Granulocyte-colony stimulating factor may improve pregnancy outcome in patients with history of unexplained recurrent implantation failure: an RCT

Background: Family of colony-stimulating factors [CSF] have an essential role on early cross talk between embryo and uterine endometrium

Objective: The aim of this study was to evaluate the effects of the single dose of Granulocyte-CSF [G-CSF] injection on clinical outcome of assisted reproductive technology cycle in patients with repeated implantation failures

Materials and Methods: This randomized control trial study was performed on 52 infertile women who referred to the clinic with the history of more than three previous In vitro fertilization/Intracytoplasmic sperm injection-embryo transfer failures. All patients were stimulated with standard long protocol. All embryos were transferred on day five in blastocyst stage in both groups. The treated group received 300 Mug [0.5 ml] recombinant human G-CSF subcutaneously which was injected 30 min before blastocyst embryo transfer

Results: There was not statistically significant differences in abortion rate in G-CSF and control group [p=0.09]. G-CSF treated group showed higher clinical pregnancy rate in comparison with control group [56.2% vs. 40.0%] but it was not statistically significant [p=0.09]. Although live birth rate in G-CSF group was higher than control group [53.1% vs. 35.0%] but there wasn't statistically significant difference in the overall live birth rate between the two groups [p=0.10]. G-CSF group had a twin pregnancies while in control group there was no twin pregnancy

Conclusion: Our result demonstrates the possibility that pregnancy outcome is better in women with repeated unexplained In vitro fertilization failure who are treated with G-CSF

Modified natural cycle frozen-thawed embryo transfer in patients with repeated implantation failure: an observational study

Background: Natural endometrium in Frozen-thawed Embryo Transfer [FET] may have some benefits upon implantation in patients with Repeated Implantation Failure [RIF]. It might be due to possible differences between natural and stimulated endometrial growth factors and cytokins secretions

Objective: The objective of this study was to compare the pregnancy rate of FET on modified natural cycle versus hormone replacement therapy [HRT] cycle endometrium in patients with RIF

Materials and Methods: In this observational study the pregnancy rate of patients with RIF undergoing day 3 FET in natural cycle endometrium [group 1, n=56], were compared with another group of patients with RIF in whom frozen-thawed day 3 embryos were transferred on HRT cycle [group 2, n=52]

Results: The pregnancy rate in group 1 was 41.07%, compared with the pregnancy rate of group 2; 36.5% [p=0.63]. The abortion rate was not significantly different among the groups

Conclusion: It can be concluded that FET in a modified natural cycle is comparable with HRT cycle in patients with RIF

Isolation and partial characterization of human amniotic epithelial cells: the effect of trypsin

Despite the extensive information available in the literature, cell surface marker signature of human Amniotic Epithelial Cells [hAECs] remains controversial. The aim of the present study was to characterize immunophenotypic features, proliferative capacity and immunogenicity of hAECs. We also tested whether expression of some cell surface markers is influenced by the type of trypsin used for tissue digestion. Single cell suspensions of amniotic membranes from four human placentas were isolated by enzymatic digestion and expression of CD9, CD10, CD29, CD34, CD38, CD44, CD45, CD73, CD105, CD133, HLA-I, HLA-DR, HLA-G, SSEA-4, STRO-1 and OCT-4 was then evaluated by flow cytometry. The differential impact of four trypsin types on the yield and expression of CD105 and HLA-I was also determined. The proliferative capacity of cultured hAECs was assessed and compared in the presence and absence of Epidermal Growth Factor [EGF]. To test their immunogenicity, hAECs were injected into Balb/c mice and the reactivity of hyperimmunized sera was examined by immunofluorescence staining. Nearly all purified cells expressed mesenchymal markers, CD9, CD10, CD29, and CD73 and the embryonic marker, SSEA-4. A large proportion of the cells also expressed STRO-1 and OCT-4. The purified cells also expressed HLA-G and HLA-I. A very small proportion of hAECs expressed CD34, CD38, CD44, CD133 and HLA-DR. The type of trypsin used for enzymatic digestion affected both the percentage and expression of HLA-I and CD105. hAECs revealed substantial proliferative capacity only when cultured in the medium supplemented with EGF. These cells were shown to be capable of inducing high amounts of anti-donor antibodies. Here we provided evidence that hAECs are immunogenic cells with high level of HLA-I expression. Furthermore, this work highlighted the impact of isolation procedure on the immunophenotype of hAEC

[Health related quality of life in women with Polycystic Ovary Syndrome [PCOS]]

Objective [s]: Polycystic ovary syndrome [PCOS] is a disorder of hyperandrogenemia and chronic anovulation which affects 5-10% of all women. The PCOS symptoms such as hirsutism, irregular menses, obesity and infertility are a major source of psychological morbidity and can negatively affect quality of life. In this study, we examined the health-related quality of life among Iranian women who suffering from PCOS

Study design: Quality of life was assessed in five domain separatively [menstrual disorders, hirsutism, infertility problems, emotions, and obesity] in 152 women who referred to Tehran selected infertility centers in Tehran, Iran in 2010-2011

Results: The findings showed that patients scored lower on menstrual disorders, hirsutism, infertility problems, emotions, and obesity

Conclusion: This study showed that menstural disorder is the most important domain that affects Iranian women's HR-QoL

Thyroid autoantibodies in euthyroid women with recurrent abortions and infertility

Evidences suggest an association between the prevalence of thyroid peroxidase [anti-TPO] and anti thyroglobulin [anti-Tg] with recurrent abortions and infertility. Iodine deficiency was once endemic in Iran and little data is available about the prevalence of these antibodies in different groups of fertile or infertile individuals. This case control study was designed to compare the presence of anti-TPO and anti-Tg in four groups of women to reveal their role in the etiology of recurrent abortion and infertility. Four groups of euthyroid women referring to Avicenna Infertility Clinic in Tehran were selected; 95 cases as fertile controls and 70, 78 and 137 cases with male and female factor infertility and recurrent abortion respectively. TSH, anti-TPO and anti-Tg were evaluated by chemiluminescent immunoassay. The prevalence of the above mentioned autoantibodies in euthyroid controls was about 25% and the percentage of people with an anti-Tg >500 was two times bigger in the abortion group compared to the control group [p<0.05] and the proportion of people with an anti-Tg>500 in younger cases in the abortion group was significantly higher than the rest of the cases [p<0.05]. Anti-TPO distribution had no significant differences. There were no statistically significant differences among four groups. It seems that more comprehensive studies are needed to reach a common conclusion about thyroid autoantibodies in women with recurrent abortions in different groups and different parts of Iran. In addition, dividing the recurrent abortion and infertility groups on the basis of their etiologies could be effective

C-reactive protein level and pregnancy rate in patients undergoing IVF/ICSI

C-reactive protein [CRP] can be increased after hormonal stimulations. The changes of CRP might affect the success of in-vitro fertilization [IVF]. The aim of this study was to determine the possible relationship between the serum CRP level and outcome of controlled ovarian stimulation, and pregnancy rate in patients undergoing IVF or intra cytoplasmic sperm injection [ICSI]. This prospective cross sectional study was performed in Avicenna Infertility Clinic on 70 consecutive infertile patients [Jan 2008-Aug 2009] who were candidate for IVF/ICSI, using standard long GnRH agonist protocol. Blood was drawn 4 times during the cycle, on first day of stimulation, the day of HCG injection, the day of ovum pick up, and the day of embryo transfer. In 82.2% of cases, the serum CRP level was higher in day of HCG injection than first day of stimulation and also the day of ovum pick up the day of HCG injection. The ratio of CRP level in the day of transfer to the day of ovum pick up, was significantly higher [ratio >/= 1.23] in patients who became pregnant after ICSI [p=0001]. All patients with less than this Ratio have not been pregnant. Controlled ovarian hyper stimulation and puncture of ovaries can potentiate systemic stimulation. Increasing serum CRP level in day of embryo transfer rather than ovum pick up can predict the success in patients undergoing IVF/ICSI

Serum leptin levels in women with immunological recurrent abortion

Recurrent abortion [RA] may be a consequence of aberrant expression of immunological factors during pregnancy. Although the relative importance of immunological factors in human reproduction remains controversial, substantial evidence suggests that autoantibodies contribute to reproductive failure. Production of such antibodies is under the control of cytokines; and leptin, besides its role in reproductive success, has a profound effect on directing the cytokine profile toward Th[1] [cellular] pattern. Therefore, the present study was performed to assess serum leptin levels in women with immunological recurrent abortion. In this prospective study, 250 women who attended Avicenna Infertility Clinic with RA were screened for known causes of abortion from July to December 2008 in Tehran, Iran. Eighty-one patients with normal karyotypes and hormonal profile with normal ovaries and uterus and no signs of infection were categorized as patients with immunological [IRA, n = 39] or unexplained [URA, n = 42] recurrent abortion based on presence or absence of autoantibodies. After blood sampling, levels of anti-nuclear antibody [ANA], anti-double stranded DNA antibody [anti-dsDNA], lupus anti-coagulant antibody [LACAb], anti-phospholipid antibody [APA], anti-cardiolipin antibody [ACA], anti-thyroglobulin antibody [TgAb], anti-thyroperoxidase antibody [TPOAb] and anti-thrombin III antibody [ATIIIAb] were measured by enzyme-linked immunosorbent assay [ELISA] or chemiluminescent enzyme immunoassay [CLEIA]. In IRA group, 9 [23.1%], 24 [61.5%], 25[64.1%] and 1 [2.6%] women were above the normal cut-off point for ANA, TgAbs, TPOAbs and AT-III Abs, respectively. IRA patients had normal values of LACAbs, APA and ACA. With normal level of fasting blood sugar [FBS], IRA and URA groups had similar serum leptin levels [23.7 +/- 13.2 ng/ml vs. 22.7 +/- 12.5 ng/ml, respectively]. Serum leptin concentrations showed a positive correlation with weight and BMI in both groups. This study suggests that serum leptin levels are higher in IRA and URA patients than normal women. The findings of this study suggest the need for a more comprehensive study and comparison of leptin levels in IRA and URA patients to women with no history of miscarriages

Effects of sperm chromatin integrity on fertilization rate and embryo quality following intracytoplasmic sperm injection

Sperm chromatin integrity has been being recognized as an important factor in male fertility. During normal fertilization, high quality sperm with intact chromatin are selected through natural selection in journey from vagina to fallopian tube. However, using Assisted Reproductive Techniques, particularly ICSI, the natural selection is bypassed. Therefore sperm with DMA breakage have the opportunity to fertilize the egg which may lead to decreased embryo quality and implantation rate. The aim of this study was to evaluate the effects of sperm chromatin integrity on ICSI outcomes. A total of 200 semen samples were collected from couples undergoing ICSI and were analyzed according to WHO criteria. Each sample was evaluated for sperm chromatin integrity using four cytochemical assays and semen processing by swim up method. The ICSI was carried out according to a long-term pituitary down-regulation protocol. The correlation between sperm parameters, sperm chromatin integrity and ICSI outcomes [fertilization rate and embryo quality] was examined. The mean number of oocyte, fertilization rate and cleavage embryos per cycles was 7.5 +/- 5.0, 74.O6% +/- 25 and 5.4 +/- 3.6, respectively. There was not significant correlation between the results of chromatin assays [AO, AB, TB, and CMA3] and fertilization outcomes following ICSI. The fertilization rate was significantly higher for a group with less than 10% chromatin abnormality [p<0.05]. Sperm chromatin integrity is essential for successful fertilization, embryo development and normal pregnancy. A protamine deficiency appeared to affect fertilization rate and embryo quality. However, the presence of confounding factors such as selection of spermatozoa according to normal morphology may influence the effect of sperm chromatin status on ICSI outcomes

Modified Blalock-Taussig shunt and giant perigraft reaction

This is a case of a modified Blalock-Taussig shunt, which was complicated by perigraft transudative, fibrinous fluid accumulation and recurrence after surgical intervention. Follow-up and expectant management of the patient was successful. Our experience regarding this complication is presented

Anti-zona pellucida antibodies in infertile patients in relation to multiple puncture of ovaries and unexplained infertility

Auto antibodies to zona-pellucida [AZA] seem to be important autoantibodies implicated in reproduction, with substantial role in both endocrine and reproductive functions of the human ovary. There are some debates on the relation of AZA with infertility, repeated In Vitro Fertilization [IVF] attempts, and outcome of it. In this study, we assessed the presence of AZA in the follicular fluids [FFs] of women who underwent intra cytoplasmic sperm injection [ICSI], in relation to etiology of infertility and multiple puncture of ovaries. In this prospective study, follicular fluids were evaluated from 96 infertile women, [19-40 years old, 31.5 +/- 5.1], who were c and idates for ICSI based on the etiology of infertility. From these 80 women had explained infertility whereas 16 had unexplained infertility. All FFs were evaluated for presence of AZA by ELISA test. Twenty patients [20.8%] were positive for AZA in follicular fluid. In patients with unexplained infertility, AZA antibody in follicular fluid, was significantly higher than the group with proven etiology of infertility [p=0.001]. In addition, 20.4% of patients who had been punctured previously showed AZA in their FFs which is statistically similar to the patients who were punctured for the first time. The high incidence of AZA in infertile women, especially women with unexplained infertility has to be considered. Relation of the presence AZA and repeated puncture of ovaries is still debatable. Determinations of AZA are highly recommended in evaluation of infertile couples especially in patient with unexplained infertility