Assessing the prevalence of Staphylococcus aureus in infertile male patients in Tabriz, northwest Iran

Background: staphylococcus aureus is an infrequent, but one of the most successful bacteria that associated with infertility and are able to spermatozoa immobilization and agglutination

Objective: the aim of present study was to determine the frequency of S. aureus in semen obtained from infertile male patients in northwest Iran

Materials and Methods: seminal fluids of 100 infertile men were evaluated. Standard semen examination was done according to World Health Organization guidelines. After isolation and identification of S. aureus isolates according to reference methods, determination of susceptibility against important antibiotics and polymerase chain reaction were performed to identify mecA and tst genes

Results: data obtained from the present study shows that 16% of infertile male patients were colonized by S. aureus. Ten [62.5%] of the individuals had abnormal seminal fluid sperm motility and morphology and three [18.8%] of them had an abnormal seminal fluid density, whereas after washing with albumin-saline declined to 5 [31.3%], 4 [25%] and 1 [6.3%], respectively. The antibiogram results showed that, except penicillin, other antibiotics have high activity on isolates. Regarding polymerase chain reaction results, mecA sequences were detected in 3 [18.7%] strains, whilst the tst gene encoding TSST-1 was not detected in any of clinical strains

Conclusion: it would appear that the S. aureus may be an additional negative factor worsening sperm quality and affecting male fertility. Therefore, it demands that all the patients attending in infertility treatment facilities be investigated thoroughly

[Efficacy of uteral injection of GCSP in repeated implantation failure: a clinical trial study]

Background: despite advances in clinical and laboratory techniques, including stimulating ovulation and transferring embryo, success rate of pregnancy remains is about 30%. The aim of this study was to assess the effect of intra uterine G-CSF on implantation and clinical pregnancy rate in patients with implantation failure in IVF

Methods: this study was a randomized clinical trial on patients undergoing in vitro fertilization within an age range of 45-18 years and a history of failure in implantation for two or more times. A total of 34 patients receiving G-CSF in the intervention group and 38 patients in the control group were enrolled

Results: mean age of the participants was 34.1 years with a standard deviation of 6.4 years. The average number of years of fertility was 10 years with a standard deviation of 5.2 years. The average number of embryos implanted in the intervention group was 2.88 with a standard deviation of 0.33. The figures for the control group were 2.97 and 0.37, respectively. The two groups did not differ significantly. With respect to the potential clinical and laboratory fertility outcomes, including existing gestational sac with observed heart rate and positive serum betaHCG, no statistically significant difference was observed between the two groups

Conclusion: it seems that the effect of G-CSF on improving fertility outcomes inpatients with implantation failure does not exist and more related studies are recommended in this regard

frequency of Staphylococcus aureus isolated from endocervix of infertile women in Northwest Iran

Background: Infertility is one of the major social issues. Due to the asymptomatic cervical infection associated with Staphylococcus aureus [S. aureus], the majority of patients remain undiagnosed. The present study intended to assess the frequency of S. aureus isolated from infertile women's endocervix in northwest Iran

Materials and Methods: In a descriptive cross sectional study, specimens were randomly collected during vagina examination using a sterile speculum and swabbing. After performance of antibiotic susceptibility testing, polymerase chain reaction [PCR] was used to identify methicillin-resistance S. aureus [MRSA] and toxic shock syndrome toxin-1 [TSST-1]

Results: About 26 [26%] and 9 [9%] women's urogenital tracts were colonized by S. aureus and Candida spp., respectively, of which three [11.5%] patients were infected with fungi and S. aureus, simultaneously. Antibiotic susceptibility results showed high activity of vancomycin and co-trimoxazole on isolates. Regarding PCR results, mecA sequences were detected in 7 [26.9%] strains, whilst the tst gene encoding TSST-1 was not detected in any of clinical strains

Conclusion: The prevalence of S. aureus was very high in infertile women. Therefore, it demands all patients undergoing infertility treatment to be investigated thoroughly for this type of infection

Frequency of null allele of Human Leukocyte Antigen-G [HLA-G] locus in subjects to recurrent miscarriage

Background: Human leukocyte antigen-G [HLA-G] is a non-classical class I molecule highly expressed by extravillous cytotrophoblast cells. Due to a single base pair deletion, its function can be compensated by other isoforms. Investigating the frequency of null allele in Recurrent Miscarriage [RM] subjects could be useful in understanding the relationship between frequency of this allele and RM in a given population

Objective: This study aimed to determine the frequency of HLA-G*0105N null allele and its potential association with down-regulation of HLA-G in subjects with RM

Materials and Methods: Western blotting was used to assess the level of HLA-G protein expression. For investigating the frequency of HLA-G*0105N null allele in RM subjects, PCR-RFLP method was used. Exon 3 of HLA-G gene was amplified by polymerase chain reaction [PCR]. Subsequently, PpuM-1 enzyme was employed to digest the PCR products and fragments were analyzed using gel electrophoresis

Results: Digestion using restriction enzyme showed the presence of heterozygous HLA-G*0105N null allele in 10% of the test population. Western blotting results confirmed the decrease in expression of HLA-G in the placental tissue of subjects with RM compared to subjects who could give normal birth

Conclusion: The frequency of heterozygous HLA-G*0105N null allele was high to some extent in subjects with RM. The mutation rate in subjects suggested that there is a significant association between RM and frequency of mutations in this allele

Correlation between follicular fluid 25-OH vitamin D and assisted reproductive outcomes

Vitamin D in complex with its receptor by regulating gene expression, endometrium immune response and stimulation of endometrium decidualization can be involved in implantation. So, it seems that the amount of vitamin D in follicular fluids [FF] may have an association with ART success. First, we intended to investigate the possible association between levels of follicular fluids 25-OH vitamin D with assisted reproductive outcomes. Second, we examined relationship between 25-OH vitamin D levels with number and quality of oocytes. In a prospective study, 80 infertile female candidates for IVF/ICSI were enrolled. Blood samples [on the day of human chorionic gonadotropin administration] and follicular fluids were taken, and then levels of serum estradiol and follicular fluids 25-OH vitamin D were measured. Also clinical characteristics of patients [duration of infertility, causes of infertility, menstrual status], number and quality of oocytes, number of fertilized oocytes, estradiol levels, and clinical pregnancy were evaluated. Concentration of FF 25-OH vitamin D in pregnant women was significantly higher than non-pregnant women [p=0.007] but there were no significant differences in age, body mass index [BMI], duration of infertility, menstrual status, number of oocytes, oocytes quality, number of fertilized oocytes, and serum estradiol levels between the two groups. Statistically positive correlation was found between 25-OH vitamin D levels with patient age and implantation rate [r=0.264, p=0.018 and r=0.301, p-0.007 respectively]. The obtained results suggest that vitamin D without affecting the number and quality of oocytes can independently improve implantation rate and 1VF outcome

Relationship between serum leptin, ghrelin and dietary macronutrients in women with polycystic ovary syndrome

Polycystic ovary syndrome [PCOS] is the most common endocrinopa-thy in women. It may involve an impairment in physiologic regulation of leptin and ghrelin. There is limited, controversial data on the relation of dietary components with leptin and ghrelin in PCOS, so the current study has been conducted to explore the effects of different macronutrients on serum levels of leptin and ghrelin in PCOS and healthy subjects. In this case-control study, we randomly choose 30 PCOS patients and 30 healthy age and body mass index [BMI] matched controls. Intake of macro-nutrients [protein, total fat, saturated, monounsaturated and polyunsaturated fatty acids [PUFA], carbohydrate, dietary fiber] and energy were assessed using 3-day, 24-hour food recall and food frequency questionnaires [FFQ]. Fasting hormonal status was measured for each participant. PCOS women had higher levels of serum leptin, insulin, testosterone, and lute-inizing hormone [LH], whereas sex hormone-binding globulin [SHBG] was lower compared to healthy women. There was no significant difference in mean ghrelin concentrations between the groups. Among PCOS women, independent of BMI and total energy intake, we observed an inverse association between leptin concentration and total dietary fat [p=-0.16, P<0.05] and saturated fatty acid [SFA] intake [p=-0.58, P<0.05]. This relationship was not seen in the healthy subjects. There was no significant association between ghrelin and macronutrients in PCOS and healthy participants. Certain habitual dietary components such as fat and SFA may decrease serum leptin, whereas ghrelin is not influenced by these in PCOS women. More studies are needed to better clarify the effects of dietary macronutrients on serum leptin and ghrelin

Paraoxonase 3 activity and the ratio of antioxidant to peroxidation in the follicular fluid of infertile women

Paraoxonase-3 [PON3], as a high density lipoprotein [HDL]-associated lactonase, is capable of preventing the oxidative modification of low density lipoprotein [LDL]. PON3 activity in follicular fluid [FF] is three times more than its activity in serum. However, the detailed role of PON3 in women's fertility remains unknown. The aim of this study was to investigate the correlation between PON3 activity in the FF of women undergoing assisted reproductive technique [ART], in vitro fertilization [IVF], or intra-cytoplasmic sperm injection [ICSI]. This cross-sectional study consisted of 50 women from couples with male factor infertility [MFI] or with female factor infertility [FFI]. The FF samples were obtained during the ART intervention. PON3 activity, HDL cholesterol [HDL C], total antioxidant status [TAS] and the level of malondialdehyde [MDA] were determined. The morphology of the embryo was determined using embryo cell number [ECN] and embryo fragmentation score [EFS]. In addition, fertilization rate [FR] was used an oocyte fertilization index. Of 50 women, 20 women belonged to FFI group and the remaining 30 women belonged to MFI group. PON3 activity in FF of women in FFI group was significantly lower [p<0.05] in comparison with corresponding value in MFI group. The value of PON3 activity/MDA in the FFI group was lower than that in MFI group. Moreover, MDA level in the FF of FFI group was significantly higher [p<0.05] than its concentration in MFI group. Meanwhile, no significant difference was found in HDL-C concentration and TAS of both groups. No significant correlation was observed between the ECN and FF biochemical parameters. There was also a negative correlation between FR and MDA [r=-0.42, p=0.02], whereas a positive relation between FR with PON3 activity [r=0.59, p=0.004], HDL-C [r=0.35, p=0.04] and PON3/MDA [r=0.59, p=0.001]. Conclusion: According to the results of this study, PON3 activity level as a key component of antioxidant system in FF may directly be associated with the success rate of ART and fertilization rate in women

effect of nitric oxide with minimal stimulation on patients with polycystic ovarian syndrome

Infertility is one of the most prevalent problems among young couples especially in women with Polycystic Ovary Syndrome. In women, PCO is associated with lack of ovulation, abdominal obesity and insulin resistance. The aim of this study is to investigate the effect of nitric oxide with minimal stimulation in the treatment of infertility in women with PCOS. Materials and In a randomized single blind clinical trial [RCT], 120 women who had polycystic ovarian syndrome [PCOS], were with PCOS who were eligible to be studied were divided into two groups; study group and a control group [60 patients in each group] and the effects of Nitric Oxide with minimal stimulation on the treatment of infertility were investigated in the patients who were being treated with IUI. The mean age of the patients, who were 21 to 35 years old, was 28.3 +/- 4.2 years. In the study group, 43 cases [71.7%] and in the control group, 52 cases [86.7%] had ovulation. The difference between these two groups was statistically significant [p=0.03]. The successful pregnancy rate was 10 cases [16.6%] in the study group and 8 cases in the control group [13.3%], however this difference was not statistically significant [p=0.18]. The difference between the two groups regarding mature follicles was not significant either [p=0.27], but the difference regarding the endometrial thickness on the gonadotropin administration day was statistically significant [p=0.02]. According to the results and since there was not a significant difference between the two groups regarding the pregnancy rate, it can be concluded that employing nitric oxide tablets in addition to the common treatment, does not affect pregnancy rate in women with PCOS

Altered of microRNA expression level in oligospermic patients

MicroRNA [miRNA] is small endogenous, single strand RNA molecules that regulate gene expression at post-transeriptional level through several mechanisms to affect key cellular event including male germ cells differentiation, proliferation, development and apoptosis. Mutation and/or aberrant expression of miRNAs have been associated with progression of various disorders, including infertility. The purpose of this research was to study the estrogen receptor beta [ERbeta], hsa-mir-21 and, hsa-mir-22 expression level in oligospermic infertile and control fertile men and correlation between them. In this study, the change in mir-21, mir-22 expression and their common target gene [ERbeta] expression levels were evaluated in oligospermic infertile men [n= 43] compared with 43 age matched healthy control by Real-Time PCR methods. Expression analysis by qRT-PCR test on miRNA have identified that mir-21, mir-22 levels were significantly higher than those in normal controls [p<0.0001] and ER beta expression level significantly decreased in comparison with the normal group [p<0.0001]. Our study showed that mir-21 and mir-22 are indirectly involved in spermatogenesis by regulating of the estrogen receptor and might have a diagnostic and prognostic value in men infertility

Fatty acid composition of human follicular fluid phospholipids and fertilization rate in assisted reproductive techniques

Fatty acids are known to be critically important in multiple biological functions. Phospholipid fatty acids of follicular fluid, an important microenvironment for the development of oocytes, may contribute to the women's fertility and the efficacy of assisted reproduction techniques. The aim of this study was to investigate the effect of fatty acid composition of follicular fluid phospholipids on women undergoing assisted reproductive techniques. Follicular fluid samples were obtained from 100 patients, referred to Tabriz Alzahra Hospital. Seventy-nine subjects underwent in vitro fertilization [IVF] and the remaining 21 underwent intracytoplasmic sperm injection [ICSI]. Total lipid of follicular fluid was extracted and fatty acids were analyzed by gas-liquid chromatography. Saturated fatty acids [SFA, P = 0.002] and the ratio of SFA to polyunsaturated fatty acids [P = 0.001] were correlated negatively with a number of mature oocytes after age adjustment. Linoleic acid [P = 0.006] was positively correlated, while the level of arachidonic acid was negatively correlated with fertility percentage after adjustment for body mass index, sperm count, sperm motility. Since phospholipids are one of the major components of lipid metabolism, the results of this study highlight the importance of this component in follicular fluid lipid metabolism. Consequently, it is proposed as an index in determination of the rate of success in assisted reproductive techniques such as IVF/ICSI

Serum leptin and ghrelin levels in women with polycystic ovary syndrome: correlation with anthropometric, metabolic, and endocrine parameters

Polycystic ovary syndrome [PCOS] patients are more prone to abnormal production of some regulatory peptides. In these patients, studies on the serum levels of leptin and ghrelin are controversial. This study aims to investigate serum levels of leptin and ghrelin and their correlation with metabolic and endocrine indices in PCOS. This case-control study was conducted on 60 women; 30 with PCOS and 30 healthy women whose age and body mass index [BMI] were matched and who were referred to Alzahra Hospital, Tabriz, Iran. Serum levels of leptin, ghrelin, insulin, luteinizing hormone [LH], follicle stimulating hormone [FSH], sex hormone-binding globulin [SHBG], and testosterone were measured. The homeostasis model assessment of insulin resistance [HOMA-IR] was calculated. Descriptive statistics and correlations were performed using SPSS 12.0 for Windows. In PCOS women, serum levels of leptin, insulin, HOMA-IR, testosterone, LH, and LH/FSH were significantly higher, while SHBG was lower than in healthy women. Ghrelin and FSH were similar in both groups. Serum levels of leptin correlated with BMI [r=0.85, p<0.001], waist to hip ratio [WHR] [r=0.55, p<0.01], insulin levels [r=0.85, p<0.001] and HOMA-IR [r=0.67, p<0.01], while ghrelin levels had an inverse association with testosterone [r=-0.32, p=0.04]. The results showed increased leptin levels while ghrelin remained unchanged in PCOS patients. In PCOS patients, leptin positively correlated with BMI, WHR, insulin, and insulin resistance, while ghrelin was only associated with serum testosterone levels

Correlation between PPAR gamma protein expression level in granulosa cells and pregnancy rate in IVF program

Peroxisome proliferative-activated receptors [PPARs] are nuclear receptors that involved in cellular lipid metabolism and differentiation. The subtype gamma of the PPAR family [PPAR gamma] plays important roles in physiologic functions of ovaries. To determine correlation between PPAR gamma protein level in granulosa cells and pregnancy rate in women undergoing in-vitro fertilization [IVF] treatment. In this cross-sectional study, twenty-five samples of granulosa cells were collected from women referred to an IVF treatment center. PPAR gamma protein expression level in granulosa cells was determined in comparison with beta -actin level as control gene with Western blot test. Laboratory pregnancy was determined by a rise in blood beta -hCG level fourteen days after embryo transfer. Correlation analyses were used to test for associations between the oocytes and pregnancy occurrence as outcome variables and PPAR gamma protein expression level. Correlation analysis indicated that there was no significant relationship between granulosa cells PPAR gamma protein level with IVF parameters including number of matured oocytes and the ratio of fertilized to matured oocytes. Comparison of granulosa cells PPAR gamma protein level with positive and negative laboratory pregnancy revealed also no significant relationship. According to the results of this study, PPAR gamma protein level in granulosa cells could not be directly correlated to the success rate of IVF

Correlation between the level of cholesteryl ester transfer protein in follicular fluid with fertilization rates in IVF/ ICSI cycles

Follicular fluid [FF] plays an important role in oocytes and embryo development, which may contribute to IVF/ICSI success rate. The aim of this study was to investigate the correlation between cholesteryl ester transfer protein [CETP] level in FF and the success rate of IVF/ICSI. In a cross-sectional study, FF samples, FF samples were obtained from 100 patients referred to Tabriz Alzahra Hospital. Seventy-nine subjects underwent IVF and the remaining 21 underwent ICSI. The levels of high-density lipoprotein cholesterol [HDL-C], apolipoprotein A-I and CETP were measured using enzymatic, turbidometric and ELISA methods respectively. Analysis of the subgroups with different levels of CETP showed a significant lower level of CETP in the subgroup with the lowest number of mature oocytes [p<0.05]. The level of CETP was also considerably lower [18%, p=0.05] in subjects with<50% oocytes fertilization ratio than subjects with >70% of this ratio. While no association was found for pregnancy, the amount of CETP in FF was associated positively to the maturity and the percentage of oocyte fertilization

Comparison of the effect of gonadotropin-releasing hormone agonist and dopamine receptor agonist on uterine myoma growth. Histologic, sonographic, and intra-operative changes

To investigate the effect of 2 medications; Diphereline and Cabergoline, on uterine leiomyoma growth, and its histologic, sonographic, and intra-operative changes. In an effort to treat large uterine leiomyoma in symptomatic patients in the Gynecology Clinics of the Alzahra Teaching Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, from September 2007 to November 2008, 60 candidates randomized to receive Diphereline 3.75 mg, 4 times every 28 days [group I], and Cabergoline 0.5 mg, once a week for 6 weeks [group II], were included in this study. Clinical symptoms, feasibility of intra-operative dissection, intraoperative complications, sonographic, and pathologic characteristics of the tumor were evaluated. Thirteen patients from group I, and 10 patients from group II underwent surgery. There was a significant difference between the groups in the rate of lymphocyte infiltration [p=0.003], but not in other pathologic features. In both groups, the mitotic index was between 0-10. While there was no significant difference between the groups in the number [p=0.30], and volume of leiomyomas [p=0.65], however, changes in the uterine artery circulation was significant [p=0.001 [group I], p=0.026 [group II]]. In addition, there was a significant difference between the groups for intra-operative hemorrhage and adhesion of leiomyomas to the uterine wall. This study found that Cabergoline is as effective as Diphereline in the shrinkage of myomas, accompanied by improvement in the sonographic, clinical, and intra-operative outcomes without any adverse pathological changes, and could be a good medical regimen as an adjunct to surgical management

Conscious sedation with and without paracervical block for transvaginal ultrasonically guided oocyte collection: a comarison of the pain and sedation levels, And postoperative side effects

The quality of intraoperative analgesia with paracervical block [PCB] during egg collection in in-vitro fertilization [IVF] is still unclear. This study performed to compare the pain levels during egg collection and the subsequent intra and postoperative side effects in patients receiving a conscious sedation with and without paracervical block. In this prospective, double-blind, and placebo'controlled study, 60 patients undergoing egg collection in their first IVF cycle were randomized to receive conscious sedation in conjunction with paracervical block with 10 ml lidocaine 1.5% [sedation + PCB patients or study group] or with 10 ml normal saline [sedation patients or placebo group]. Patients in study group experienced significantly less vaginal [10.40 +/- 8.40 mm vs 20.77 +/- 4.60 mm respectively; p<0.0005] and abdominal pain [10.87 +/- 5.08 mm vs 35.33 +/- 4.27 mm respectively; p<0.0005] during egg collection, compared with those in placebo group. Propofol requirements was 8.67 +/- 2.42 mg in PCB patients vs 25.60 +/- 5.29 mg in placebo group [p<0.0005]. Incidence of intraoperative [9.90% vs 50% respectively; p=0.002] and postoperative [3.33% vs 56.66% respectively; p<0.0005] side effects were significantly less in study patients compared with placebo group. Conscious sedation with PCB appears to be an effective and safe method of providing analgesia and anesthesia for transvaginal retrieval of oocyte

Evaluation of endometriosis in diagnostic laparoscopy of infertile women without any significant symptoms of endometriosis

Regarding the importance of infertility, endometriosis is one of its important and curable causes. We have evaluated in this study the rate of occult endometriosis in infertile patients with unknown cause undergoing laparoscopy. We prospectively studied 58 patients with unexplained infertility who had been referred to Al-Zahra Hospital in a 12-month period [from Dec. 2001 to Dec 2002] who underwent laparoscopy. Of 58 studied patients, 8 [13.79%] had pathologically proven, endometriosis, In laparoscopy, 4 cases [6.89%] had uterine myomatosis and in the others, uterus proved to be normal. 4 Patient [6.89%] had peritoneal adhesion, and adhesion of right adenexa was found in 8 [13.79%] and the left adenexa in 10 [17.24%], and posterior portion of uterine in 6 [10.34%]. Two cases had posterior cul-de-sac fluid. In this study there was a significant relationship between dysparonia and adhesion of left adenexa, adhesion.of posterior surface of uterine and fluid in cul-de-sac in laparoscopy [P=0.001, P=0,006, and P-0,027, respectively]. Also, there-was a significant relationship between galactohea and peritoneal adhesion and adhesion of posterior surface of uterine and fluid in cul-de-sac [P=0.021, P=0.49, and P=0.004, respectively]. In our study the prevalence of occult endometriosis was 13.79% that is in accordance with the previous researches, so in cases with unexplained infertility that do not respond to any treatment, one can immediately try to treat infertility with suspicion of probable occult endometriosis