effect of vitamin e and selenium on sperm chromatin quality in couples with recurrent miscarriage

Background and Aims: Due to the paucity of studies, association between the morphology and function of sperm and recurrent miscarriage [RM] is not yet completely known. Increased reactive oxygen species and decreased antioxidant levels in men have been shown to be associated with RM. Recently it has been accepted that antioxidant therapy can approve sperm parameters. The goal of this study was to evaluate the effect of paternal factor and antioxidant therapy on sperm parameters in the couples with RM

Materials and Methods: Sixty ejaculate samples with RM patients were analyzed before and after 3 months of vitamin E and selenium therapy. Sperm chromatin assay was assessed by cytochemical tests including aniline blue, chromomycin A3, and toluidine blue. To measure DNA fragmentation index, terminal deoxynucleotidyl transferase dUTP nick end labeling [TUNEL] test was used. Data were analyzed by SPSS software

Results: Patients had significantly higher percentage of sperm parameters [p<0.001] compared to the time before treatment. TUNEL positive spermatozoa were decreased in post treatment compared to pre-treatment phase [p<0.0001]

Conclusions: Our study demonstrates that antioxidants can improve sperm parameters and chromatin condensation in recurrent miscarriage male partner

Evaluation of intracellular anion superoxide level, heat shock protein A2 and protamine positive spermatozoa percentages in teratoasthenozoospermia

Background: Teratoasthenozoospermia [TA] is a severe form of male infertility with no clear etiology

Objective: To compare the level of intracellular anion superoxide [O[2]-], heat shock protein A2 [HSPA2] and protamine deficiencies in ejaculated spermatozoa between teratoasthenozoospermic and normozoospermic men

Materials and Methods: In this case- control study, semen samples of 20 infertile men, with TA [with normal morphology lower than 4%_ and total motility lower than 40% ] as the case group and 20 normozoospermic fertile men as the control group were evaluated for intracellular O[2] - and HSPA2 by flow cytometry and protamine deficiency by Chromomycin A3 [CMA3] test

Results: The rate of CMA3+ spermatozoa in the case group was higher than controls [p=0.001]. The percentages of HSPA2[+] spermatozoa in the cases were significantly lower than controls [p=0.001]. Also, intracellular O[2] - levels in the case group were significantly higher than controls [p=0.001] and had positive correlations with sperm apoptosis [r=0.79, p=0.01] and CMA3 positive sperm [r=0.76, p=0.01], but negative correlations with normal morphology [r=-0.81, p=0.01] and motility [r=-0.81, p=0.01]. There was no significant correlation between intracellular O[2] - and HSPA2 in the case group [r=0.041, p=0.79]

Conclusion: We suggest that the increase in intracellular O[2] -, decrease in spermatozoa HSPA2[+], and high percentages of spermatozoa with immature chromatin might be considered as etiologies of infertility in TA patients

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 the appropriate size of follicles on success rate in patient undergoing controlled ovarian stimulation and intrauterine insemination cycles

Objectives: Intra-Uterine Insemination [IUI] is one of the methods for infertility treatments. The size of the follicles and endometrial thickness are two important factors in pregnancy rate of patients undergoing controlled ovarian stimulation and intrauterine insemination cycles [COH-IUI]. The aim of this study was to investigate the success rate of IUI and follicular size and other associated factors in infertile couples

Materials and Methods: The study group was the patients who were undergoing COH-IUI. BMI of all women recorded and ovulation induction was propelled and when there was appropriate endometrial thickness and at least one dominant follicle in trans-vaginal ultrasonography. 36 hours after HCG injection, IUI was performed. Then pregnancy rate between patients who had follicle size fewer than 20 mm and higher than 20 mm was assumed

Results: 159 cases of IUI were performed and pregnancy happened in 22[14.1 %]. In non-pregnant group [134 cases], 78 cases had under 20 mm follicles and 47 cases had higher than 20 mm follicles. In pregnant group [22 cases] 10 cases had fewer than 20 mm follicles and 12 cases had higher than 20 mm follicles in the time of HCG injection. Endometrial thickness was 8.01+/-1.42 mm in patients with follicles more than 20 mm

Conclusion: The success rate in controlled ovarian stimulation and intrauterine insemination cycles closely related to obtaining of optimal size of follicles and endometrial thickness

Etiologies of sperm oxidative stress

Sperm is particularly susceptible to reactive oxygen species [ROS] during critical phases of spermiogenesis. However, the level of seminal ROS is restricted by seminal antioxidants which have beneficial effects on sperm parameters and developmental potentials. Mitochondria and sperm plasma membrane are two major sites of ROS generation in sperm cells. Besides, leukocytes including polymer phonuclear [PMN] leukocytes and macrophages produce broad category of molecules including oxygen free radicals, non-radical species and reactive nitrogen species. Physiological role of ROS increase the intracellular cAMP which then activate protein kinase in male reproductive system. This indicates that spermatozoa need small amounts of ROS to acquire the ability of nuclear maturation regulation and condensation to fertilize the oocyte. There is a long list of intrinsic and extrinsic factors which can induce oxidative stress to interact with lipids, proteins and DNA molecules. As a result, we have lipid peroxidation, DNA fragmentation, axonemal damage, denaturation of the enzymes, over generation of superoxide in the mitochondria, lower antioxidant activity and finally abnormal spermatogenesis. If oxidative stress is considered as one of the main cause of DNA damage in the germ cells, then there should be good reason for antioxidant therapy in these conditions

Comparison of pregnancy outcome after letrozole versus clomiphene treatment for mild ovarian stimulation protocol in poor responders

Poor ovarian response to controlled ovarian stimulation is one of the most important interest points in assisted reproduction. Mild ovarian stimulation seems to be preferable to high dose of FSH regimens in women with a history of poor ovarian response in previous protocol. Clomiphene citrate and letrozole alone or in combination with FSH have been used in mild ovarian stimulation protocol. To compare the efficacy of letrozole and clomiphene citrate for mild ovarian stimulation on assisted reproductive technology outcomes in poor responders. In a randomized control study, 184 women aged between 20 and 45 years with the history of poor response to ovarian stimulation who were candidate for ART were randomly subdivided into two groups: group I [n= 80], women who underwent the clomiphene/gonadotropin/antagonist protocol; and group II [n= 87], patients who underwent the letrozole/gonadotropin/antagonist protocol. Groups were compared regarding implantation, chemical and clinical pregnancy rates, There was a significant difference in the mean endometrial thickness between two groups [9.16 +/- 1.2 mm vs. 83 +/- 0.3 mm]. The implantation rate was significantly higher in letrozole group compare to clomiphene group [7.2 vs. 6.6%, p=0.024 respectively]. No significant differences were found in chemical and clinical pregnancy rate between two groups. In mild ovarian stimulation protocol, letrozole and clomiphene have similar value for the poor responder. The optimal treatment strategy for these patients remains debated

Preservation of ovarian function during chemotherapy and radiotherapy in young women with malignancies

Malignancies are not rare in girl and women during their reproductive years. Over the past three decades, the survival rate for cancer has been improving due to progress in cancer diagnosis and treatment. These patients frequently experience a variety of treatment, and disease-related side effects that diminish their quality of life during and after treatment; among these are loss of fertility and sexual dysfunction. There have been recent advances in the field of fertility preservation, which can allow many of these genital cancer survivors to have children in the future. This topic review discusses available options and specific strategies for fertility preservation in adolescent and young women with malignancies who wish to preserve their ability to become pregnant in the future

Coexisting pelvic tuberculosis and endometriosis presenting in an infertile woman: report of a rare case

Primary and secondary infertility are the most common presenting symptom in patients with pelvic tuberculosis [PT]. Endometriosis is commonly associated with an increased risk of infertility. Here, we report a rare case of coexisting PT and endometriosis in a 30-year- old woman, and the effects of controlled ovarian stimulation on reactivation of pathogen. Coexisting endometriosis and tuberculosis of fallopian tube and ovary, as in present case, may alter clinical and radiological features, leading to difficulty in diagnosis. Early diagnosis with surgical exploration and adequate treatment can improve the chances of conception and also minimize morbidity

Evaluation of clinical factors influencing pregnancy rate in frozen embryo transfer

Frozen embryo transfer [FET] is one of the most important supplementary procedures in the treatment of infertile couples. While general information concerning the outcome of fresh embryo transfer has been documented, paucity of investigations has addressed the clinical factors influenced on pregnancy rates in FET. In this study, we performed a retrospective analysis of clinical factors that potentially influence the outcome of FET. We reviewed the data from 372 women who were subjected to FET registered from April 2009-2011 at the Research and clinical center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Baseline data and pregnancy rate were collected. The data were analyzed statistically using the Kolmogorov-Smirnov, and Mann-Whitney tests. The clinical pregnancy rate was 57.7 and 29.2% in women <35 years old, and women >35 years old, respectively [p<0.0001]. Clinical pregnancy rates in women with FSH <10 IU/ml, and FSH >10 IU/ml were 56.3% and 17.5%, respectively [p<0.0001]. Whereas the other clinical parameters consist of reason of fetus freezing, primary IVF protocol, IVF procedure, endometrial thickness, treatment duration to fetal transfer found to be unrelated to FET outcomes [p>0.05]. Female age and basal FSH level are the most important factors influencing the clinical pregnancy rate following FET

Duration of storage does not influence pregnancy outcome in cryopreserved human embryos

Cryopreservation of embryos has been an usual component of clinic in assisted reproductive technology [ART] programs. Recently the dramatic increase in cryobiology activity in the clinical centers has enhanced methods of freezing and improved vitrification protocols are being developed. The aim of our study was to assess the effect of storage duration of frozen embryo on ART outcome. In this retrospective study the data of 651 frozen-thawed embryo transfer cycles were assessed over a 36-months period. Our patients were categorized according to storage time of freeze. Group I: less than 90 days, Group II: between 90-365 days. Group III: between 365-730 days. Group IV: between 730-1095 days. Group V: more than 1095 days. Clinical pregnancy and implantation rate were defined and statistical analysis was performed using Student t-test and Chi-square. According to our finding patient's mean age was 31.05 +/- 5.231 years [range, 18-53 years], and 1204 embryos were transferred . The mean storage duration was 296.72 +/- 301.82 days. The mean number of embryo transferred per cycle was similar between groups [p=0.224]. According to our analysis clinical pregnancy rate per embryo transfer cycle was similar between groups [p=0.563]. Our results showed that duration of storage had no negative effects on implantation of cryopreserved embryos. In our literature review we found a little article In this context. However our study showed duration of freezing don't have any negative effects on implantation and pregnancy outcome, but more studies are needed to evaluate long term effects of storage duration on babies were born by cryopreserved embryos