Detection of Y chromosome microdeletions and hormonal profile analysis of infertile men undergoing assisted reproductive technologies

Background: Y chromosome deletions [YCDs] in azoospermia factor [AZF] region are associated with abnormal spermatogenesis and may lead to azoospermia or severe oligozoospermia. Assisted reproductive tech- nologies [ART] by intracytoplasmic sperm injection [ICSI] and testicular sperm extraction [TESE] are commonly required for infertility management of patients carrying YCDs. The aim of this study was to estimate the frequency of YCDs, to find the most frequent variant in infertile men candidate for ART and to compare YCD distribution with a control fertile group. The semen parameters, hormonal profiles and ART outcomes of the infertile group were studied

Materials and Methods: This case-control study consisted of 97 oligozoospermic or non-obstructive azoospermic [NOA] infertile men, who had undergone ART, as the case group and 100 fertile men as the control group. DNA samples were extracted from blood samples taken from all 197 participants and YCDs were identified by multiplex polymerase chain reaction [PCR] of eight known sequence-tagged sites. The chi-square test was used to compare the mean values of hormone and sperm parameters between the two groups. P<0.05 was considered statistically significant

Results: No YCD was detected in the control group. However, 20 out of 97 [20.6%] infertile men had a YCD. AZFc, AZFbc and AZFabc deletions were detected in 15 [75%], four [20%] and one [5%] YCD-positive patients. No fertilization or clinical pregnancy was seen following ICSI in this sub-group with YCD. The mean level of FSH was significantly higher in the group with YCD [28.45 +/- 22.2 vs. 4.8 +/- 3.17 and 10.83 +/- 7.23 in YCD-negative patients with and without clinical pregnancy respectively]

Conclusion: YCD is frequent among NOA men and YCD screening before ART and patient counseling is thus strongly recommended

Delayed start protocol with gonadotropin-releasing hormone antagonist in poor responders undergoing in vitro fertilization: a randomized, double-blinded, clinical trial

Objectives: We sought to determine the effects of the delayed start protocol with gonadotropin-releasing hormone [GnRH] antagonists in poor responders undergoing in vitro fertilization [IVF]

Methods: This randomized clinical trial was conducted during a 15-month period from April 2014 to July 2015 in clinics in Shiraz, Iran. total of 42 poor responders with primary infertility were randomly assigned to the controlled ovarian stimulation group utilizing the delayed start protocol [n = 21] or the traditional group [n = 21] using GnRH antagonist, Cetrotide. The primary endpoint was the number of patients undergoing oocyte pick-up, implantation, and the rate of pregnancy

Results: The baseline characteristics of the two study groups were comparable including age, infertility duration, and body mass index. The number of follicles measuring > 13 mm in diameter [p = 0.057], retrieved oocytes [p = 0.564], mature metaphase II oocytes [p = 0.366], embryos [p = 0.709], and transferred embryos [p = 0.060] were comparable between the two groups. The number of patients undergoing oocyte pick-up [p = 0.311], the rates of implantation [p = 0.407], and pregnancy [p = 0.596] were also comparable between the two groups

Conclusions: The delayed start protocol was not associated with better conception results or cycle outcomes in poor responders with primary infertility undergoing IVF cycles

effects of endometrial injury on intrauterine insemination outcome: a randomized clinical trial

Implantation is considered as the rate-limiting step in success of assisted reproduction techniques, and intrauterine insemination cycles. It might be affected by ovarian superovulation and endometrial local scratching. This study aims to investigate the effect of local endometrial injury on the outcome of IUI cycles. In this randomized clinical trial 144 women with unexplained infertility, mild male factor, and mild endometriosis randomly divided into two study groups through block randomization. The patients were randomly assigned to undergo endometrial biopsy between days 6-8 of the previous menstrual cycle before IUI [n=72, IUI cycles =126] or receive no interventions [n=72, IUI cycles=105]. The pregnancy rate per patient was 17 [23.6%] and 14 [19.4%] in endometrial biopsy and control groups, respectively [p=0.686]. The pregnancy rate per cycle was 17/126 [13.5%] and 14/105 [13.3%] in endometrial biopsy and control groups, respectively [p=0.389]. The abortion rate was comparable between the two groups [6.9% vs. 9.7%; p=0.764]. The ongoing pregnancy rate was found to be comparable between the two study groups, as well [16.7% vs. 9.7%; p=0.325]. Endometrial thickness [p=0.609] was comparable between the groups; however E2 was significantly lower in the endometrial biopsy group [p<0.001]. Application of local endometrial injury in the cycle before the IUI cycles is not associated with increased pregnancy rate per patient and per cycle, decreased abortion, and increased endometrial thickness

Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/ intracytoplasmic sperm injection: a randomized clinical trial

The direct effect of hCG on the human endometrium was studied several times. The objectives of this study were to evaluate the effectiveness of intrauterine injection of recombinant human chorionic gonadotropin [rhCG] before embryo transfer [ET]. In this randomized placebo-controlled clinical trial, a total number of 182 infertile patients undergoing their first in vitro fertilization/ intracytoplasmic sperm injection [IVF-ICSI] cycles were randomly assigned to receive 250 micro g intrauterine rhCG [n=84] or placebo [n=98] before ET. The implantation and pregnancy rates were compared between groups. Patients who received intrauterine rhCG before ET had significantly higher implantation [36.9% vs. 22.4%; p=0.035], clinical pregnancy rates [34.5% vs. 20.4%; p=0.044] and ongoing pregnancy rate [32.1% vs. 18.4%; p=0.032] when compared to those who received placebo. The abortion [2.4% vs. 2.0%; p=0.929] and ectopic pregnancy rates [1.2% vs. 1.0%; p=0.976] were comparable between groups of rhCG and placebo, respectively. Intrauterine injection of 250 micro g of rhCG before ET significantly improves the implantation and pregnancy rates in IVF/ICSI cycles.

Hypothalamic expression of KiSS1 and RFamide-related peptide-3 mRNAs during the estrous cycle of rats

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