International Journal of Fertility and Sterility

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).