatment group decreased the level of perceived stress, when compared with the control group. According to ANCOVA there were significant differences between the mean PSS scores of both groups (p=0.01). Conclusion: Logotherapy is related to stress reduction and can decrease psychiatric symptoms of worry and perceived stress. This approach tends to improve an infertile person's ability to deal with their problem of finding the meaning of life. Thus it can be concluded that logotherapy along with other treatment methods, is a useful approach for infertile couples (Registration Number:IRCT201108247407N2).

232-237

Authors: Firouzeh Ghaffari , Kiandokht Kiani , Akram Bahmanabadi , Mohammadreza Akhoond

Background: The aim of this study was to compare the effects of easy and difficult embryo transfers (ET) on implantation and pregnancy rates. Materials and Methods: In this prospective study, we analyzed the results of 706 ET procedures over a 12-month period. An easy ET was defined as a transfer that occurred without the use of force or other instrumentation. A difficult ET was defined as the use of force for catheter placement, and/or the use of additional instruments, and/or manipulation. Pregnancy rate was compared between patients with easy or difficult ETs. Results: There was a significantly higher implantation rate in the easy group (21.7%) compared to the difficult group (12.1%, p<0.05).The easy group had a higher pregnancy rate (38.1%) compared to patients who had difficult ETs (21.4%; p<0.05). Conclusion: Any uterine manipulation during ET adversely affects in vitro fertilization (IVF). Precaution should be taken to identify possibly difficult ET cases in advance.

244-249

Authors: Fatemeh Pourteymour Fard Tabrizi , Beitollah Alipoor , Mahzad Mehrzad Sadaghiani , Alireza Ostadrahimi , Aida Malek Mahdavi

Background: Metabolic syndrome (MetS) is a clustering of factors known to increase the risk for cardiovascular disease (CVD) and diabetes mellitus. Polycystic ovary syndrome (PCOS), the most common endocrine disorder among reproductive-aged women, is also closely linked to MetS. Limited information is available pertaining to the prevalence of MetS in Iranian PCOS women; therefore this study assesses the frequency of MetS and its components among PCOS women from Tabriz, Iran. Materials and Methods: In this cross-sectional study, we evaluated a total of 200 women with PCOS who referred to the only specialty and subspecialty gynecological center in Northwestern Iran. PCOS was diagnosed according to Rotterdam criteria. This study defined clinical and biochemical parameters for MetS by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Statistical analyses were performed with descriptive-analytical methods using SPSS software version 16. Results: MetS was identified in 39.5% of PCOS women. The frequencies of individual components of MetS among studied subjects were: high-density lipoprotein cholesterol level (HDL-C)<50 mg/ dL (99.5%), waist circumference(WC) ≥88cm (65%), triglycerides (TG) ≥150 mg/dL(98%), and blood pressure≥130/85 mmHg(34%).There were no fasting glucose concentrations≥110 mg/dL. The frequency of MetS increased with body mass index (BMI)as follows: normal (5.4%), overweight (41.5%) and obese (85.7%) women (p<0.0001). Conclusion: The PCOS women in this study had a high frequency of MetS and its individual components, particularly decreased HDL-C and increased triglyceride levels. These data can useful for lifestyle modification programs.

258-265

Authors: Mohammad Ali Ghaffari , Morad Rostami

Background: Spermatozoa are a group of cells that consume adenosine triphosphate (ATP) rapidly. Creatine kinase (CK), produced by creatine phosphate, is an energy reservoir for the rapid buffering and regeneration of ATP and can play an important role in sperm motility. Therefore, this study investigates the effects of cigarette smoking on human sperm CK activity in males who smoke. Materials and Methods: In this case - control study, we obtained semen samples from male smokers (n=64) and nonsmokers (n=83). Smokers were categorized as light, moderate, or heavy smokers according to the daily number of cigarettes smoked and the number of years they have smoked. Data were analyzed by the independent t test and Pearson’s analysis. Results: This investigation showed significantly lower sperm CK activity and movement in male smokers compared to nonsmokers. In addition, it was demonstrated that cigarette smoking had a dose-dependent effect on these parameters. There was a positive relation, although not significant, between sperm CK activity and its motility in male smokers. Conclusion: Smoking, by diminishing sperm CK activity, may potentially impair sperm energy homeostasis and have an association with damage to sperm motility. This effect can be an important mechanism that may cause infertility in male smokers. However, further research is necessary to elucidate the underlying mechanism of sperm motility damage caused by cigarette smoking.

272-277

Authors: Daniela Paes de Almeida Ferreira Braga , Tatiana Carvalho de Souza Bonetti , Ismael Dale Cotrim Guerreiro da Silva , Amanda Souza Setti , Assumpto Iaconelli Jr , Edson Borges Jr

Background: This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles. Materials and Methods: This prospective study performed in a private assisted fertilization center included 1016 follicles collected from 96 patients who underwent intra cytoplasmic sperm injection (ICSI). After follicular aspiration, oocytes were assigned to two groups according to the diameter of the derived follicle. The large follicle group (n=96) comprised oocytes derived from the leading follicle of the cohort and the small follicle group (n=920) consisted oocytes derived from the smaller follicles of the cohort. The fertilization and percentage of topquality embryos were compared between groups by Chi-square or Fisher’s exact test, where appropriate. The effect of the follicular diameter on oocyte dimorphism was assessed by binary logistic regression. Results: A significantly higher percentage of oocytes derived from the leading follicle were in the metaphase II (MII) stage (100 vs. 70.0%, p<0.001). However we observed no significant differences regarding the percentage of degenerated oocytes between the large (6.25%) and small follicle (5.0%) groups (p=0.550). Regression analysis demonstrated a nearly two-fold increase in the incidence of vacuoles in oocytes derived from the largest follicle of the cohort (OR: 1.81, p=0.046). The fertilization rate (50.0 vs. 38.8%, p=0.038) and the percentage of top quality embryos (84.7 vs. 76.4%, p=0.040) were significantly higher for oocytes derived from the largest follicle. However, the percentage of abnormal fertilized oocytes was equally distributed between the large follicle (15.0%) and small follicle (12. 8%) groups (p=0.550). Conclusion: Our data suggest that intrafollicular mechanisms within the larger follicle of the cohort may allow for these follicles to amplify the responsiveness to exogenous gonadotropin, which leads to the formation of more competent oocytes with higher fertilization and developmental capacities.

286-293

Authors: Aygul Akyuz , Memnun Seven , Gonul Şahiner , Bilal Bakır

Background: The aim of this descriptive study was to evaluate the level of marital violence among Turkish women and to determine whether infertility was a risk factor for marital violence. Materials and Methods: This descriptive study was conducted during January-July 2009 at a training hospital. The study groups comprised 204 fertile and 228 infertile women. We administered the Descriptive Information Questionnaire and Scale for Marital Violence against Women (SDVW) to obtain data. Results: There was a statistically significant difference between infertile and fertile women for the total score of violence in marriage. The emotional, economic and sexual violence scores were higher in the infertile group. However, the verbal violence score was lower. Conclusion: We performed a detailed study aimed at uncovering the presence of any violence from the data collection stage to the end of treatment in infertile couples with the intent to include questions to this effect in the care plan.

304-309

Authors: Mohammad Saied Salehi , Mohammad Reza Jafarzadeh Shirazi , Mohammad Javad Zamiri , Farid Pazhoohi , Mohammad Reza Namavar , Ali Niazi , Amin Ramezani , Nader Tanideh , Amin Tamadon , Afsoon Zarei

Kisspeptin and RFamide-related peptide-3 (RFRP-3) are known to affect GnRH/luteinizing hormone (LH) in several species, including the rat. It has been hypothesized that GnRH/LH changes during the rat estrous cycle may result from changes in the expression of KiSS1 and RFRP-3 genes. Therefore, the present study investigates KiSS1 and RFRP-3 gene expression at the transcriptional level in the rat hypothalamus during the estrous cycle. In the present experimental study, 36 adult female Sprague-Dawley rats (3-4 months old) were used to study the expression of KiSS1 and RFRP-3 mRNA in the hypothalamus during the estrous cycle. Four rats were ovariectomized, whereas the remainder were allotted to four different phases of the estrous cycle (n=8 per estrus phase). Rats were decapitated, and the hypothalami were immediately dissected and frozen in liquid nitrogen. Expressions of KiSS1 and RFRP-3 mRNAs were analyzed by real-time PCR. The expression of KiSS1 mRNA during estrus was lower than other phases of the cycle (p<0.01). Expression of KiSS1 mRNA during the metestrus phase was lower than the proestrus phase (p<0.01). The expression of RFRP-3 mRNA during proestrus was lower than the diestrus phase (p<0.01). Results of the present study showed the role of coordinated expression of KiSS1 and RFRP-3 mRNA in the hypothalamus in the control of the rat estrous cycle.