Serum Anti-Mullerian hormone and embryo morphokinetics detecting by time-lapse imaging: a comparison between the polycystic ovarian syndrome and tubal factor infertility

Background: Anti-Mullerian hormone [AMH] is considered as a good marker for quantitative evaluation of ovarian response to the stimulation during assisted reproductive technology cycles

Objective: to evaluate the association between serum AMH level and embryo morphokinetics using time-lapse imaging and intracytoplasmic sperm injection [ICSI] outcomes in women with polycystic ovarian syndrome [PCOS]

Materials and Methods: we evaluated a total of 547 embryos from 100 women underwent ICSI cycles; 50 women with PCOS and 50 women with tubal factor infertility. Serum AMH level was measured in all participants. Time-laps records were annotated for time to pronuclear fading [tPNf], time to 2-8 cells [t2-t8], reverse cleavage, direct cleavage, and also for the presence of multinucleation

Results: AMH was negatively correlated with t5, t8, and the third cell cycle [p=0.02, p=0.02, and p=0.01; respectively] in PCOS group. AMH had no correlation with embryo kinetics in infertile women with tubal factor infertility. Moreover, AMH level is similar between embryos with and without direct cleavage as well as reverse cleavage and Multinucleation in both groups. The Receiver operating characteristic curves analyses indicated that AMH was not an accurate predictor of clinical pregnancy as well as a live birth [AUC=0.59 [95% CI, 0.42-0.76]] in PCOS women. However, in the women with tubal factor infertility AMH showed a fair prediction value for clinical pregnancy [AUC=0.64 [95% CI, 0.48-0.82]] along with the live birth [AUC=0.70 [95% CI, 0.55-0.85]]

Conclusion: some of the time-lapse embryo parameters may be related to the AMH concentration. However, AMH is not an accurate tool to predict the ICSI outcomes in PCOS women

Fresh versus frozen embryo transfer after gonadotropin-releasing hormone agonist trigger in gonadotropin-releasing hormone antagonist cycles among high responder women: a randomized, multi-center study

Background: The use of embryo cryopreservation excludes the possible detrimental effects of ovarian stimulation on the endometrium, and higher reproductive outcomes following this policy have been reported. Moreover, gonadotropin-releasing hormone agonist trigger in gonadotropin-releasing hormone [GnRH] antagonist cycles as a substitute for standard human chorionic gonadotropin trigger, minimizes the risk of ovarian hyperstimulation syndrome [OHSS] in fresh as well as frozen embryo transfer cycles [FET]

Objective: To compare the reproductive outcomes and risk of OHSS in fresh vs frozen embryo transfer in high responder patients, undergoing in vitro fertilization triggered with a bolus of GnRH agonist

Materials and Methods: In this randomized, multi-centre study, 121 women undergoing FET and 119 women undergoing fresh ET were investigated as regards clinical pregnancy as the primary outcome and the chemical pregnancy, live birth, OHSS development, and perinatal data as secondary outcomes

Results: There were no significant differences between FET and fresh groups regarding chemical [46.4% vs. 40.2%, p=0.352], clinical [35.8% vs. 38.3%, p=0.699], and ongoing [30.3% vs. 32.7%, p=0.700] pregnancy rates, also live birth [30.3% vs. 29.9%, p=0.953], perinatal outcomes, and OHSS development [35.6% vs. 42.9%, p=0.337]. No woman developed severe OHSS and no one required admission to hospital

Conclusion: Our findings suggest that GnRHa trigger followed by fresh transfer with modified luteal phase support in terms of a small human chorionic gonadotropin bolus is a good strategy to secure good live birth rates and a low risk of clinically relevant OHSS development in in vitro fertilization patients at risk of OHSS

etiologies of sperm DNA abnormalities in male infertility: an assessment and review

The sperm DNA damage may occur in testis, genital ducts, and also after ejaculation. Mechanisms altering chromatin remodeling are abortive apoptosis and oxidative stress resulting from reactive oxygen species. Three classifications of intratesticular, post-testicular, and external factors have been correlated with increased levels of sperm DNA damage which can affect the potential of fertility. Alcohol consumption may not increase the rate of sperm residual histones and protamine deficiency; however, it causes an increase in the percentage of spermatozoa with DNA fragmentation and apoptosis. In a medical problem as spinal cord injury, poor semen parameters and sperm DNA damage were reported. Infection induces reactive oxygen species production, decreases the total antioxidant capacity and sperm DNA fragmentation or antigen production that lead to sperm dysfunctions and DNA fragmentation. While reactive oxygen species generation increases with age, oxidative stress may be responsible for the age-dependent sperm DNA damage. The exposing of reproductive organs in older men to oxidative stress for a long time may produce more DNA-damaged spermatozoa than youngers. Examining the sperm chromatin quality in testicular cancer and Hodgkin's lymphoma patients prior to chemotherapy demonstrated the high incidence of DNA damage and low compaction in spermatozoa at the time of diagnosis. In chemotherapy cycles with genotoxic agents in cancer patients, an increase in sperm DNA damage was shown after treatment. In overall, those factors occurring during the prenatal or the adult life alter the distribution of proteins associated with sperm chromatin induce changes in germ cells which can be detected in infertile patients

Evaluation of sperm protamine deficiency and apoptosis in infertile men with idiopathic teratozoospermia / 대한생식의학회지

OBJECTIVE: Sperm morphology plays an important role in infertility, especially in cases of defects in the heads of spermatozoa. Tapered-head or elongated-head spermatozoa are examples of morphological abnormalities. The aim of this study was to compare the semen parameters, levels of protamine deficiency, and frequency of apoptosis between patients with normozoospermia and those with teratozoospermia with tapered-head spermatozoa. METHODS: Fifty-two semen samples (27 patients with tapered-head sperm and 25 fertile men) were collected and semen analysis was performed according to the World Health Organization criteria for each sample. Protamine deficiency and the percentage of apoptotic spermatozoa were evaluated using chromomycin A3 (CMA3) staining and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) assays, respectively. RESULTS: Sperm concentration, motility, and normal morphology in the tapered-head spermatozoa (cases) were significantly lower than in the normozoospermic samples (controls). CMA3-reactive spermatozoa (CMA3+) in the case group were more common than in the controls. Apoptotic spermatozoa (TUNEL-positive) were significantly more common in the cases than in the controls. CONCLUSION: This analysis showed that tapered-head spermatozoa contained abnormal chromatin packaging and exhibited a high rate of apoptosis, which can be considered to be an important reason for the impaired fertility potential in teratozoospermic patients with tapered-head spermatozoa.

Perinatal outcome in fresh versus frozen embryo transfer in ART cycles

Background: Despite of higher pregnancy rate after frozen embryo transfer [FET] which is accepted by the majority of researches, the safety of this method and its effect on neonatal outcome is still under debate

Objective: The aim of this study was to evaluate pregnancy and neonatal outcome of FET compare to fresh cycles

Materials and Methods: In this study,1134 patients using fresh ET and 285 women underwent FET were investigated regarding live birth as primary outcome and gestational age, birth weight, gender, multiple status, ectopic pregnancy, still birth and pregnancy loss as secondary outcomes

Results: Our results showed that there is no difference between FET and fresh cycles regarding live birth [65.6% vs. 70.4% respectively]. Ectopic pregnancy, still birth and abortion were similar in both groups. The mean gestational age was significantly lower among singletons in FET group compared to fresh cycles [p=0.047]. Prematurity was significantly elevated among singleton infants in FET group [19.6%] in comparison to neonates born after fresh ET [12.8%] [p=0.037]

Conclusion: It seems that there is no major difference regarding perinatal outcome between fresh and frozen embryo transfer. Although, live birth is slightly increased in fresh cycles and prematurity was significantly increased among singleton infants in FET group

luteinizing hormone beta-subunit exon 3 [Gly102Ser] gene mutation and ovarian responses to controlled ovarian hyperstimulation

Despite extensive progress in IVF techniques, one of the most difficult problems is the variability in the response to controlled ovarian hyperstimulation [COH]. Recent studies show the effects of individual genetic variability on COH outcome. To evaluate the correlation between LHbeta G1502A polymorphisms in exon 3 of the LH gene and ovarian response to COH. A total of 220 women treated with a long protocol for ovarian stimulation were studied. Three genotypes of GG, GA and AA were detected by polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] analysis. In total, 34 [17%] patients were poor responders, 154 [77%] were normal responders and 12 [6%] were hyper responders. The most frequent genotype was GA [55.5%] whereas 44.5% of patients showed GG genotype and there was no patient with AA genotype. In total 54.5% of normal responders, 61.8% of poor responders and 50% of hyper responders showed GA genotype. Our results did not establish a significant relationship between this polymorphism and the ovarian response. Therefore it is still very difficult to use the genotype of patients for prediction of the ovarian response to stimulation

Comparison of reactive oxygen species in neat and washed semen of infertile men

Male are involved in near 50% of cases of infertility and reactive oxygen species [ROS] playing an important role in decreasing fertility potential. Accurate measurement of ROS seems to be important in evaluation of infertile male patients. To compare ROS measurement in neat and washed semen samples of infertile men and define the best method for evaluation of ROS in these patients. We measured the level of ROS in semen samples of thirty five non-azoospermic men with infertility. The semen samples were divided into two parts and the semen parameters and ROS levels in neat and washed samples were evaluated. We also evaluated the presence of pyospermia using peroxidase test. The differences regarding sperm count and quick motility were significant in neat and washed semen samples. The mean ROS level was significantly higher in neat samples compared with washed spermatozoa [7.50 RLU vs. 1.20 RLU respectively]. Difference in ROS levels was more significant in patients with pyospermia compared to whom with no pyospermia [378.67 RLU vs. 9.48 RLU respectively]. Our study confirmed that neat or unprocessed samples are better index of normal oxidative status of semen samples. Because we do not artificially add or remove factors that may play an important role in oxidative equilibrium status

Age as a predictor of assisted reproductive techniques outcome

This study evaluated the effect of age on ovarian response to gonadotropin stimulation and the success of IVF and ICSI cycles. In this retrospective analytic study, 280 women undergoing first IVF and ICSI cycles were collected. Patients were divided in three groups: <35 years old, 35- 39 years and e"40 years old. Stimulation protocol for all patients was Long standard protocol. There were significant decrease in the number of follicles, oocytes retrieved and embryos obtained with increasing age [p<0.05]. Fertilization rate did not differ significantly with increasing age [P>0.05]. Clinical pregnancy rate were 21.8% in patients < 35, 13.2% in patients 35-39 and 5.9% in e"40 [p= 0.157] and Live birth rate were 14.2% in patients <35,7.9% in 35-39 and 5.9% in e"40 years old. [p= 0.50]. Clinical pregnancy rate and live birth rate diminished with increasing age

Knowledge and attitude about HIV/AIDS among pregnant women in Yazd, Iran

Since AIDS is not only a vital medical problem, but also a socioeconomic complication, therefore increasing people's knowledge and replacing their unhealthy behavior by a healthy one is of important consideration. Women, specially in reproductive ages of their life, have a special situation regarding the probability of pregnancy and infection of their fetus. The aim of this study was to explore pregnant women's knowledge about HIV/AIDS, their perception of risk, risk behavior and management, and their attitudes towards AIDS. In a cross sectional study, a total of 120 pregnant women, who referred to family health clinics in Yazd, were selected by simple random sampling. Information was collected via a special designed questionnaire containing 22 questions for evaluating knowledge and 6 questions for evaluating attitude. Statistical analysis was performed using Chi-square test with SPSS software. The knowledge of pregnant women about AIDS was not significantly different in different age groups [p=0.151], while it had a significant relationship with their education [p=0.000]. There was a correlation between general knowledge and attitude in pregnant women [p=0.033] [r=0.126]. The attitude about AIDS in pregnant women was fairly good and there was a significant difference in this regard related to their education [p=0.000], while there was not significant difference regarding their age [p=0.410] [Mean =19.8]. There is an urgent need for HIV prevention efforts, such as health education and focusing on the pregnant women in developing world. Health educators should tailor education programs for women at risk, particularly those with lower education, to enhance their knowledge about HIV and to improve their attitude about AIDS