Showing papers in "Iranian Journal of Reproductive Medicine in 2020"

Platelet-rich plasma in the management of Asherman's syndrome; An RCT

Abstract: Background: Asherman’s syndrome (AS) is a rare reproductive abnormality, resulting in endometrial collapse due to aggressive or recurrent endometritis and/or curettage. Objective: We aimed to assess the effectiveness of using platelet-rich plasma (PRP) to lower the recurrence rate of intrauterine adhesions (IUAs) following postlysis hysteroscopy. Materials and Methods: In a nonrandomized controlled study, women aged 20-45 years with AS diagnosed by sonohysterography, 3D sonography, hysteroscopy, or uterosalpingography between May 2018 and September 2018 were included. Patients (n = 30) were divided into case and control groups. Following hysteroscopic adhesiolysis, a Foley catheter was placed into the uterine cavity in all women. After two days, the catheter was removed, and 1-mL PRP was injected into the uterine cavity of women in the PRP (case) group, while the control received no PRP. All controls and subjects underwent diagnostic hysteroscopy 8-10 weeks following the intervention to assess the IUAs according to the American Society for Reproductive Medicine scoring system. Result: Our results did not reveal any significant difference in the menstrual pattern of either the control or test groups before or after treatment (p = 0.2). Moreover, the IUA stage in both studied groups before and after treatment was similar (p = 0.2). The duration of menstrual bleeding in both studied groups before and after treatment was also similar. Conclusion: PRP cannot decrease the menstrual pattern or development of postsurgical IUAs, as evaluated by follow-up hysteroscopy. Key words: Asherman’s syndrome, Platelet-rich plasma, Pregnancy rate.

The effectiveness of counseling based on acceptance and commitment therapy on body image and self-esteem in polycystic ovary syndrome: An RCT.

Abstract: Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders known with irregular menstruation, hirsutism, alopecia, obesity, infertility, and acne. These symptoms cause a negative effect on the satisfaction of body image, self-esteem, and quality of life in such patients. Recent studies emphasize the need to consider the psychological problems in these women and also the need for appropriate interventions. Objective: The aim of this study was to determine the effectiveness of group counseling based on acceptance and commitment therapy (ACT) on body image and self-esteem in patients with PCOS. Materials and Methods: In this randomized controlled trial, 52 women with PCOS were randomly allocated to intervention and control groups (n = 26/each) using the table of random numbers. Group counseling based on the ACT was held in eight sessions of 90 min once a week for the intervention group. The demographic questionnaire, Littleton development of the body image concern inventory and Rosenberg self-esteem scale were completed in both groups before, immediately after, and one month after the intervention. Results: The mean scores of body image concern (p = 0.001) and self-esteem (p ≤ 0.001) in the intervention group after the intervention and follow-up were significantly different from the control group. Conclusion: Based on the findings of this study, use of cognitive-behavioral therapies in health care centers is recommended as a complementary method. Key words: Acceptance and commitment therapy, Body image, Self-esteem, Polycystic ovary syndrome, Cognitive behavior therapies.

Effects of selenium supplementation on glucose homeostasis in women with gestational diabetes mellitus: A randomized, controlled trial.

Abstract: Background: There is limited evidence about the anti-diabetic effects of selenium supplementation in women with gestational diabetes mellitus (GDM). Objective: This study investigates the effects of selenium supplementation on glucose homeostasis in women with GDM. Materials and Methods: A total of 60 pregnant women with GDM were enrolled in this prospective randomized, double-blind, and placebo-controlled clinical trial. They were randomly assigned to take either 100μg selenium supplements as tablet or a placebo daily for 12 wk since 24-28 wk of gestation. The primary outcomes were changes in the glucose homeostasis, including fasting plasma glucose, the 2-hr post prandial blood glucose, serum insulin level, glycosylated hemoglobin (Hb A1C), and the homeostasis model assessment of insulin resistance(HOMA_IR) at the initial period and 3 months after intervention. Results: The mean maternal age of the patients who took selenium supplements was 29.19 ± 6.16 (range 18-41) years. In the placebo group, the mean maternal age was 31 ± 4.43 (range 24-39) years. Compared with the placebo group, fasting plasma glucose, 2- hr post-prandial blood glucose, glycosylated hemoglobin(Hb A1C), serum insulin level, and homeostasis model of assessment-estimated insulin resistance(HOMA_IR) were not significantly changed in the selenium group at the end of study (p = 0.25, p = 0.87, p = 0.34, p = 0.57, and p = 0.31, respectively). Conclusion: The results of this trial suggest that supplementation with 100μg of selenium does not modulate glucose homeostasis in women with GDM. Key words: Diabetes, Gestational, Selenium.

Effect of hydroalcoholic extract of Berberis integerrima and resveratrol on ovarian morphology and biochemical parameters in Letrozole-induced polycystic ovary syndrome rat model: An experimental study.

Abstract: Background Resveratrol and Berberis integerrima (B. integerrima) are known to be natural antioxidants and regulators of human metabolism. However, the effects of resveratrol and B. integerrima on the ovarian morphology in polycystic ovary syndrome (PCOS) are not obvious. Objective This study aimed to determine the effect of the hydroalcoholic extract of B. integerrima in combination with resveratrol on some biochemical parameters and ovarian morphology in the letrozole-induced PCOS rat. Materials and methods Seventy adult female Sprague-Dawley rats aged 10-12 weeks weighing 200 ± 20 gr were randomly divided into seven groups (n = 10/each). Group I): normal; Group II): vehicle; Group III): letrozole-induced PCOS 1 mg/kg letrozole orally, rats receiving 1 cc normal saline orally; Group IV): PCOS + receiving 150 mg/kg metformin orally; Group V): PCOS + receiving 20 mg/kg resveratrol orally; Group VI): PCOS + 3 gr/kg barberry orally; and Group VII): PCOS + receiving 3 gr/kg barberry and 20 mg/kg resveratrol orally. All animals were followed-up for 63 days. The biochemical parameters and histological assessments of ovaries were performed. Results Resveratrol alone and/or in combination with B. integerrima treatment in rats led to a significant decrease in low-density lipoprotein, triglyceride, malondialdehyde, and tumor necrosis factor-alpha concentrations (p = 0.02). The groups IV, V, VI, and VII showed a decrease in insulin resistance and an increase in the superoxide dismutase, total antioxidant capacity, and high-density lipoprotein (p = 0.01). No significant difference was observed between the level of serum glucose in the treatment groups. Number of cystic follicles had a significant decrease in barberry, resveratrol, and their combination groups (p 0.001). Conclusion Resveratrol, B. integerrima, and their combination as natural products with fewer side effects might be effective as an alternative medicine in treatment of PCOS.

Protective effects of licorice extract on ovarian morphology, oocyte maturation, and embryo development in PCOS-induced mice: An experimental study

Abstract: Background Polycystic ovary syndrome (PCOS) is an oxidative state resulting in ovarian dysfunction. Licorice is one of the natural antioxidants used for the treatment of infertility. Objective To evaluate the effect of licorice extract on ovarian morphology, oocyte maturation, and embryo development in PCOS-induced mice. Materials and methods thirty-two female NMIR mice were divided into four groups (n = 8/each): control group receiving no treatment (group I); PCOS group injected with estradiol valerate once daily for 21 days (group II); and experimental groups receiving either 100 mg/kg (group III) or 150 mg/kg (group IV) licorice by gavage along with estradiol valerate once daily for 3 wk. Serum levels of the testosterone and estrogen were measured using ELISA kit. Histological study of ovaries was evaluated, and oocyte maturation, fertilization rate, and embryo development were determined after in vitro maturation. Results Experimental groups (III, IV) had significantly higher testosterone and estradiol levels compared to the PCOS group (p ≤ 0.001). A significant increase in the number of healthy follicles (primary, preantral follicles) (p = 0.001), corpus luteum (p = 0.001) with significant decrease in the number of atretic follicles (primary, preantral, cystic follicles) (p ≤ 0.001) was seen in the experimental groups. Increase in the fertilization rate (p ≤ 0.001) and blastocyst stage embryos (p = 0.02, p = 0.004) were observed in the experimental groups. Conclusion It appears that the two doses (100 mg and 150 mg) of licorice could decrease ovarian cyst and improve the fertilization rate of oocyte and embryo development in PCOS mice. However, there was no statistically significant difference between the two experimental groups.

Effectiveness of cognitive-behavioral therapy on sexual function and sexual self-efficacy in pregnant women: An RCT

Abstract: Background Cognitive-behavioral therapy (CBT) is one of the ways to improve an undesirable sexual function. Objective The purpose of this study was to investigate the effect of CBT on the sexual function and sexual self-efficacy of pregnant women. Materials and methods In this randomized clinical trial, 36 pregnant women referred to five healthcare centers in Ahvaz, Iran, from December 2016 to January 2017 were enrolled through stratified random sampling in two groups. The case group received counseling based on cognitive behavioral therapy for eight consecutive weeks and the control group received the routine training provided by healthcare staff. Two and four weeks after the end of sessions, both groups completed the Female Sexual Function Index and self-efficacy questionnaires again. Results The mean of sexual function and self-efficacy scores in pregnant women in the case and control groups before the intervention did not show a significant difference (p = 0.56). The mean of sexual function and self-efficacy scores of pregnant women in the case and control groups was statistically significant two and four weeks, respectively, after the intervention (p ≤ 0.0001). Conclusion The results of this study showed that counseling based on CBT in comparison with the routine training during pregnancy improves the sexual performance and self-efficacy of pregnant women.

Improvement in the epigenetic modification and development competence in PCOS mice oocytes by hydro-alcoholic extract of Nigella sativa during in-vitro maturation: An experimental study

Abstract: Background: Nigella Sativa (NS) and its active component, thymoquinone, have beneficial protective effects on experimental animal models of polycystic ovary syndrome (PCOS) and different human diseases. Objective: The present study aimed to investigate the effects of NS hydro-alcoholic extract (NSE) on the oocyte quality of PCOS mice during in vitro maturation. Materials and Methods: For induction of PCOS, 40 prepubertal 21-days old female B6D2F1 mice (18-22 g body weight) received subcutaneous dehydroepiandrosterone daily. After validation of the model, germinal vesicle-stage oocytes of superovulated mice were collected and placed in the culture medium containing different concentrations (0, 1, 50, and 100 μg/ml) of NSE. For the measurement of developmental competency, some mature oocytes were fertilized with epididymal spermatozoa. Other mature oocytes were assessed for oxidative stress. Also, some mRNA expression levels involved in oocyte maturation and epigenetic modification were evaluated. Results: The 50 μg/ml NSE treated group showed significantly higher r ates o f maturation, f ertilization, and blastocyst formation in comparison with both control and PCOS groups. A high level of glutathione concentration and glutathione peroxidase mRNA expression, besides a low level of reactive oxygen species content all, were observed in oocytes treated with 50 μg/ml NSE, indicating the modification of oxidative statue. Furthermore, the oocytes in the 50 μg/ml-treated group showed an upregulation of mRNA expression in epigenetic-related genes (Dnmt1 and Hdac1) and maternally derived genes (Mapk and Cdk1), correspondingly downregulation of cyclooxygenase2 mRNA expression, in comparison to other groups. Conclusion: The results of this study indicated that 50 μg/ml NSE improves oocyte maturation, oxidative statues and epigenetic modifications. These may be the all reasons for the developmental competency in the control and PCOS mice oocytes. Key words: Epigenetic modification, In-vitro maturation, Nigella sativa, Oxidative stress, Polycystic ovary syndrome. Key words: Epigenetic modification, In-vitro maturation, Nigella sativa, Oxidative stress, Polycystic ovary syndrome. Key words: Epigenetic modification, In-vitro maturation, Nigella sativa, Oxidative stress, Polycystic ovary syndrome.

Sulforaphane response on aluminum-induced oxidative stress, alterations in sperm characterization and testicular histomorphometry in Wistar rats.

Abstract: Background The exposure of male individual to environmental toxicant is regarded as a channel that results in reduced sperm counts and infertility. Objective This study investigated the ameliorative response of Sulforaphane (SFN) on Aluminum trichloride (AlCl 3 ) induced testicular toxicity in adult male Wistar rats. Materials and methods A total of 32 adult male Wistar rats (180-200 gm between 8-10 wk) were divided into four groups (n = 8/each). Group A) received distilled water orally as placebo; Group B) received 100 mg/kgbw AlCl 3 only orally; Group C) received 100 mg/kgbw AlCl 3 and 100 mg/kgbw SFN orally; and Group D) received 100 mg/kgbw SFN only orally. After 28 days of experiment, animals underwent cervical dislocation, blood serum was obtained for analysis, and testes were harvested for biochemical assays, histology, hormonal profile, and sperm characterization. Results The sperm parameters showed a significant difference within the AlCl 3 only group compared with the control and SFN only groups (p = 0.02). However, AlCl 3 and SFN co-treatment showed improvement in the motility, viability, and sperm count compared with the AlCl 3 only group (p = 0.02). Furthermore, there was a significant decline in the levels of hormones profile and antioxidant status in AlCl 3 only group compared to the control and SFN only (p = 0.02). The testicular histoarchitecture of the AlCl 3 only group showed shrinkage of seminiferous tubules, spermatogenesis disruption, and empty lumen compared to the control and SFN only groups. Conclusion The present study revealed the ameliorative response of SFN on AlCl 3 -induced testicular toxicity on serum hormone profiles, antioxidant status, lipid peroxidation, and histomorphometric analysis through oxidative stress.

Prevalence of metabolic syndrome in four phenotypes of PCOS and its relationship with androgenic components among Iranian women: A cross-sectional study.

Abstract: BackgroundPolycystic ovary syndrome (PCOS) increases the risk of metabolic syndrome (MetS). Insulin resistance (IR) plays a major role in the pathophysiology of both PCOS and MetS.ObjectiveThis study was designed to compare the prevalence of MetS among different phenotypes of PCOS and its relationship with androgenic components.Materials and Methods182 participants eligible for this five-group comparative study were selected by convenience sampling method. They were classified according to the Rotterdam criteria: clinical and/or biochemical hyperandrogenism (H) + PCOS on ultrasound (P) + ovulation disorders (O) (n = 41), clinical and/or biochemical H + PCOS on P (n = 33), PCOS on P + O (n = 40), clinical and/or biochemical H + O (n = 37), and control (without PCOS) (n = 31). MetS was measured based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Androgenic components included freeandrogen-index (FAI), total-testosterone (TT) level and sex-hormone-binding-globulin(SHBG).ResultsA significant difference was observed between the study groups in terms of MetS prevalence (p = 0.01). In phenotype H+P+O, there was a statistically significant positive association between TG and TT, and a significant negative association between SBP and DBP with SHBG. In phenotype O+P, WC was inversely associated with SHBG. In phenotype H+O, FBS and TG were positively associated with FAI but HDL was inversely associated with FAI. Moreover, WC and DBP were positively associated with TT in phenotype H+O. No associations were detected between MetS parameters and androgenic components in other PCOS subjects (phenotype H+P) and in the control group. TT was significantly higher in the PCOS group suffering from MetS (p = 0.04).ConclusionAccording to the research results, hyperandrogenic components are potent predictors of metabolic disorders. Thus, we suggest that MetS screening is required for the prevention of MetS and its related complications in PCOS women.

Effect of embryo transfer depth on IVF/ICSI outcomes: A randomized clinical trial.

Abstract: Background: Although there has been remarkable advancement in the field of assisted reproductive technology, implantation failure remains a significant issue in most infertile couples receiving these treatments. Embryo transfer is important in assisted reproductive technology and directly affects the implantation rates and pregnancy outcomes. Objective: To assess the effect of two different distance embryo transfer sites from fundal endometrial surface on the outcomes of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Materials and Methods: A total of 180 women who were candidate for IVF/ ICSI/ embryo transfer in Yazd Research and Clinical Center for Infertility were equally assigned to two groups based on the distance between the fundal endometrial surface and catheter tip to investigate implantation, chemical and clinical pregnancy (group A: 15 ± 5 mm and group B: 25 ± 5 mm, respectively). Results: The subjects in the group B showed significantly higher implantation rate, chemical and clinical pregnancy rate compared to the group A (p = 0.03, 0.01, 0.04, respectively). The rate of ongoing pregnancy and miscarriage indicated no significant differences between groups (p = 0.21, 0.27, respectively). Conclusion: In conclusion, our study showed that the depth of embryo replacement inside the uterine cavity at a distance of 25 ± 5 mm beneath fundal endometrial surface have better effects on the pregnancy outcomes of IVF/ICSI cycles and can be considered as an important factor to improve the success of IVF cycles. Key words: Embryo transfer, Endometrium, Pregnancy outcomes, IVF, ICSI.

Maternal and neonatal outcomes among pregnant women with different polycystic ovary syndrome phenotypes: A cross-sectional study

Abstract: Background: Pregnancy is a process associated with various metabolic and hormonal changes, and polycystic ovary syndrome (PCOS) can affect this process. Objective: This study aimed to evaluate and compare the maternal and neonatal outcomes among pregnant women with different polycystic ovary syndrome phenotypes. Materials and Methods: In this cross-sectional study, 200 pregnant women with PCOS according to the 2003 ESHRE/ASRM criteria were categorized into four phenotype groups (A-D). The maternal outcomes include gestational diabetes mellitus, pregnancy-induced hypertension, premature rupture of membranes, preterm labor, small-for-gestational age birth, intrauterine growth restriction, intrauterine mortality, preeclampsia, abortion, amniotic fluid disorders, delivery method, and cause of cesarean section were studied between groups. Additionally, neonatal outcomes such as neonatal weight, neonatal recovery, 5-min Apgar score, neonatal icter, the need for NICU admission, the cause of hospitalization, and infant mortality rate were investigated and compared among the groups. Results: According to the results, phenotype D (37%) was the most common phenotype among the participants. The risk of gestational diabetes was more common in phenotype A than in the other phenotypes, whereas pregnancy-induced hypertension was most common in phenotype B. No significant differences were observed in the neonatal complications among the PCOS phenotypes. Conclusion: Considering the higher risk of gestational diabetes mellitus and pregnancy-induced hypertension in PCOS phenotypes A and B, women with these phenotypes need more precise prenatal care. Key words: Pregnancy outcome, Polycystic ovary syndrome, Phenotype, Pregnancy.

The effect of acupuncture on the day of embryo transfer on the in vitro fertilization outcomes: An RCT

Abstract: Background: Acupuncture is an adjunct therapy to support infertile women received in vitro fertilization (IVF) treatment; however, the efficacy of this approach needs more evaluation. Objective: This randomized clinical trial (RCT) study aimed to evaluate the influence of acupuncture on reproductive outcomes in women undergoing IVF treatment. Materials and Methods: The study was carried out on 186 participants who had undergone IVF treatment in the Mother and Child Hospital between September 2015 and February 2016. Subjects were randomly divided into three groups: Acupuncture 25 min before embryo transfer (ET) (ACU1 group, n = 62), acupuncture 25 min before and after ET (ACU2 group, n = 62), and ET without acupuncture (control group, n = 62). Pregnancy rates (biochemical, clinical, and ongoing) were evaluated and compared between groups. Results: There were significant differences between the ACU1 group and the control group regarding biochemical (p = 0.005), clinical (p = 0.006), and ongoing (p = 0.007) pregnancies. Also, our results showed that two-session acupuncture (ACU2) lead to a significant reduction in frequency of biochemical (p = 0.002), clinical (p = 0.003), and ongoing (p = 0.01) pregnancy rates when compared to the one-session acupuncture (ACU1). No significant difference was found between the ACU2 and control groups regarding the aforementioned terms (p = 0.50). Conclusion: Acupuncture 25 min before ET significantly increased the IVF outcomes in women undergoing IVF compared with no acupuncture. Repeating acupuncture 25 min after ET did not improve the IVF outcome. Key words: Acupuncture, Embryo transfer, In vitro fertilization, Pregnancy rate.

Endometrial preparation using gonadotropin-releasing hormone agonist prior to frozen-thawed embryo transfer in women with repeated implantation failure: An RCT

Abstract: Background: Preparation of endometrial thickness in frozen-thawed embryo transfer (FET) is extremely important, particularly in repeated implantation failure (RIF) patients. Objective: This study aimed to investigate the clinical outcomes of FET cycles among RIF women, based on the effects of administering gonadotropin-releasing hormone (GnRH) agonist prior to estrogen-progesterone preparation of the endometrium. Materials and Methods: In this randomized clinical trial, 67 infertile women who were candidates for FET were divided into two groups: A) case group (n = 34), treated with GnRH agonist prior to endometrial preparation and B) control group (n = 33), which received the routine protocol. (6 mg daily estradiol started from second day) The clinical outcomes) including chemical and clinical pregnancy, in addition to implantation rates, were compared between the two groups. Results: The results showed no significant differences in women’s age (p = 0.558), duration (p = 0.540), type (p = 0.562), and cause of infertility (p = 0.699). Regarding pregnancy and implantation rates, there was a trend toward an increase in the case group; however, differences were not statistically significant. Conclusion: Although our results showed no significant differences between groups. Because there are trends to better results in case group larger sample size may show significant difference. Key words: Implantation failure, Gonadotropin-releasing hormone, Embryo transfer, Pregnancy, Implantation.

Impact of coadministration of apigenin and bone marrow stromal cells on damaged ovaries due to chemotherapy in rat: An experimental study

Abstract: Background: Apigenin is a plant-derived flavonoid with antioxidative and antiapoptotic effects. Bone marrow stromal cells (BMSCs) are a type of mesenchymal stem cells (MSCs) that may recover damaged ovaries. It seems that apigenin may promote the differentiation of MSCs. Objective: The aim of this study was to investigate the effect of coadministration of apigenin and BMSCs on the function, structure, and apoptosis of the damaged ovaries after creating a chemotherapy model with cyclophosphamide in rat. Materials and Methods: For chemotherapy induction and ovary destruction, cyclophosphamide was injected intraperitoneally to 40 female Wistar rats (weighing 180–200 gr, 10 wk old) for 14 days. Then, the rats were randomly divided into four groups (n = 10/each): control, apigenin, BMSCs and coadministration of apigenin and BMSCs. Injection of apigenin was performed intraperitoneally and BMSC transplantation was performed locally in the ovaries. The level of anti-mullerian hormone serum by ELISA kit, the number of oocytes by superovulation, the number of ovarian follicles in different stages by H&E staining, and the expression of ovarian Bcl-2 and Bax proteins by western blot were assessed after four wk. Results: The results of serum anti-mullerian hormone level, number of oocytes and follicles, and Bcl-2/Bax expression ratio showed that coadministration of apigenin and BMSCs significantly recovered the ovarian function, structure, and apoptosis compared to the control, BMSC, and apigenin groups (p < 0.001). Conclusion: The results suggest that the effect of coadministration of apigenin and BMSCs is maybe more effective than the effect of their administrations individually on the recovery of damaged ovaries following the chemotherapy with cyclophosphamide in rats. Key words: Apigenin, Bone marrow stromal cells, Chemotherapy, Ovary, Regeneration.

The effect of hydro-alcoholic extract of Ceratonia Silique L. on spermatogenesis index in rats treated with cyclophosphamide: An experimental study

Abstract: BackgroundCeratonia silique (Ceratonia) is a medicinal herb with antioxidant properties that reduces oxidative stress.ObjectiveThe aim of this study was to investigate the antioxidant effects of Ceratonia extract on improving the toxicity induced by cyclophosphamide (CP) on spermatogenesis.Materials and Methods54 male Wistar rats (4 months old) weighing 200-250 gr were randomly divided into 6 groups (n = 9/each): “group 1 (control) underwent the normal diet and water; group 2 (sham) received 2 ml/day normal saline; group 3 (positive control) received 300 mg/kg/day Ceratonia extract; group 4 (Ceratonia + CP) received Ceratonia extract (300 mg/kg/day) + 5 mg/kg/day CP (Endoxan, baxter oncology gmbh, Germany) after 4 hr; group 5 (CP) received 5 mg/kg/day CP + normal saline 4 hr after it; and group 6 (CP + Ceratonia) received Ceratonia extract (300 mg/kg/day) 4 hr after 5 mg/kg/day CP.” 24 hr after the last gavage, heart blood sampling was performed to measure the levels of malondialdehyde (MDA), ferric reducing antioxidant power, testosterone, luteinizing hormone, and follicle-stimulating hormone. The left caudal epididymis was cut in the Ham’s F10 and the released spermatozoa were used to analyze sperm parameters. The histology of the right testes was studied using stereological techniques and the left testes were used to measure the level of tissue MDA and ferric reducing antioxidant power.ResultsA significant increase in the mean level of MDA (p = 0.013) was seen in the CP compared to the control group. Sperm motility (p = 0.001) and count (p = 0.002), serum and tissue total antioxidant (p ≤ 0.001) and serum testosterone levels (p = 0.019) decreased in the CP compared to the control group. Ceratonia extract could significantly prevent the adverse effects of CP on sperm motility (p < 0.001), the mean levels of tissue MDA (p = 0.018), serum total antioxidant (p = 0.045), and testosterone (p < 0.001).ConclusionThe Ceratonia extract can modify the reproductive toxicity of CP in rat due to the presence of antioxidant compounds.

Expression levels of circulatory mir-185-5p, vascular endothelial growth factor, and platelet-derived growth factor target genes in endometriosis.

Abstract: Background Using blood-based biomarkers such as microRNAs (miRNAs) may allow particularly effective and minimally invasive diagnosis and treatment of endometriosis. Objective: We evaluated the differential expression of circulating miRNA-185-5p (miR-185-5p), vascular endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) target genes between endometriosis and healthy women. Materials and methods 25 women with a history of endometriosis (grad III-IV) diagnosed by laparoscopy as the case group and 25 women without endometriosis underwent laparoscopy for ovarian cysts or pelvic pain as the control group were enrolled in this case-control study. Blood samples were obtained, and total RNA was used for high-throughput small RNA sequencing, and this was confirmed by means of quantitative real-time polymerase chain reaction (qRT-PCR). Results miRNA expression profiling using non-coding RNA sequencing revealed that one miRNA including miR-185-5p was significantly down-regulated in the case group compared with the controls. The qRT-PCR results showed significant downregulation of the expression level of miR-185-5p (p 0.01) in the plasma of the case group. Receiver operating characteristic (ROC) curve analysis showed the area of miR-185-5p under the ROC curve for endometriosis diagnosis was 0.919 (p 0.001). The RT-PCR results demonstrated that there was no significant difference in the expression of VEGF and PDGF mRNA of blood samples in the cases compared to the control group (PDGF, p = 0.09 and VEGF, p = 0.36). Conclusion The low expression of miR-185-5p in the plasma of women with endometriosis could be employed as an important non-invasive biomarker for early detection and screening of endometriosis by blood samples.

The prophylactic effect of date palm (Phoenix dactylifera L.) fruit extract on testicular toxicity induced by formaldehyde: An experimental study.

Abstract: BackgroundFormaldehyde (FA) is one of the most widely used materials in industries and in sciences. Prolonged contact with FA might have harmful effects on fertility due to the increase in the reactive oxygen species level. On the other hand, date palm (Phoenix Dactilifera L.) fruit extract (DPFE) contains a high concentration of natural antioxidants that could scavenge free radicals.ObjectiveThe aim was to investigate the prophylactic effects of DPFE, with strong antioxidant properties, on FA-induced testicular toxicity in male mice.Materials and MethodsThirty-two adult NMRI male mice with a weight range of 25-35 gr (9-10 wk old) were randomly divided into four groups: control group (distilled water, orally for 35 days), FA group (FA; 0.25 mg/kg intraperitoneally (i.p.) for 20 days), treatment group (Date (DT) + FA; DPFE, 4 mg/kg for 35 days followed by FA administration, 0.25 mg/kg, i.p., for 20 days), date fruit extract group (DT; DPFE, 4 mg/kg, orally for 35 days). After this, blood was collected and left epididymis and testis tissues were isolated to evaluate the sperm parameters and histological examination, respectively.ResultsThe FA administration increased the sperm morphological anomalies and reduced the sperm count, viability and motility, and also testosterone compared to the control group (p ≤ 0.001). In addition, histological studies of the testes showed that FA causes changes in the testis seminiferous tubules such as destruction of germinal epithelium and vacuolization of the tubules. The DPFE consumption before FA administration could partially ameliorate the reduced testosterone, sperm, and testicular parameters due to FA.ConclusionThe DPFE use might have discount effects on FA-induced testicular toxicity.

Maternal serum levels of C-reactive protein at early pregnancy to predict fetal growth restriction and preterm delivery: A prospective cohort study.

Abstract: Background: A considerable evidence suggests that maternal inflammation dysregulation may play as a risk factor for both maternal and neonatal outcomes. Objective: The study’s objectives were designed to evaluate the correlation between serum C-reactive protein (CRP) levels, as an inflammation factor, preterm delivery, and small for gestational age (SGA) births. Materials and Methods: This prospective cohort study was conducted on 120 singleton pregnant women with gestational age less than 20 wk. Maternal CRP serum concentration was measured before 20 wk gestation. Patients were followed-up until the delivery and final outcomes of pregnancy were recorded in terms of preterm delivery and SGA births. Results: Serum CRP levels in participants with normal fetuses and SGA births were 4.09 ± 1.35 mg/l and 6.04 ± 3.29 mg/l, respectively (p = 0.19), while in cases of preterm delivery, it was 9.63 ± 5.78 mg/l (p < 0.001). By using receiver operating characteristic (ROC) curve, serum CRP levels (cut-off point 5.27 mg/l, area 0.836) had acceptable diagnostic accuracy value in distinguishing preterm delivery (sensitivity (75%), specificity (86.1%), positive predictive value (37.5%), negative predictive value (96.87%), accuracy (85%)) and serum CRP levels (cut-off point 6.67 mg/l, area 0.673) in distinguishing SGA births (sensitivity (50%), specificity (91.2%), positive predictive value (23.07%), and negative predictive value (97.19%), and accuracy (89.16 %)). Conclusion: Higher maternal serum CRP levels measured early in pregnancy may associate with higher risk of preterm delivery and SGA. Key words: C-reactive protein, Small for gestational age, Preterm birth.

Hsa-miR-27a-3p overexpression in men with nonobstructive azoospermia: A case-control study

Abstract: Background: The role of KDM3A and its downstream genes in male fertility has been approved in animal models. Additionally, the expression shrinkage of KDM3A is significantly correlated with human azoospermia phenotype. Aberrant expression of micro-RNAs could mislead spermatogenesis and mostly lead to diverse phenotypes of male infertility. Objective: The aim of this study was to evaluate the expression level of hsa-miR-27a- 3p in azoospermic men to reveal its possible association with infertility. Materials and Methods: This case-control study was conducted on 30 azoospermic men, of whom, 19 had non obstructive azoospermia (NOA) and 11 obstructive azoospermia (OA) according to the pathological examinations. Comprehensive bioinformatics investigations were performed securely and hsa-miR-27a-3p was selected afterward. Reverse Transcriptase-quantitative polymerase chain reaction (RTqPCR) method was used and statistical analysis was performed to compare the expression level of hsa-miR-27a-3p in both OA and NOA individuals. Results: In silico analysis suggested hsa-miR-27a-3p, with its potential binding ability to target KDM3A transcripts. The expression analysis of candidate hsa-miR-27a-3p indicated its significant overexpression in NOA men. Conclusion: The hsa-miR-27a-3p was overexpressed in NOA men compared to OA-control individuals. As a consequence, the overexpressed micro-RNA could downregulate directly KDM3A and indirectly TNP1 and PRM1. Therefore, spermatogenesis could be misled and male infertility could be developed. Key words: hsa-miR-27a-3p, Male infertility, KDM3A.

Biological and physiological characteristics of human cumulus cells in adherent culture condition

Abstract: Background: Cumulus cells, as oocyte nurse cells, provide a suitable microenvironment with growth factors and cellular interactions required for oocyte maturation. Thus, these cells may serve as a natural niche for in vitro studies of female germ cell development. Cumulus cells may help attain a better understanding of the causes of infertility in women and eventually improve the outcomes of cases that respond poorly to standard infertility treatment. Objective: The aim of this study was to isolate, culture, and investigate the biological characteristics of human cumulus cells. Materials and Methods: In this experimental study, cumulus cells were isolated, cultured, and characterized using reverse transcription-polymerase chain reaction analyses of specific genes including FOXL2, CYP19A1, FSHR, AMHR, and LHR. The presence of vimentin, a structural protein, was examined via immunofluorescent staining. Moreover, levels of anti-mullerian hormone (AMH) and progesterone secretion by cumulus cells were measured with ELISA after 2, 4, 12, 24, and 48 hr of culture. Results: In adherent culture, human cumulus cells expressed specific genes and markers as well as secreted AMH and progesterone into the medium. Conclusion: Cumulus cells secrete AMH and progesterone in an adherent culture and might be applicable for in vitro maturation (IVM) and in vitro gametogenesis (IVG) studies. Key words: Cumulus cells, Conditioned medium, In vitro maturation, In vitro gametogenesis, Niche.

A systematic review and meta-analysis of pregnancy and COVID-19: Signs and symptoms, laboratory tests, and perinatal outcomes.

Abstract: Background: Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 appeared in December 2019 in Wuhan, China. Objective: To investigate the clinical manifestations including signs and symptoms, laboratory results, and perinatal outcomes in pregnant women with COVID-19. Materials and Methods: Scholarly databases such as PubMed via LitCovid hub, Embase, Scopus, Web of sciences, and Google scholar were searched on April 7, 2020. Meta-analysis was performed via comprehensive meta-analysis software using the Mantel-Haenszel method. The event rate with 95% CI was calculated for each variable. Results: Ten studies were selected. The pooled prevalence for fever, post-partum fever, cough, myalgia, fatigue, dyspnea, sore throat, and diarrhea were 66.8%, 37.1%, 35%, 24.6 %, 14.9%, 14.6%, 11.5%, and 7.6%, respectively. Laboratory test results were 49.8% for lymphopenia, 47.7% for leukocytosis, 83.7% for elevated neutrophil ratio, 57% for elevated C-reactive protein, and 71.4% for decreased lymphocyte ratio. The rate of cesarean section for delivery in all cases was 84%. Of the newborns of the corona positive mothers, only one had a positive test result. Also, there was only one death due to a decreased lymphocyte ratio. Conclusion: Fever was the most common sign and symptom in pregnant women with COVID-19. Among the laboratory tests, the highest amount was related to elevated neutrophil ratio. It seems that due to the differences between pregnant women and the general population, special measures should be considered to treat these patients. Key words: COVID-19, Pregnancy, Diagnosis, Signs and symptoms, Meta-analysis.

Protective effects of Equisetum arvense methanolic extract on sperm characteristics and in vitro fertilization potential in experimental diabetic mice: An experimental study

Abstract: Background Diabetes mellitus is a metabolic disorder characterized by impaired insulin secretion or the inability of tissues to respond to insulin. This disease can damage the testis and reduce semen quality. Therefore, it can impair the potential for male fertility. Different herbal therapeutic treatments have been used to control diabetes and its complications. Objective This study aimed to evaluate the effects of streptozotocin-induced diabetes on sperm and in vitro fertilization (IVF) potential and investigate the protective effects of Equisetum arvense methanolic extract on diabetic mice. Materials and methods Twenty-four adult male mice were divided into four groups: control-sham, diabetic, diabetic + Equisetum extract (250 mg/kg), and diabetic + Equisetum extract (500 mg/kg). After 45 days, sperm samples were collected from the cauda epididymis to evaluate the characteristics of sperm (including viability, count, motility, morphology and chromatin/DNA integrity of sperm) and the IVF potential. Results Sperm motility and viability were increased remarkably (p ≤ 0.001) in the treated groups compared with the non-treated diabetic group. The decrease in sperm count in the diabetic group compared with the treated groups was not significant. Moreover, the percentage of sperm with DNA damage, nuclear immaturity, and abnormal morphology was decreased significantly (p ≤ 0.001) in the treated groups compared with the diabetic group. The treated animals exhibited remarkably higher fertilization rates and a higher percentage of fertilized oocytes that developed toward the blastocyst stage compared with the non-treated diabetic group (p ≤ 0.001). Conclusion The methanolic extract of the Equisetum arvense inhibited diabetes-induced detrimental effects on sperm quality and fertilization rate, which may have been associated with hypoglycemic and antioxidative activities in this plant.

Iranian women's experiences of infertility: A qualitative study.

Abstract: Background: There are concerns and diverse experiences related to infertility and childlessness. The lived experience of infertile people from various cultures needs to be explored. Objective: The aim of this qualitative study was to explore Iranian women experiences of their infertility. Materials and Methods: The data comprised interviews about fertility issues in the Persian language with eighteen women, aged 17-45 yr old, who agreed to be interviewed at the Mottahari Infertility Treatment Clinic, affiliated to the Urmia University of Medical Sciences about their fertility problems. They were approached by the researchers at the time of their first visit. The verbatim transcribed interviews were analyzed using deductive conventional content analysis. Results: The experiences of the informants were conceptualized into four major themes: 1) Shock (subthemes: Disbelief and Denial); 2) Reaction (subthemes: Distress, Guilt, Loss of self-esteem and Sexual reluctance); 3) Processing (subthemes: Internal processing, Avoidance, Marriage at risk, External processing, Stigma caused by the family and Stigma caused by the community) and 4) Reorientation (subthemes: Forgetting, Marriage to saving marriage and Sexual consent). Conclusion: Infertility can be a challenging condition. Considering that infertilityrelated issues affect Iranian women more contextual factors is necessary. So, culturally sensitive and gender specific protocols are suggested to provide suitable and about culturally sensitive and genderspecific protocols is a necessity in order to provide suitable care to infertile women. Key words: Iran, Women, Infertility, Qualitative.

Knowledge, attitude, intention, and religion aspect toward fertility preservation among obstetrics and gynecology residents in Indonesia: A cross-sectional study

Abstract: Background: The lack of knowledge from healthcare providers regarding fertility preservation will certainly affect the patient’s knowledge, attitude, behavior, and also perspective. Obstetrics and Gynecology (OB/GYN) residents may most likely be the first line professionals to integrate fertility preservation technologies into their practice which plays an important task in giving an understanding of the relationship between age and fertility for patients. Objective: This study aims to assess OB/GYN resident knowledge and beliefs regarding age-related fertility decline, intentions, and religion aspect toward fertility preservation. Materials and Methods: A cross-sectional study was conducted on 92 Indonesian OB/GYN residents at the Cipto Mangunkusomo Hospital between November and December 2017. Data were collected using a questionnaire which had four sections, knowledge, attitude, intention, and religion aspect toward fertility preservation. Results: The majority of participants believed that an OB/GYN should encourage discussions about potential childbearing desires (96.74%) and age-related fertility decline (94.57%) with patients, of which 79.34% believed that these discussions should be part of a woman’s annual health examination. Cancer patients are likely to undergo oocyte cryopreservation than people who choose career as priority. From the religion aspect, fertility preservation options such as sperm, oocyte, embryo, and ovarian cortex cryopreservation were accepted by most residents with varied religions, while oocyte and sperm donor methods were unacceptable (48% and 57%, respectively) because of the belief that oocyte/sperm should only be given to legitimate partners, but many still do not know that oocyte and sperm donor were prohibited by all religions. Conclusion: Age-related fertility decline and frozen egg storage should be discussed during annual woman wellness examinations by OB/GYN specialists. Key words: Knowledge, Attitude, Intention, Fertility preservation.

Characteristics of the human endometrial regeneration cells as a potential source for future stem cell-based therapies: A lab resources study

Abstract: Background: Human endometrium with consecutive regeneration capability undergoes monthly hormonal changes for probable implantation, which confirms the presence of the cells in the basalis layer known as stem cell. Objective: Previously, we reported the isolation and culture of the mesenchymal-like cells from human endometrium. In this study, we evaluated the biological and stemness characteristics of these cells. Materials and Methods: The characterization of Yazd human endometrialderived mesenchymal stem/stromal cells (YhEnMSCs) was assessed using immunofluorescence (IF) staining for CD105, VIMENTIN, and FIBRONECTIN as markers and RT-PCR for CD166, CD10, CD105, VIMENTIN, FIBRONECTIN, MHCI, CD14, and MHCII genes. Flow cytometry (FACS) was performed for CD44, CD73, CD90, and CD105 markers. Moreover, the differentiation capacity of the YhEnMSCs to the osteoblast and adipocytes was confirmed by Alizarin Red and Oil Red staining. Results: YhEnMSCs expressed CD105, VIMENTIN, FIBRONECTIN, CD44, CD73, and CD90 markers and CD166, CD10, CD105, VIMENTIN, FIBRONECTIN, and MHCI, but, did not express CD14, MHCII. Conclusion: Our data confirm previous reports by other groups indicating the application of endometrial cells as an available source of MSCs with self-renewal and differentiation capacity. Accordingly, YhEnMSCs can be used as a suitable source for cell-based therapies. Key words: Cell-based therapy, Endometrium, Mesenchymal stem/stromal cells, Regenerative medicine, Stem cells, Uterus.

The Effect of Vitamin D Status on Ovarian Reserve Markers in Infertile Women: A Prospective Cross-Sectional Study

Abstract: Background: Vitamin D deficiency and infertility are two important health problems in Iran. Some studies suggest that vitamin D may influence Anti-Mullerian hormone (AMH) and antral follicle count (AFC) as an ovarian reserve. Objective: The present study aimed to investigate the impact of vitamin D on AMH serum concentrations/AFC. Materials and Methods: three hundred and five infertile women referred to the IVF Unit of Yas hospital, between July and December 2017, were enrolled in this cross-sectional study. The demographic characteristics of the participants, as well as the serum levels of vitamin D, AMH, and ultrasonic examination of AFC were recorded. Results: Finally, 287 infertile women were included in the analysis with a mean age of 29.95 ± 4.73 yr (18-45 yr) and a mean Body mass indexof 25.11 ± 4.41 kg/m2. The median AMH and vitamin D levels were 3.20 and 22.82 ng/ml, respectively. Considering the cut-off level of 20 ng/ml, 58.7% were vitamin D deficient. Regression analysis showed no association between AMH and vitamin D levels (p = 0.161), even after adjusting for baseline variables (p = 0.182). A total of 120 patients had an AFC < 6 and 164 ≥ 6, which was not statistically different between the groups with normal level or deficient vitamin D (p = 0.133). Conclusion: The present cross-sectional study showed no significant association between serum levels of vitamin D and AMH or AFC in infertile women, even after adjusting for baseline variables. Key words: Anti-Mullerian hormone, Infertility, Vitamin D deficiency, Ovarian follicle.

L-Carnitine reduces the negative effects of formalin on sperm parameters, chromatin condensation and apoptosis in mice: An experimental study.

Abstract: Background Formalin is commonly applied as an antiseptic and tissue fixative. It has reactive molecules that lead to its cytotoxic effects. According to recent studies, formalin causes a change in the testicular and sperm structure and L-carnitine (LC) acts as an antioxidant to counteract its effects. Objective This study aimed to investigate the protective effects of LC on the parameters, chromatin condensation and apoptosis of mice sperm exposed to formalin. Materials and methods In this experimental study, 24 balb/c mice (25-40 gr,10-12 wk) were divided into three groups (n = 8/each): group I without any injections or gavage; group II, received 10 mg/ kg formalin intraperitoneally (I.P); and group III was exposed to formalin and LC, where a dose of 10 mg/kg formalin was injected I.P daily and LC the dose of 100 mg/kg was kept in a solvent solution. After 31 days, the sperm examination was performed as follows: to evaluate chromatin and DNA quality of the sperm, we applied aniline blue (AB), toluidine blue (TB), chromomycin A3 (CMA3), and terminal transferase-mediated deoxy uridine triphosphate biotin end labeling (TUNEL) tests. Results Sperm parameters such as count, motility, morphology, and viability displayed a significant decrease in the formalin group. While the data exhibited a considerable augment in sperm parameters in the formalin + LC than the formalin and control groups (p 0.001), significant differences were detected between groups with respect to TB staining, TUNEL test, CMA3 test and AB staining in the formalin and formalin + LC groups. Conclusion LC can reduce the negative effects of formalin on sperm parameters, chromatin stability, and percentage of apoptosis in an animal model.

Iranian temporal changes in semen quality during the past 22 years: A report from an infertility center.

Abstract: Background: Despite numerous reports about temporal changes in semen quality from all over the world, the debates continue. The latest systemic review has shown an overtime decrease in semen quality worldwide. Objective: To assess the temporal changes in the semen quality among Iranian population referred to an infertility center. Materials and Methods: In this retrospective cross-sectional study, semen parameters including concentration, motility, and morphology were compared between Iranian men reffered to Research and Clinical Center for Infertility, Yazd between 1990 to 1992 (group 1, n = 707) and 2010 to 2012 (group 2, n = 1108). Demographic characteristics and semen analysis were collected from the records. The effect of age on semen parameters was also investigated. Results: Despite the increase in sperm concentration l in group 2, sperm with normal morphology decreased significantly (p < 0.001). Grade-A motility decreased (p < 0.001), grade B motility increased (p < 0.001), and grade C and D motile sperm remained constant (p = 0.303 and p = 0.315, respectively). Also, no significant correlation between the age and semen parameters were observed. Conclusion: This study showed inconsistent temporal changes in the participant semen quality. Significant temporal decline were obtained between various semen parameters, sperm morphology and grade A motility. These results should be further evaluated by larger studies in the future. Key words: Infertility, Semen quality, Temporal changes.

Radioprotective effect of a combination of melatonin and metformin on mice spermatogenesis: A histological study.

Abstract: Background: The spermatogenesis system includes highly radiosensitive cells. Hence, this system is a potential target for toxic effects of ionizing radiation during radiotherapy of abdomen and pelvis cancers, as well as after accidental radiation events. Accordingly, metformin and melatonin are two important radioprotectors that have shown an ability to prevent cell death through neutralization of free radicals and stimulating DNA damage responses. Objective: To evaluate the radioprotective effects of melatonin and metformin on mice spermatogenesis when administered alone or as a combination. Materials and Methods: In this histological Study, 40 (6-8 wk, 30 gr) NMRI mice were divided into 8 groups (n = 5/each) as control, metformin, melatonin, melatonin + metformin, radiation, radiation + melatonin, radiation + metformin, and radiation + melatonin + metformin. 37 days after the irradiation, the testicular tissues were collected for histological evaluation. Results: Single administration of melatonin could ameliorate effectively radiation toxicity in mice testis. Metformin showed radioprotective effects on some parameters such as the numbers of spermatogonia and mature sperms. Interestingly, the melatonin and metformin combination reversed the reduced number of sperms rather than single drug administration. Conclusion: The combination of melatonin with metformin can protect mice spermatogenesis against ionizing radiation more effectively compared to the single forms of these drugs. Key words: Radiation, Testis, Leydig cells, Melatonin, Metformin, Spermatogenesis.

Role of resilience training on compromising of infertile couples' applicant for divorce: A cross-sectional study.

Abstract: Background: Divorce is a social issue, which challenges not only the structure of family but also of a society. Studies have shown that infertility affects the marital boredom. In addition, resilience training and emphasizing on increasing piety (religiousness) can help to decrease this boredom. Objective: This study aimed to evaluate the resilience training effects on the compromising of infertile couples’ applicant for divorce. Materials and Methods: In this cross-sectional study, 100 infertile couples who had requested for divorce and referred to the Center for consolidation of the family foundation were enrolled. Participants were randomly divided in two categories (n= 50/each): the case group received some consultation classes on social services as well as resilience training by a consultant in 5 sessions lasting 2 hr. In total, 10 hr of treatment; while the control group just received the consultation and social services. Canner and Davidson questionnaires were utilized as pre- and posttest in both groups. Groups answered the resilience’s criterion of Canner and Davidson. Results: The resilience training significantly increased the compromises made by couples in the case group compared to the control (p < 0.01). The results showed that 26% of members of the case group relinquished divorce, while 10% of control group members did the same; this difference was statistically significant (p < 0.01). Conclusion: The resilience training leads to increased psychological well-being elements and compromises in infertile couples. Key words: Resilience, Education, Infertility, Divorce.