Journal of Reproduction & Infertility

Radical Changes in Infertility Practice: It Is Coming Soon

Mohammad Reza Sadeghi — 2024-11-17

The Article Abstract is not available.

The Influence of Artificial Light Exposure on Indigenous Populations: Exploring Its Impact on Menarcheal Age and Reproductive Function

Mayowa Jeremiah Adeniyi — 2024-11-17

The impact of artificial light exposure on human health has garnered significant attention in recent years. In particular, its effects on reproductive health have raised concerns. Given that the onset of menarche serves as a crucial indicator of reproductive maturity, understanding the implications of artificial light exposure becomes paramount. Age of menarche onset occurs relatively earlier in urban females than females raised in rural areas. Besides the decline in age of menarche onset, exposure to artificial light may contribute to impairment in reproductive hormones, particularly gonadotropins, by disrupting rhythms of reproductive hormones, modulating stress hormones and kisspeptin productions, and causing body weight changes. This drastic environmentally induced change may increase the proportion of teenage pregnancies, unfulfilled childhood dreams, depression, and ill-prepared marriages, thus creating a potential need for public health intervention. Due to limited studies and often lack of longitudinal data, a significant knowledge gap exists in unraveling the potential mechanism involved in alteration of these physiologic processes. The purpose of the current review was to elucidate the intricate interplay between environmental factors, cultural practices, and biological processes within indigenous communities. By meticulously examining the multifaceted influences of artificial light, including its prevalence and varying intensity based on geographical locations and light pollution levels, this study aimed to provide scholarly insights in-to the pathophysiologic mechanisms underlying the observed changes. The findings of this inquiry will also inform evidence-based strategies and interventions aimed at safeguarding the reproductive well-being of indigenous populations amidst the escalating challenges posed by artificial light exposure.

Association of NOX5 Expression with Sperm Activity and Motility in Pathospermic Infertile Men

Benay Daylan — 2024-11-17

Background: The newest NOX isoform, NOX5, has been found in mammalian spermatozoa. Many physiological and pathological situations in spermatozoa are mediated by reactive oxygen species (ROS). NOX5 is the main source of ROS in spermatozoa. Our purpose was to investigate the changes in NOX5 expression and the effect of NOX5 expression on sperm motility, chromatin integrity, and oxidative status in oligoasthenozoospermic compared to normozoospermic men.

Methods: Semen samples were collected from 30 normozoospermic (NS) and 30 oligoasthenozoospermic (OAS) men. NOX5 protein expression in sperm samples was evaluated by immunohistochemistry and western blot. Oxidative stress status was evaluated by total antioxidant capacity (TAC), total oxidant capacity (TOC), and oxidative stress index (OSI) parameters. Chromatin integrity in spermatozoa was evaluated by toluidine blue staining.

Results: NOX5 expression levels were significantly higher in OAS group than in NS group (p<0.001). In addition, chromatin integrity was significantly higher in the OAS group in comparison to NS group (p<0.001). TAC levels were higher in the NS group, but OSI and TOC levels were significantly higher in OAS group (p<0.001). It was found that NOX5 protein expression was positively correlated with oxidative stress and chromatin integrity and negatively correlated with motility (p<0.01).

Conclusion: These results suggest that overexpression of NOX5 may be the source of excessive ROS production and oxidative stress injuries in oligoasthenozoospermic men. Considering that NOX5 expression is positively correlated with oxidative stress and chromatin integrity but negatively correlated with motility, it can be considered a biomarker to be used in assisted reproductive procedures.

The Impact of NADPH Oxidase 5 Activity and Reactive Oxygen Species on Ca-pacitated Human Sperm

Mohammad Hojjati Far — 2024-11-17

Background: Progesterone (P4) activates sperm calcium channels (CatSper), allowing calcium to enter the cell, which activates NADPH Oxidase-5 (NOX5) and produces reactive oxygen species (ROS). While calcium and ROS are essential for sperm capacitation, the role of NOX5 in capacitated sperm is unclear. This study investigated NOX5 activity in capacitated human sperm.

Methods: Forty semen samples from fertile men were processed, with motile sperm separated and divided into nine groups: control (Ham's F-10), solvent (DMSO), progesterone, diphenyleneiodonium chloride (DPI, NOX5 inhibitor), phorbol-12-my-ristate 13-acetate (PMA, NOX5 activator), P4+DPI, P4+PMA, Trolox, and P4+ Trolox. Sperm kinematics, membrane integrity, survival rate, and ROS production was evaluated. Data were analyzed using ANOVA and Kruskal-Wallis tests, p£ 0.05 considered statistically significant.

Results: Progressive motility significantly decreased with DPI (56.2±2.1%) and PMA (56.5±2.1%), both alone and combined with progesterone (58.0±2.0% and 57.4±2.2%), compared to the progesterone group (66.0±1.9%). No significant change was observed in the Trolox groups. Progesterone, alone or combined with DPI, PMA, and Trolox, significantly reduced sperm linearity from 0.6±0.01 to 0.5± 0.01%. Straight-line velocity decreased in P4+PMA and P4+Trolox groups (88.2± 4.4 and 89.7±3.9 μm/s) compared to the control group (105.0±5.5 μm/s). Trolox reduced ROS content, while other treatments had no effect on ROS levels.

Conclusion: NOX5 does not play a prominent role in capacitated sperm. The negative effects of PMA and DPI on sperm motility appear independent of their actions on NOX5 and ROS production. Trolox did not affect sperm motility and survival, indicating that capacitated sperm require little or no ROS.

The Protective Effects of Citrulline on Testicular Injury Induced by Torsion and Detorsion in Adult Male Rats: An Experimental Study

Vida Motamed Nia — 2024-11-17

Background: Testicular torsion is a critical urological emergency that can lead to testicular ischemia and significant tissue damage. Citrulline, a supplement known for enhancing cellular metabolism and mitigating oxidative stress and inflammation, has been explored for its protective effects against testicular injury resulting from torsion and detorsion in rat models.

Methods: This study involved 42 Wistar rats, divided into six groups: Sham, torsion/detorsion (T/D), and four groups receiving varying doses of Citrulline (300, 600, 900 mg/kg) and vitamin E (20 mg/kg). A surgical procedure was performed to induce torsion by rotating the left testicle for 4 hr, followed by reperfusion. Daily oral administration of the supplements continued for one week post-surgery. Assessments included oxidative stress markers, apoptosis, inflammation, pathology, and sperm parameters. Statistical analysis was conducted using GraphPad Prism.

Results: Citrulline administration at doses of 600 and 900 mg/kg significantly reduced malondialdehyde (MDA) and reactive oxygen species (ROS) levels. Additionally, it increased glutathione (GSH) levels and decreased protein carbonyl levels at the 900 mg/kg dose. The expression of interleukin-6 (IL-6) decreased at 900 mg/ kg, tumor necrosis factor-alpha (TNF-α) levels dropped at 600 and 900 mg/kg, and the pro-apoptotic factor Bax was reduced at all doses. Sperm analysis showed improved sperm count and motility at the 900 mg/kg dose. Histological examination revealed significant positive effects of Citrulline on testicular tissue.

Conclusion: Citrulline effectively lowers oxidative stress, inflammation, while enhancing sperm quality and pathological outcomes. These results indicate that Citrulline has potential as a therapeutic agent for testicular torsion.

Cesarean Section and Its Impact on Uterine Artery Resistance and the Risk of Pre-eclampsia in Subsequent Pregnancies

Neda Hashemi — 2024-11-17

Background: The purpose of the current study was to compare the color Doppler findings of uterine arteries and perinatal outcomes in pregnant women with and without previous cesarean section (C/S).

Methods: This cohort study enrolled 308 pregnant women aged 20-35 without underlying diseases, with at least one previous pregnancy and childbirth. The participants were divided into two groups: 154 women without C/S and 154 women with C/S. Baseline data were collected, followed by uterine artery Doppler scans. Then, the perinatal outcomes, including pre-eclampsia, intrauterine growth restriction (IUGR), premature delivery, and birth weight were evaluated.

Results: The average age of patients in the C/S group was 30.46±3.81, which was significantly higher than the non-C/S group (28.86±4.64). It was found that uterine artery resistance was higher in women with C/S history (1.11±0.44, p<0.001) compared to those without (1.00±0.37, p<0.001). Pre-eclampsia incidence was also higher in C/S group (16.1%, p=0.042) compared to non-C/S group (9.1%, p=0.042). The incidence of preterm birth in the C/S group (p=0.209), the incidence of IUGR (p= 0.791), and the average birth weight (p=0.291) in the two groups did not differ significantly. The average gestational age in the C/S group was 37.54±1.4, and in the non-C/S group was 38.01±1.99 weeks. The results were not affected by potential confounders such as age, the time interval between pregnancies, and also body mass index.

Conclusion: Previous cesarean section can significantly increase the uterine artery resistance in subsequent pregnancy.

Cervical Anatomical Characteristics in Women with Endometriosis: A Diagnostic Approach

Elahe Afshari — 2024-11-17

Background: Endometriosis is a gynecologic disorder which causes dysmenorrhea and infertility. Early diagnosis of endometriosis can help prevent the necessity for invasive diagnostic procedures. Medical imaging has been widely utilized to diagnose various diseases without the need for invasive procedures. The purpose of this study was to investigate the cervical length in women with endometriosis.

Methods: In this case-control study, the case group consisted of nulliparous women with endometriosis, while the control group comprised nulliparous women without endometriosis. A total of 42 individuals were included in each group. Cervical length was measured using transvaginal ultrasound from the external os to the internal os. The patients in the case group underwent laparoscopy to confirm the diagnosis. Pearson chi-square test and Fisher’s exact test were employed to compare categorical variables with a p<0.05 considered statistically significant.

Results: In both groups, there were no notable variations in any of the demographic characteristics. However, the severity of dysmenorrhea was significantly different between the two groups (p=0.01). The average diameter of the mediolateral cervix (29.48±6.2 and 27.14±3.8) was statistically significant between the patient group and control group, respectively (p=0.04). The mediolateral width may have a positive predictive effect on the presence of endometriosis, while cervical length appears to have a protective effect against endometriosis.

Conclusion: Demographic data do not predict endometriosis. This study suggests that mediolateral width in transvaginal sonography can serve as a minimally invasive diagnostic tool for endometriosis, showing correlation with endometriosis symptoms like dysmenorrhea and dyspareunia.

Assisted Reproductive Technology Outcomes After Ethanol Sclerotherapy in Poor Responder Patients with Endometriomas: A Before-After Clinical Trial

Farah Ghasemi — 2024-11-17

Background: The purpose of the present study was to investigate the assisted reproductive technology (ART) outcomes after ethanol sclerotherapy (EST) in poor responder patients with endometriomas.

Methods: In this before-after clinical trial, the outcomes of ART of 31 poor responders with endometriomas were evaluated after EST between July 2023 to March 2024. These patients had undergone ART at least in one cycle before and did not respond well. Recurrence rate, antral follicle count (AFC), anti-Müllerian hormone (AMH), and relief of symptoms including dysmenorrhea and abnormal uterine bleeding (AUB) were evaluated before the procedure. Follow-up assessments were conducted two and six weeks after the procedure for evaluating the complications. Fisher’s exact test, chi-square test, and paired sample t-test were used for statistical analysis using SPSS 24.

Results: In this study, the levels of AFC and AMH increased significantly after endometrioma stripping therapy (p<0.05). Additionally, the number of embryos obtained increased significantly, indicating potential improvement in oocyte quality. There was a significant reduction in pelvic pain scores (p=0.001), as well as a notable decrease in dysmenorrhea (p=0.02) and dyspareunia (p=0.001). Moreover, 16.12% of patients reported recovery from intermenstrual bleeding. However, no significant difference was observed in the amount of gonadotropin used (p=0.56).

Conclusion: EST is an appropriate and safe procedure before ART for poor responders who have endometriomas and can be a replacement for surgery among selected patients.

Placental Histopathological Changes and the Level of Anti-Spike Antibody After Covid-19 Vaccination During Pregnancy: A Case Series

Zohreh Heidary — 2024-11-17

Background: COVID-19 infection during pregnancy could be associated with placental histopathological changes such as vascular diseases and malperfusion. There are studies showing that mRNA vaccines are not associated with significant placental pathological changes. Our objective was to evaluate the placental histopathology in pregnant women who received Sinopharm, an inactivated virus vaccine, during pregnancy.

Case Presentation: The study included placental samples collected from mothers who gave birth of living singletons through elective cesarean sections performed between March 2022 and May 2022 at Imam Khomeini Hospital Complex. The study included women who had no history of positive reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 during pregnancy, and had received at least one dose of COVID-19 vaccine during their pregnancy. Humoral levels of anti-SARS-CoV-2 spike IgG were measured in both the mothers and neonates.

Results: The study included 20 mother-neonate pairs. The mean maternal age was 34±3.6 years, and all mothers received Sinopharm vaccine as their first and second doses. The last vaccine dose was administered during pregnancy, with 3 mothers receiving it in the first trimester, 9 in the second trimester, and 8 in the third trimester. The histopathological findings in the placental samples included decidual vasculopathy, subchorionic thrombosis, and chronic histiocytic intervillositis. All mothers and neonates, except one pair, were positive for anti-spike antibody.

Conclusion: Multiple abnormal histopathological findings were reported in placenta of vaccinated mothers. However, similar to previous studies, these placental findings are considered mild lesions and have been observed in both vaccinated and unvaccinated mothers.

The Migration of an Intrauterine Device in the Bladder of an Asymptomatic Woman: A Case Report

Seyedeh Azam Pourhoseini — 2024-11-17

Background: The use of intrauterine devices (IUDs) for contraception has increased in many countries. However, their application has some serious complications such as uterine perforation and injury to adjacent organs. The translocated IUD into the bladder is a very rare occurrence.

Case Presentation: Our case was a 41-year-old woman whose IUD was accidentally discovered in her bladder during a routine ultrasound. The IUD has migrated from its normal position in the uterus to the bladder. The IUD was successfully removed by cystoscopy without any complications.

Conclusion: The mislocation of an IUD in the bladder, while uncommon, is a possibility that should be considered when the IUD string is not visible during examinations.