International Journal of Fertility and Sterility

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