Asian Pacific Journal of Reproduction

1-2

Authors: Mawiya Sana

In conclusion, even though Pakistan ranking 79th globally on the Inclusive Internet Index 2022, which measures the ability of citizens to use the internet, Pakistan has the strongest performance being affordability and despite there being evidence of technology being proven to be an effective and socially acceptable method of positively influencing reproductive health, the incorporation of telehealth seems to be a great challenge. This is due to the lack of awareness of such programs and insufficient training of healthcare professionals in this area of expertise. Therefore, it is essential to introduce nationwide awareness of online and mobile technologies and lay out rules and regulations to allow virtual practices in improving online sexual and reproductive health.

12-21

Authors: Seyed Sobhan Bahreiny, Mojtaba Aghaei, Mohammad Reza Dabbagh, Hamid Ghorbani, Moslem Javidan,Reza Mohammadpour Fard

Objective: To investigate the relationship between ambient sulfur dioxide (SO 2 ) exposure and semen quality parameters. Methods: A systematic literature search was conducted to identify relevant studies investigating the association between SO 2 exposure and semen quality parameters. This search encompassed the timeframe from January 2000 to May 2023 and included electronic databases such as Web of Science, Google Scholar, PubMed, Cochrane, and Scopus. Pooled effect estimates with 95% confidence intervals (CI) were calculated using percent changes (PC). The meta-analysis included seven studies with 6 711 participants and 15 087 semen samples. Results: The results revealed a significant negative association between ambient SO 2 exposure and certain semen quality parameters. In particular, SO 2 exposure was associated with a significant decrease in progressive motility (PC=0.032; 95% CI: -0.063 to -0.001; P=0.044) and sperm concentration (PC = -0.020; 95% CI: -0.036 to -0.005; P=0.012). However, no statistically significant associations were observed for total sperm count (PC = -0.038; 95% CI: -0.079 to 0.003; P=0.070), seminal fluid volume (PC = -0.009; 95% CI: -0.048 to -0.030; P=0.662) and sperm motility (PC = -0.17; 95% CI: -0.363 to 0.022; P=0.830). In addition, the results of the subgroup analysis revealed specific variables that were associated with the decrease in relevant sperm parameters. Conclusions: This systematic review and meta-analysis provides compelling evidence supporting a consistent negative association between exposure to ambient SO 2 and semen quality parameters.

28-33

Authors: OKUTUCU Gulcan, EVSEN Mehmet S, PEKER Nurullah, YAMAN TUNC Senem, ICEN Mehmet S

Objective: To evaluate the effect of bilateral hypogastric artery ligation (BHGAL) on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage. Methods: Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study. The records of cases were obtained from the hospital database, retrospectively. Maternal demographic data, morbidities or complications associated with BHGAL surgery, any additional haemostatic interventional or surgical procedures, preoperative admission and lowest postoperative haematocrit-hemoglobin values, blood products given, type of anaesthesia, intensive care unit (ICU) and length of hospital stay were recorded. In cases without surgical sterilization, future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation. Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed. Results: Sixty-eight patients with BHGAL surgery history were included in the study. 26 Of 37 cases (70%) that did not undergo surgical sterilization had a desire for pregnancy after the surgery. Six of these cases (23%) were diagnosed with secondary infertility. The fertility rate of these cases was 77%, and subsequent pregnancy was detected in 20 women. A total of 25 pregnancies, including first and second pregnancies, developed, and 15 of these pregnancies resulted in term delivery, six preterm births, one stillbirth, and three abortions. Conclusions: The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems, and this surgery does not seem to adversely affect pregnancy outcomes. This is a tertiary center experience and cohort studies with large patient series are needed.

42-48

Authors: Suherni Susilowati, Imam Mustofa, Tri Wahyu Suparyogi, Adeyinka Oye Akintunde, Djoko Agus Purwanto, Wurlina Wurlina, Suzanita Utama, Sri Mulyati

Objective: To improve the quality of post-thawing Boer buck semen for artificial insemination by adding green tea extract chitosan nanoparticles to skimmed egg yolk diluent, and the proper thawing temperature. Methods: The ejaculate of Boer buck was added to skimmed egg yolk diluent without (the control group) and with adding 1 µg of chitosan nanoparticles of green tea extract per mL of diluent (the treatment group). Then, the diluted semen was filled in French mini straws containing 60×10 6 live sperm per straw, frozen in a standard protocol, and stored as frozen semen at −196 ℃ for a week. Six replicates from each group were diluted for 30 s at 37 ℃ or 39 ℃ sterile water to evaluate the semen quality. Results: Post-thawing (at 37 ℃ or 39 ℃ ) of live sperm, progressive motility, and plasma membrane integrity were lower compared to those of the pre-freezing stage (P<0.05). Thawing at 37 ℃ resulted in no significant difference in live sperm, progressive motility, and plasma membrane between the control group and the treatment group (P>0.05). The live sperm, progressive motility, and plasma membrane of the treatment group in the pre-freezing stage, and post-thawed at 39 ℃ were higher compared to those of the control group (P<0.05). There was no significant difference in malondialdehyde (MDA) concentration, DNA fragmentation, and catalase concentration of thawing at 37 ℃compared to those of 39 ℃ in the same group. The MDA concentration and DNA fragmentation in thawing at 37 ℃ and 39 ℃ of the treatment group were significantly lower than those of the control group (P<0.05). However, the catalase concentration in thawing at 37 ℃ and 39 ℃ of the treatment group was not significantly different than the control group (P>0.05). Conclusions: Higher quality post-thawing Boer buck semen is achieved by adding 1 µg/mL of chitosan nanoparticles of green tea extract to the skimmed egg yolk diluent and thawing at 39 ℃.

201-210

Authors: Cakir Kaya Hacer, Eroglu Onur

Objective: To give a brief overview of the field of epigenetics and the potential predictive power that small non-coding RNA (sncRNA) may hold in relation to improving the treatment and diagnosis of male infertility. Methods: PRISMA-ScR was used as the scoping review guideline for this investigation. All article data here have been accessed from MEDLINE–PubMed, Science Direct, EBSCO, Scopus, Sage Journals, and Google Scholar. The terms "small non coding RNA, male, infertility, miRNA, sperm" were used in the search between 2015 and 2023. Results: The study comprised 35 publications in total. Several sncRNAs, miR-155, miR-16, miR-196, miR-525-3p, miR-891 were found to be effective in regulating the mechanism of spermatozoa processing in the infertility of men. sncRNA can be used as a biomarker of male infertility. Conclusions: sncRNAs can act as biomarkers for the diagnosis of reproductive diseases. Actually, by recognizing sncRNAs and their mechanisms, a new way to treat infertile men would be paved. The functional annotation of sncRNAs in spermatogenesis is still in its infancy but has enormous potential. This is despite the fact that many potential sncRNAs have been found to date with the use of cutting-edge technology and publicly accessible sncRNA annotation tools.

220-228

Authors: Fahad Afzal, Arindam Das

Objective: To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care (ANC) services utilization. Methods: A cross-sectional survey was conducted in rural regions of the Patna district, India. The sample size (n=328) was estimated using Cochran’s formula. Five parameters of the social support system were identified (autonomy, spousal support, family support, social circle support, and government support). The score for each was calculated as a composite score using multiple variables; these served as independent variables. The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria. Results: The regression results showed that four out of five social parameters had a significant effect on ANC behavior. Spousal support was the strongest predictor (standardized regression coefficient β=0.57, OR 1.16, 95% CI 1.08-1.79, P=0.007). Government support was found to be the second strongest predictor (β=0.40, OR 1.49, 95% CI 1.04-2.14, P=0.027), followed by family support (β=0.31, OR 1.36, 95% CI 1.23-2.57, P=0.034) and autonomy (β=0.11, OR 1.32, 95% CI 1.11-2.26, P=0.030). The social circle support was found to be non-significant in predicting ANC behavior (P>0.05). Conclusions: The policymakers could focus on the identified predictors to strengthen and modify the existing policies for left- behind wives of male outmigrants. The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net. One strategy we suggest is to launch an awareness campaign focusing on husbands (male outmigrants) and family members.

239-248

Authors: İrfan Yılmaz, Gaffari Türk, Aslıhan Çakır Cihangiroğlu, Tutku Can Acısu, İbrahim Halil Güngör, Gözde Arkalı, Edanur Güler Ekmen

Objective: To investigate the effect of taxifolin added to rabbit semen on freezing-induced cold-shock damages in spermatozoa. Methods: Semen was collected from six adult New Zealand rabbits once a week by artificial vagina. The collected semen was pooled at 38 ℃ and divided into four equal volumes. They were diluted with 0, 50, 100 and 200 µM taxifolin-containing Tris + egg yolk extender at 38 ℃ and their temperatures were lowered to 4 ℃. Following equilibration, semen drawn into 0.25 mL straws were frozen in an automatic semen freezing device and stored in liquid nitrogen container at -196 ℃. Samples were thawed in 38 ℃ water for 25 s and the analyses of motility, kinematic parameters, morphological deformities, changes in membrane integrity, mitochondrial membrane potential, dead-live ratio, acrosomal damages and as well as oxidative stress analyses were performed in semen. Results: Addition of 50 µM taxifolin significantly improved motility (total, progressive, rapid and static), high mitochondrial membrane potential and the ratios of spermatozoa with acrosomal damage compared to the control group. Compared to the control group, malondialdehyde (MDA) levels in the 50 and 100 µM taxifolin groups were significantly lower, while the MDA level was high and viable spermatozoa ratio was low in the 200 µM taxifolin group. There were no significant differences between the groups in terms of kinematic parameters, morphological deformities, membrane integrity and antioxidant levels. Conclusions: The low dose of taxifolin (50 µM) has a positive effect and the high dose (200 µM) has a negative effect. Therefore, it is concluded that the addition of low-dose (50 µM) taxifolin to the extenders would be a useful additive in reducing cold-shock damage that occurs during freezing of rabbit semen.

147-154

Authors: Andriana K Dewi, Anggi L Wicaksana, Muhammad Lutfi, Agung Dewanto

Objective: To determine the barriers of joining in-vitro fertilization (IVF) programs among infertile couples in developing countries. Methods: This study assessed infertile couples and the barriers or associated factors resulting in delayed decision-making of joining IVF program by searching databases PubMed, ScienceDirect, EBSCO, ClinicalKey, and Cochrane Library from inception until December 31, 2021. Additional search strategies were snowballing literature search and citation tracking. Results: Eleven articles were included in the scoping review. The cost was the greatest barrier of joining IVF program. Limited access and lack of assisted reproductive technology centers, few qualified infertility trained staff, insufficient government support, low priority in government policy, along with sociocultural factors, such as religion and false beliefs or myths were also majorly considered to be associated obstacles. Conclusions: The main barrier associated with IVF program among infertile couples in developing countries is the high cost of the IVF services. KEYWORDS: In vitro fertilization; Assisted reproductive technology; Barrier; Developing countries

162-169

Authors: Tatapudi S V Parvathi Devi, Alka Gahlot, Sangita Sharma, Manisha Choudhary, Ravikant Soni, Meeta Sharma

Objective: To determine whether a single dose of gonadotropin-releasing hormone (GnRH) agonist administered subcutaneously in addition to the regular progesterone supplementation could provide a better luteal support in antagonist protocol fresh embryo transfer cycles. Methods: This prospective, multicentric, cohort study included total 140 women, 70 in each group. Controlled ovarian stimulation was carried out as per fixed GnRH antagonist protocol. The trigger was given with hCG. In vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) was performed and day-3 embryos were transferred. Patients were divided into groups 1 and 2 based on computer generated randomization sheet. Six days following oocyte retrieval, group 1 received 0.2 mg decapeptyl subcutaneously in addition to regular progesterone support while group 2 received progesterone only. Luteal support was given for 14 days to both groups; if pregnancy was confirmed luteal support was continued till 12 weeks of gestation. The clinical pregnancy rate was the primary outcome. The implantation rate, miscarriage rate, live birth delivery rate, and multiple pregnancy rates were the secondary outcomes. Results: A total of 140 patients were analysed, 70 in each group. Clinical pregnancy rates (47.1% vs. 35.7%; P=0.17), implantation rates (23.4% vs. 18.1%, P=0.24), live birth delivery rates (41.4% vs. 27.1%, P=0.08), and multiple pregnancy rates (21.2% vs. 16.0%, P=0.74) were higher in group 1 than in group 2. Group 1 had a lower miscarriage rate than group 2 (5.7% vs. 8.6%; P=0.75). However, these differences were not statistically significant between the two groups. Conclusions: Administration of a single dose of GnRH agonist in addition to regular natural micronized vaginal progesterone as luteal support in GnRH antagonist protocol cycles marginally improves implantation rates, clinical pregnancy rates, and live birth delivery rates. However, more studies with higher sample sizes are needed before any conclusive statements about GnRH agonist as luteal phase support can be made.

182-193

Authors: Wankeu-Nya Modeste, Kengne In è s T, Ateba Benjamin S, Bend Fortune E, Djeumeni Ornela N, Hatho Dominique T, Ngadjui E, Moundipa Paul F, Massoma Dieudonné L , Dongmo Alain B, Watcho Pierre

Objective: To evaluate the effects of three oxidized palm oil diets (OPD) on female rat reproductive function. Methods: Forty-four female Wistar rats presenting five consecutive and regular estrous cycles were divided into 4 groups. The rats were fed with: a standard diet, 70% of standard diet+30% oxidized palm oil diet (OPD1), OPD1+5 g of boiled yolk egg (OPD2) and OPD1+10% sucrose (OPD3) for 125 days, respectively. During the feeding period, morphometric, estrous cycle, sexual behavior, gestation, biochemical and histomorphometric parameters were evaluated. Results: All OPDs significantly increased abdominal circumference, body mass index and Lee index coupled to an irregularity and lengthening of the estrous cycle. They significantly decreased appetite and consumption behaviours, quantic pregnancy index, fertility rate, implantation sites and index, serum progesterone and high-density lipoprotein levels, increased pre-implantation losses, anti-implantation activities, serum estradiol, triglycerides, total and low-density lipoprotein-cholesterol levels, and impaired brain and ovaries oxidative status. Histomorphometric examinations revealed increases in the number of atresic and primary follicles and decreases in secondary, tertiary, Degraaf, total and corpus luteum follicles in ovaries coupled to a neurodegeneration of hypothalamic anteroventral periventricular neurons in the OPD groups compared to the standard diet group. Conclusions: The three OPDs induce obesity and impair the female reproductive function, especially OPD2 and OPD3. These findings contribute to a better understanding of the adverse effects of palm oil bleaching on the reproductive function in female rats, which could be useful in the management of women with obesity-related sexual dysfunction.

97-108

Authors: Oyovwi Mega Obukohwo, Onome Bright Oghenetega, Falajiki Yewande Faith, Emojevwe Victor, Rotu Arientare Rume, Joseph Gregory Uchechukwu, Oyeleke Abiodun Abioye

bjective: To identify the role of protein kinase in male reproduction in animal models and human spermatogenic function. Methods: This study assessed the protein kinase of male reproduction in animal models and human using different reviewed paper indexed in PubMed, Science Direct, EBSCO, Scopus, Cochrane Library, Sage Journals, and Google Scholar. Data were charted based on author, year of publication published between 1893 and 2023, country, purpose, data collection, key findings, and research focus/domain. Results: The MAPK pathway contributed to the growth, maturation, and functionality of male germ cells. We also found out that certain influencing factors categorized into hormonal/non hormonal factors and chemotoxicant, as well as heat stress expressed an inhibitory mechanism on protein kinase, thus affecting spermatogenic functions and maintenance/remodeling of the blood testis barrier, as well as the physiology of the Sertoli cells necessary for nutritional support of spermatogenesis. However, activating protein kinases pathway like the mTOR pathway as well as increased expression of peroxiredoxin-4 and L-carnitine mediated protein kinases may be useful for treating or managing male reproductive dysfunction. Conclusions: Protein kinase plays an important role in spermatogenic functions and blood testis remodeling in animal and human. Its assessment provides essential information that can guide treatment strategies aimed at improving male reproductive potential. Taken together, these recent advances highlight a future therapeutic intervention in assessing male reproductive potential. It might also be possible to look at potential targets for male contraceptives in the MAPK pathway.

117-123

Authors: Garg Megha, Sharma Aditi, Choudhary Manjusha , Kaur Prabhjeet

Objective: To evaluate the antifertility activity of hydroalcoholic extract of Delonix regia (Boj. ex Hook.) Raf. leaves and seeds which are traditionally being used by Yanadi tribe to treat dysmenorrhea. Methods: Three experimental animal models, including anti- implantation, early abortifacient, and estrogenic activity in female rats, were used for evaluation of the antifertility activity of both extracts at two dose levels (250 and 500 mg/kg, orally). There were five groups in the anti-implantation and early abortifacient activity while six groups in estrogenic activity including the standard. The number of implants, resorptions, vaginal cornification, body weight, uterus weight, and biochemical parameters were measured. Results: At doses 250 and 500 mg/kg, the leaf extract was found to have strong anti-implantation action. The extract administered at the same doses also caused a significant rise in the number of resorptions, showing early abortifacient activity, increased uterine weight, and altered numerous biochemical parameters. Meanwhile, the seed extract only displayed slight anti-implantation activity at both levels. Conclusions: Based on these preliminary findings, we can conclude that the leaf extract outperformed the seed extract in terms of antifertility activity, exhibiting potent estrogenic, anti-implantation and early abortifacient activities in a dose-dependent manner. These findings are consistent with the literature study and corroborate to the antifertility activity of the plant.

131-143

Authors: S. S. Ramteke, J. S. Rajoriya, A. M. Shende, S. K. Ghosh, J. K. Prasad, P. Peruma

Objective: To optimize the concentration of PDC-109 protein in semen for higher cryopreservability and fertility by sequestration or neutralization of PDC-109 by its antibodies (anti-PDC-109 antibodies) in bubaline species. Methods: PDC-109 protein was purified by applying two-step chromatography procedures. Purified protein was injected in rabbits to raise antibodies. These raised anti-PDC-109 antibodies were used in neutralization or sequestration of PDC-109 in in-vitro model. Ejaculates were collected from buffaloes and splited for four groups. Group 1 received egg yolk Tris glycerol extender, without anti-PDC-109 antibodies, while group 2 to 4 received anti-PDC-109 antibodies 266 µg/mL, 80 µg/mL, and 26 µg/mL in Tris-fructose- citrate buffer, respectively. Semen quality parameters viz., forward progressive motility, viability, total morphological abnormality, acrosomal integrity, plasma membrane integrity, cryoinjury and in- vitro zona binding index were evaluated. Results: Semen quality parameters of neat semen were within the normal range of bubaline species. Sperm motility, livability, acrosomal integrity, plasma membrane integrity, and cholesterol content of sperm were decreased and total sperm abnormality was increased significantly in post-thaw semen compared to those in pre-freeze and fresh semen (P<0.05). Semen in group 2 had higher sperm motility, livability, acrosomal integrity, plasma membrane integrity, and cholesterol content of sperm and lower total sperm abnormality significantly compared to those in group 1, 3 and 4 at pre-freeze and post-thaw stages (P<0.05). Conclusions: Sequestration or neutralization of PDC-109 by its antibodies significantly improves pre-freeze, and post-thaw semen quality parameters and in-vitro zona binding index with simultaneously reducing cryoinjury or cryodamage in the sperm of bubaline species.

51

Authors: Non

The Asian Pacific Journal of Reproduction would like to thank all reviewers for their expertise and sparing their precious time to review articles. Their efforts have contributed greatly to the continuous growth of the journal. Here we acknowledge, with special thanks, to those who reviewed one or more papers for the Journal in 2022. All the reviewers are listed below by countries or regions.

58-63

Authors: Yasuhiro Ohara, Shimpei Mizuta, Hidehiko Matsubayashi, Tomomoto Ishikawa, Tsuyoshi Takiuchi,Tadashi Kimura

Objective: To assess whether the coronavirus disease 2019 (COVID-19) mRNA vaccine affects sperm morphokinetics using a computer-assisted semen analyzer and other semen parameters using a sperm chromatin structure assay. Methods: Healthy male volunteers in two Japanese clinics between May 2021 and December 2021 were prospectively analyzed. Participants donated sperm twice, two days apart, in the following phases: before vaccination, 2 weeks after the first vaccine dose, and 2, 4, and 12 weeks after the second dose. Basic sperm parameters, sperm motility characteristics, and the percentage of DNA-damaged sperm were compared among the different phases. Results: Ninety-six semen samples from ten volunteers, who were vaccinated with the BNT162b2 mRNA vaccine, were evaluated. There were no significant differences between any phases in basic semen findings and parameters of the sperm chromatin structure assays. Regarding sperm motion characteristics, the average linear velocity, beat-cross frequency, and sperm motility index significantly decreased after the second vaccine dose (P=0.018, P=0.003, and P=0.027, respectively), with no significant differences between any two phases by post-hoc pairwise comparisons. Conclusions: After COVID-19 mRNA vaccination, while sperm motion characteristics might fluctuate, no apparent deterioration of basic sperm parameters or sperm DNA integrity was observed. Given the adverse effects of COVID-19 on sperm, our findings suggest that there might be no reason to refrain from vaccination for healthy individuals.

71-80

Authors: Agrawal Karuna Shahani Lata, Bhatnagar Pradeep

Objective: To investigate the protective role of pumpkin seed ethanolic extract against escitalopram-induced reproductive toxicity in male mice. Methods: Swiss albino male mice were randomly divided into five groups with six mice in each group. Group I received normal water orally, Group II , III , IV and V received escitalopram oxalate (10 mg/kg), pumpkin seed extract (300 mg/kg) plus escitalopram oxalate (10 mg/kg), escitalopram oxalate (20 mg/kg), and pumpkin seed extract (300 mg/kg) plus escitalopram oxalate (20 mg/kg), respectively. All test doses were continuously administered orally once daily per animal body weight for 30 days and 60 days. Body weight and sexual organ weight were evaluated on day 31 and 61. Effects of pumpkin seed extract on sperm parameters, biochemical parameters and histology of testis were also investigated. Results: Escitalopram 10 or 20 mg/kg caused reproductive toxicity in male mice after 30 and 60 days of treatment. However, simultaneous administration of escitalopram oxalate (10 or 20 mg/kg) with pumpkin seed extract (300 mg/kg) attenuated escitalopram-induced testicular toxicity. Significant increase in the body weight and relative organ weight was observed. Sperm count, sperm motility and viability significantly increased (P<0.05). The histopathological alterations caused by escitalopram was also ameliorated. Conclusions: Ethanolic extract of pumpkin seeds (300 mg/kg body weight) protects again reproductive toxicity induced by escitalopram. Therefore, dietary intake of pumpkin seed extract might be useful for male patients who expose to antidepressant drug due to depression.

90-96

Authors: Delsuz Rezaee, Mojgan Bandehpour, Bahram Kazemi, Saiyad Bastaminejad, Sajad Najafi, Mohammad Salehi

Objective: To compare the effect of human chorionic gonadotropin (hCG)-producing peripheral blood mononuclear cells (PBMCs) and PBMCs activated by hCG in vitro and expressions of related immune genes in mouse implantation. Methods: hCG-producing PBMCs (transfected PBMC) and PBMCs activated by hCG in vitro were introduced into isolated mouse endometrial cells, while cell cultures were divided into four groups: the control, PBMC, transfected, and activated PBMC groups. The expression of studied genes (IL-1 β , IL-6, Lif, and Vegf) was evaluated and blastocyst attachment on the cocultured cells (isolated endometrial cells and PBMC cells) was monitored in all four groups. Results: Data showed that expression decreased in the PBMC group compared to the treated PBMC (transfected and activated PBMCs) and increased in transfected PBMC compared to the activated PBMC. Attachment and migration of blastocysts were dramatically enhanced in the transfected PBMC group compared to the activated PBMC group (P<0.05). Conclusions: Use of hCG-producing PBMCs (transfected PBMC) has more influence on endometrial receptivity.