Journal of Reproduction & Infertility

Fertility in Fevered Planet, Hidden Costs of Global Warming

Mohammad Reza Sadeghi — Mon, 17 Nov 2025 03:41:13 +0000

The Article Abstract is not available.

Reactive Oxygen Species in Follicular Fluid as a Potential Biomarker of Oocyte Developmental Competence

Mon, 17 Nov 2025 03:45:41 +0000

Background: Reactive oxygen species (ROS) are critical factors for oocyte maturation and early embryogenesis; however, excessive ROS can induce oxidative stress, impairing mitochondrial function, DNA integrity, and embryo competence. The role of oxidative status in buffalo follicular fluid (FF) remains underexplored. This study assessed the relationship between total oxidant status (TOS) in buffalo FF and the developmental competence of oocytes retrieved by ovum pick-up (OPU) for subsequent in vitro fertilization (OPU-IVF).

Methods: Follicular fluid and cumulus–oocyte complexes (COCs) were collected from 62 healthy buffaloes. Oocytes were matured and fertilized in vitro, and the animals were classified based on blastocyst yield: G1 (no blastocysts), G2 (≥2 blastocysts), and G3 (>3 blastocysts). TOS was measured spectrophotometrically. The relationship between TOS and oocyte competence was analyzed by ROC (G1 vs. G3) and Spearman correlation (G1 vs. G2), with p<0.05 considered statistically significant.

Results: G2 group with >2 blastocyst exhibited lower TOS levels (1.10±0.51 µmol H₂O₂ Eq/L) than G1 (2.15±0.92; p=0.004), with higher follicle counts, oocyte yield, cleavage rate, and blastocyst production (p<0.05). ROC analysis identified a TOS threshold of 1.12 µmol H₂O₂ Eq/L (area under the curve [AUC]=0.851), and TOS in-versely correlated with the proportion of high-quality blastocysts (r=-0.553, p= 0.021).

Conclusion: Elevated oxidative stress in FF compromises oocyte developmental competence and embryo quality. TOS may serve as a predictive biomarker, supporting antioxidant-based optimization of assisted reproductive technology (ART) in buffalo.

The Effect of hCG Supplementation on Embryo Quality after Rescue In Vitro Maturation (r-IVM)

Mon, 17 Nov 2025 03:53:40 +0000

Background: The supplementation of human chorionic gonadotropin (hCG) into culture medium in rescue in vitro maturation (r-IVM) has been reported to improve the maturation rates of immature oocytes derived from stimulated cycles. However, the impact of this enrichment on embryo quality is yet to be understood. The purpose of the current study was to investigate the effect of hCG on the embryo quality following r-IVM.

Methods: A total of 152 immature oocytes consisting of germinal vesicles (GV) and metaphase I (MI) were collected and classified into 1) control group (n=73; GV=22, MI=51) cultured in culture medium only, and 2) experimental group (n=79; GV= 23, MI=56) cultured in culture medium supplemented with 0.5 IU hCG. Study parameters were analyzed using Student’s T-test or Kruskal Wallis and chi-square at a 95% confidence level.

Results: After 24 hr, the maturation rate of the control and experimental groups was comparable (57% vs. 70%, p=0.58). Following intracytoplasmic sperm injection (ICSI), the fertilization rate was significantly higher in the experimental group than in the control group (49% vs. 36%; p=0.03). However, the number of good-quality embryos was similar in the groups (16% vs. 6%).

Conclusion: Our study suggests that hCG supplementation into the culture medium during r-IVM does not affect embryo quality but improves the fertilization rate. Further research is needed to scrutinize the role of hCG in fertilization.

Comparison of Long-Term and Stimulated Cycle Protocols in Frozen Embryo Transfer Cycles in Women with Polycystic Ovary Syndrome: A Non-Randomized Clinical Trial

Shamim Pilevari , Mahnaz Yavangi , Zakieh Yarahmadi , Elahe Talebi Ghane — Mon, 17 Nov 2025 03:59:29 +0000

Background: In women with polycystic ovary syndrome (PCOS), the optimal endometrial preparation strategy for frozen embryo transfer (FET) remains unclear. This clinical trial aimed to compare a long-term protocol with a stimulated cycle protocol in FET cycles of PCOS women, with clinical pregnancy rate per embryo transfer as the primary outcome.

Methods: This non-randomized, open-label, two-arm clinical trial was conducted at Fatemieh Hamedan Hospital, Iran, involving 340 women with PCOS. Participants were allocated to the long-term or stimulated cycle protocols based on clinical scheduling and physician decision. The long-term protocol included low-dose combined oral contraceptives for 14 days, GnRH agonist downregulation, estradiol valerate (4–6 mg/day for ≥10 days), and progesterone before embryo transfer. The stimulated cycle protocol involved recombinant FSH with ultrasound monitoring, hCG trigger for oocyte maturation, and intramuscular progesterone (50 mg/day) for luteal phase support. For each participant one FET cycle was analyzed.

Results: Baseline characteristics were similar between groups (n=170 each). The long-term protocol showed higher clinical pregnancy rates (35.9%) compared to the stimulated cycle (22.9%) (OR=1.92; 95%CI: 1.15–3.19; p=0.011). Chemical pregnancy rates also favored the long-term protocol (34.7% vs. 21.8%) (OR=1.91; 95%CI: 1.17–3.09; p=0.008). Endometrial thickness was significantly greater in the long-term protocol (8.7±0.9 mm vs. 8.4±0.8 mm; p=0.004).

Conclusion: Although the long-term protocol showed higher clinical pregnancy rates in unadjusted analyses, after adjusting for confounders, protocol type was not independently associated with clinical pregnancy. Larger randomized trials are needed to confirm these findings, and adverse outcomes should be assessed in future studies.

The Effect of Aspirin Administration on Fetal Cardiovascular Function Between 18 to 24 Weeks of Gestation: A New Perspective on ASA Indication in Obstetrics

Mon, 17 Nov 2025 04:12:46 +0000

Background: Low-dose aspirin (ASA) is used in obstetrics for different indications, mainly to prevent preeclampsia. This study investigated the underlying mechanism of ASA’s effect on the fetus’s cardiovascular functions.

Methods: 42 pregnant women at 18-24 weeks of gestation, identified as high-risk for preeclampsia, received 160 mg of ASA daily. Fetal Doppler ultrasound was performed before and three weeks after ASA treatment, assessing ductus venosus, middle cerebral, umbilical, and uterine arteries pulsatility indices as well as pulmonary, aorta, and superior vena cava (SVC) diameters in the three-vessel view, including pulmonary/aorta and SVC/aorta ratios. All analyses were performed using SPSS software version 27, with a significance threshold set at p<0.05. A paired t-test was used to assess differences in means. The Chi-square and Fisher’s exact test analyzed nominal variables.

Results: Post-intervention analysis revealed significant improvements in abnormal uterine artery resistance (p<0.001) and abnormal pulsatility index of the umbilical artery, middle cerebral artery, and ductus venosus (p<0.001 for all). Moreover, 160 mg/day aspirin administration significantly increased mitral E/A (early filling velocity/atrial contraction velocity: 0.397±0.029; p<0.001), diameters of aorta (4.390±0.852; p<0.001), pulmonary artery (4.895± 1.087; p<0.001), and SVC (2.511±0.535; p<0.001), while significantly decreasing left ventricular myocardial performance index (p<0.05).

Conclusion: Daily administration of 160 mg of aspirin enhances fetal vascular and cardiac function. Evaluating fetal cardiovascular parameters beyond routine uterine artery Doppler, especially in high-risk pregnancies, and initiating ASA therapy in cases of insidious abnormalities, may help delay or prevent fetal complications such as intrauterine growth restriction (IUGR) by improving cardiovascular function.

Fetal Brain Midline Structure Measurements: Cavum Septi Pellucidi and Corpus Callosum Indices in Multiple Views at Late Gestation

Mon, 17 Nov 2025 04:17:56 +0000

Background: The literature lacks studies specifically focusing on cavum septum pellucidum (CSP) and corpus callosum (CC) indices in late gestation. In this study, various CSP and CC indices, as well as frontal lobe measurements were assessed and the potential correlations among these parameters were evaluated.

Methods: A cross-sectional study was conducted at Imam Khomeini Hospital Complex on 150 fetuses at gestational age of 36 weeks and later. CSP length, width, trace length, and area in the axial view; frontal lobe thickness measured from the most anterior and posterior parts of CSP in horizontal and vertical directions; CC lengths and thickness; and CSP trace length and area in midsagittal view were all obtained via transabdominal ultrasound. SPSS version 23 was used for data analysis.

Results: The gestational age, biparietal diameter (BPD), head circumference (HC), and estimated fetal weight (EFW) Mean±SD were 37.56±1.08 weeks, 90.73±3.20 mm, 326.58±10.59 mm, and 2987.82±333.68 gr, respectively. In the trans-thalamic axial view, medians (IQR) CSP length, width, trace length, and axial surface area were 8.92 mm (7.79-9.90), 6.05 mm (5.10-6.71), 2.81 mm (2.51-3.11), and 0.49 mm² (0.39-0.59), respectively. Median CSP height in the coronal view was 5.85 mm (4.93-7.00). In midsagittal view, mean±SD CC outer-to-outer length, inner-to-inner length, CSP trace length, and area were 41.31±4.81 mm, 29.73±4.17 mm, 2.56±0.63 mm, and 0.36±0.19 mm², respectively. All CC and CSP indices correlated significantly with HC (p<0.05). Vertical and horizontal distances from the frontal bone to the anterior and posterior CSP parts in axial and near-field views also showed significant correlations with HC (p= 0.0001).

Conclusion: This study presented normative data and new indices including fetal CC, CSP, and frontal lobe measurements in prenatal sonographic exam of fetuses at gestational age of 36 weeks and later.

A Comparative Analysis of Oxidative Stress and Inflammatory Biomarkers in Different Stages of Endometriosis

Mon, 17 Nov 2025 04:26:47 +0000

Background: The fundamental mechanisms behind the causes and development of endometriosis are still poorly understood. Therefore, identifying biomarkers that can help with early detection and targeted treatment is crucial for effective management of this disease. This study aimed to compare total antioxidant capacity (TAC), the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx), and the concentrations of interleukin-6 (IL-6) and phenylalanine (Phe) across different stages of endometriosis.

Methods: The plasma samples were collected from women with endometriosis who had undergone laparoscopic surgery. The stages were confirmed by a gynecologist, with 30 plasma samples from stages I-II (mild) and 30 from stages III-IV (severe). The obtained measurement data were first normalized and tested for normality, followed by analysis using the t-test and Mann-Whitney U test. The p-value below 0.05 was considered statistically significant. The sample size was determined based on Cohen's guideline of 30. Biomarker levels were assessed using ELISA and colorimetric techniques.

Results: TAC levels, GPx, and SOD activities, as well as Phe concentration significantly differed between endometriosis stages I-II and III-IV (p<0.05). These measured biomarkers were higher in stage I-II. On the other hand, although IL-6 levels were higher in stages III–IV, the differences between stages were not statistically significant.

Conclusion: The potential of TAC, SOD, GPx, and Phe as biomarkers for the early diagnosis and treatment of endometriosis underscore the roles of inflammation and oxidative stress in the pathogenesis of the disease, providing insights that may aid in developing more targeted diagnostic and therapeutic strategies.

Trends of Multiple Births in Iran from 2014 to 2023

Milad Ahmadi Gohari , Maryam Chegeni , Firoozeh Mirzaee , Yunes Jahani — Mon, 17 Nov 2025 04:38:40 +0000

Background: The aim of this study was to analyze the trends of multiple births at both national and provincial levels in Iran from 2014 to 2023.

Methods: Data on the number of live births and multiple births from 2014 to 2023 at national and provincial levels were obtained from the Iran’s Bureau of Vital Statistics. The multiple birth rate (MBR), defined as the number of live births from multiple births per 1,000 live births, was calculated annually. To examine temporal trends and detect significant changes in MBR over the study period, joinpoint regression analysis was performed. Annual percent change (APC) and average annual percent change (AAPC) were calculated for the entire period.

Result: The national AAPC in the MBR was estimated at 2.38% (95%CI: 1.95 to 2.76) over the entire study period. A significant shift in trend was identified in 2020. Specifically, the APC from 2014 to 2020 was 0.24%. However, from 2020 to 2023, the APC markedly increased to 6.8%, reflecting a substantial rise in MBR during this latter period. Furthermore, the study findings demonstrated that nearly all provinces across the country have exhibited an upward trend in MBR in recent years.

Conclusion: The increasing trend of multiple births in Iran aligns with global patterns. Several factors may have contributed to this rise, including increased maternal age at childbirth, higher prevalence of infertility, expanded use of assisted reproductive technologies (ARTs), and shifts in population policies.

Optimizing Reproductive Autonomy in Cystic Fibrosis: The Role of Oocyte Cryopreservation

Mon, 17 Nov 2025 04:43:02 +0000

The Article Abstract is not available.

Management of Recurrent Intrahepatic Cholestasis of Pregnancy: A Case Report

Mon, 17 Nov 2025 04:54:41 +0000

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most prevalent hepatic disorder exclusive to pregnancy, associated with significant maternal morbidity and increased risk of adverse perinatal outcomes. Recurrence in subsequent pregnancies and comorbidities such as gestational diabetes and hypertensive disorders further complicate clinical management. This case presentation, an attempted to describe the diagnostic and therapeutic challenges in managing recurrent ICP, especially in the context of overlapping maternal comorbidities and limited diagnostic resources.

Case Presentation: A case of a 32-year-old Iranian woman, gravida 3 para 2, with a history of one intrauterine fetal death and one neonatal death, was ultimately diagnosed with recurrent ICP. In her third pregnancy, elevated bile acid levels were confirmed by routine monitoring from 20 weeks’ gestation, peaking at 333 µmol/L by 32 weeks. Despite intensive medical therapy including ursodeoxycholic acid, hydroxychloroquine, corticosteroids, and low-molecular-weight heparin, her pruritus worsened and bile acid levels escalated, prompting preterm cesarean delivery. The neonate experienced complications, including respiratory distress, suspected Hirschsprung’s disease, sepsis, and hyperbilirubinemia. Management included continuous positive airway pressure (CPAP), broad-spectrum antibiotics, surgery, phototherapy, and parenteral nutrition. Multidisciplinary intervention enabled neonatal recovery, and maternal symptoms resolved postpartum.

Conclusion: This case underscores the complexities of managing recurrent ICP, particularly in resource-limited settings. It highlights the critical need for early diagnosis, vigilant monitoring, and a multidisciplinary approach to mitigate the risk of stillbirth and improve perinatal outcomes. Additionally, it suggests that recurrent ICP may present earlier or with greater intensity in subsequent pregnancies, necessitating more comprehensive surveillance and tailored management strategies for affected mothers.