Journal of Reproduction & Infertility

Two Paths to Discovery: Bridging Outside-in High Throughput Technologies and Inside-Out Artificial Intelligence for Biological Decoding of Women Reproductive Failure

Amir-Hassan Zarnani — Tue, 11 Mar 2025 10:13:13 +0000

The Article Abstract is not available.

Impact of Time-Lapse Incubator Systems on Fertilization, Blastocyst Development, and Clinical Pregnancy Outcomes

Tue, 11 Mar 2025 10:13:18 +0000

Background: The use of the time-lapse (TL) technology in infertility treatment centers has expanded, and the findings indicate its positive effect on embryo development, selection and increased pregnancy success rates. The purpose of the current study was to compare TL culture system and conventional incubator (CI) on IVF outcomes.

Methods: A total of 4,769 infertile couples undergoing IVF programs were enrolled in the study. The participants were categorized into two groups according to the embryo culture system, with 2,184 patients assigned to TL incubator and 2,585 to CI group. The outcomes measured included fertilization rate, proportion of top-quality embryos on day 3 and 5, and clinical pregnancy rate. Statistical analyses were conducted utilizing the Mann-Whitney U test and chi-square test. A p<0.05 indicated significance.

Results: This study revealed significantly higher fertilization rates and top-quality blastocysts in the TL group in comparison to CI group (p<0.001). Despite these differences, a comparable clinical pregnancy rate was observed between the two culture systems, with rates of 45.7% for TL and 41.1% for CI (p=0.169). These findings remained consistent in the good prognosis group, but not in the poor prognosis group. In the poor prognosis group, the TL culture system significantly improved fertilization rates (p<0.001), while the rates of top-quality cleavage and blastocyst formation were comparable between the two systems (p=0.075).

Conclusion: Based on the findings of the study, time-lapse culture system demonstrated superior performance compared to the conventional incubator system in generating top-quality blastocysts.

Determining Factors Affecting the Successful Outcome of Fresh Embryo Transfer During In Vitro Fertilization: A Retrospective Cohort Study

Tue, 11 Mar 2025 10:13:23 +0000

Background: Fresh embryo transfer has been decreasing because of advancements in vitrification techniques and safety concerns related to ovarian hyperresponse. However, in normal responders, clinical outcomes appear to be comparable with those with frozen embryo transfer. This study aimed to determine factors that influence successful fresh embryo transfer.

Methods: This retrospective cohort study included 521 women who underwent in vitro fertilization (IVF) and fresh embryo transfer at King Chulalongkorn Memorial Hospital, Thailand. Patients’ clinical data, embryo details, endometrial characteristics (thickness and pattern), and embryo transfer procedures (tip and flow during transfer, embryo placement location, difficulty of the procedure, and presence of blood and mucous at catheter) were analyzed. Chi-square test, Fisher’s exact test, Student’s t-test, and logistic regression were performed for data analysis. A p-value of <0.05 was considered statistically significant.

Results: The overall clinical pregnancy rate was 17.1%. Women aged >40 years were less likely to have a clinical pregnancy than those aged <35 years (adjusted odds ratio [aOR] 0.422; 95% confidence intervals [CI] 0.196-0.908, p=0.027). Day 3 embryo transfer showed a significant decrease in clinical pregnancy compared with blastocyst transfer (aOR 0.514; 95%CI 0.287-0.923, p=0.026). In the subgroup analysis for blastocyst transfer, women with good-quality blastocyst (≥322) were 2.439 times more likely to have a clinical pregnancy than those with poor-quality blastocysts (aOR 2.439; 95%CI 1.199-4.962, p=0.014).

Conclusion: Advanced age and day 3 embryo transfer were significantly associated with low clinical pregnancy rates in fresh embryo transfer

Exploring the Factors Influencing Premenstrual Syndrome and Its Severity: The Role of Lifestyle Determinants

Haniyeh Azadi, Sadra Madani, Laleh Payahoo, Mohammad Taghi Khodayari — Tue, 11 Mar 2025 10:13:29 +0000

Background: Women experience at least one of the Symptoms of Premenstrual Syndrome (PMS) during the menstrual cycle. The present study aimed to determine the factors that influence PMS occurrence and its severity in the medical students.

Methods: This cross-sectional study was carried out on 369 undergraduate female students of Maragheh University of Medical Sciences, Iran, between September 2021 and April 2022. The sampling method was random and participants were recruited through public announcements. The collected data included the provisional diagnosis of premenstrual syndrome, the Iranian version of Premenstrual Syndrome Screening Tool (PSST), the International Physical Activity Questionnaire (IPAQ), Food Frequency Questionnaire (FFQ), and the self-reported measurement of weight and height. All data and questionnaires were designed and then completed online by participants. The multivariable logistic regression analysis determined the potential predictors of PMS, and p-values less than 0.05 were considered significant.

Results: About 70% of participants had PMS. According to the PSST, 69% of them were positive in terms of the severity of PMS. There was a significant correlation between PMS and the severity of PMS symptoms (p<0.001), BMI (p=0.031), and dietary fat (p=0.013). The odds ratio for PMS, BMI, and dietary fat was 10.314, 1.073, and 1.008, respectively.

Conclusion: The present study demonstrated that among lifestyle factors, dietary fat and BMI play a significant role in premenstrual syndrome. Future studies are needed to identify other factors influencing its occurrence and to propose approaches for improving the quality of life of female medical students during their lifespan.

Serum Progesterone Levels on the Day of Oocyte Retrieval as a Predictor of Pregnancy Outcomes in Fresh Embryo Transfer Cycles

Tue, 11 Mar 2025 10:13:34 +0000

Background: Progesterone levels are critical for endometrial receptivity and implantation success in assisted reproductive technology (ART). The purpose of the current study was to determine whether serum progesterone levels on oocyte retrieval day predict pregnancy success in fresh embryo transfers.

Methods: This cross-sectional study was conducted at a university-affiliated infertility clinic in Tehran, Iran, in 2024. Blood samples were collected to analyze serum levels of estradiol (E2), progesterone (P4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) using standardized methods. Student’s t-test and the Mann-Whitney U test and Logistic regression were applied for statistical analyses participants. The optimal progesterone cutoff was calculated by receiver operating characteristic (ROC) curve with level of statistical significance of 0.05.

Results: The mean age of participants was 35.56±4.45 years and their mean BMI was 25.98±2.2. Among those who underwent fresh embryo transfer (n=63), 21 had positive serum β-hCG results, and fetal heart rate was detected via ultrasound in 17 patients at six weeks. Progesterone levels were significantly higher in the pregnancy-confirmed group (8.46 ng/ml) in comparison to the non-pregnant group (5.95 ng/ml, p=0.005). Similarly, patients with clinically confirmed pregnancies had significantly higher progesterone levels (8.38 ng/ml) compared to those without clinical pregnancy (6.19 ng/ml, p=0.02). A cutoff of 7.1 ng/ml predicted chemical pregnancy with 76.2% sensitivity and a cutoff of 7.55 ng/ml predicted clinical pregnancy with 71% sensitivity.

Conclusion: Elevated serum progesterone levels on the day of oocyte retrieval may predict positive pregnancy outcomes, highlighting the importance of monitoring progesterone to optimize the success rate of ART.

Enhancing Sperm Quality Through Consecutive Ejaculation After Short Abstinence in Men with Low Semen Parameters Undergoing ICSI

Tue, 11 Mar 2025 10:13:40 +0000

Background: Longer abstinence time is believed to be associated with the production of reactive oxygen species (ROS), which in excessive amounts may be detrimental to the sperm. To enhance sperm quality, multiple research studies have proposed reducing the duration of abstinence by encouraging consecutive ejaculations. This approach has been shown to improve sperm motility and morphology, which are associated with better ICSI and IUI outcomes. The purpose of the current study was to evaluate sperm quality and fertilization rate, cleavage rate, as well as embryo quality in severe oligoasthenozoospermic men using the consecutive ejaculate collected within an hour of abstinence.

Methods: A prospective study was conducted at Halim Fertility Center from August 2020–April 2022, involving male partners undergoing ICSI treatment who presented with severe oligoasthenozoospermia on their previous semen analysis. The non-parametric Mann-Whitney and Wilcoxon tests were used to analyze the parameters of the groups, including characteristics of the study participants, oocytes and sperm samples, as well as the ICSI outcomes, using a significance level of 5%.

Results: A statistically significant improvement in the sperm total motility was recorded in the consecutive ejaculate compared to the first (31.53±11.73% vs. 22.52± 8.85%; p<0.001). Both fertilization and cleavage rates were higher in the consecutive ejaculate group, although they were not statistically significant (61.41±28.04% vs. 55.45±31.76%; p=0.081 and 88.10±28.63% vs. 81.07±36.34%; p=0.262).

Conclusion: Consecutive ejaculates collected within an hour of the first may enhance sperm total motility, fertility, and cleavage rates in male partners with low sperm count and quality undergoing ICSI treatment.

The Effect of Spiritual Health on Psychological Distress of Infertile Women: The Role of Perceived Social Support as a Mediator

Tue, 11 Mar 2025 10:13:46 +0000

Background: The objective of this study was to evaluate the model of spiritual health in relation to psychological distress among infertile women, with perceived social support as a mediator.

Method: In this study, structural equation modeling (SEM) was employed. The study population included all infertile women in Shiraz from which a sample of 250 individuals was selected using a targeted sampling method. The research data were collected by Spiritual Health questionnaire developed by Iranian Academy of Medical Sciences; Depression, Anxiety, and Stress Scale 21 (DASS-21); and Multidimensional Scale of Perceived Social Support (MSPSS). Data analysis was performed using SPSS and AMOS software.

Results: The results demonstrate that the direct impact of spiritual health on psychological distress and perceived social support was statistically significant. Furthermore, a significant indirect effect of spiritual health on psychological distress was identified through perceived social support.

Conclusion: According to the findings of this study, it may be beneficial to address aspects of spiritual health and social support to alleviate psychological distress among infertile women.

A New Strategy for Chronic Endometritis Treatment Using Fermented Soy Product (ImmuBalanceTM)

Tue, 11 Mar 2025 10:13:51 +0000

Background: Chronic endometritis (CE) significantly contributes to repeated implantation failure (RIF). Although antibiotics are common treatments for CE, some patients do not achieve resolution. Therefore, the use of an alternative method involving the administration of ImmuBalance^TM (IMB), a combination of pre- and probiotics, was explored in the current study.

Methods: This retrospective study was conducted between April 2021 and August 2022. A total of 819 women with CE were treated with antibiotics-1 (doxycycline, n=809) or IMB (n=10, Group 1). Following endometrial biopsies, CE was not resolved in 209 out of 819 women. Subsequently, 194 patients were treated with antibiotics-1 (n=4) or -2 (amoxicillin, azithromycin, and metronidazole, n=190), whereas 15 were treated with IMB (n=15, Group 2). After the treatment with antibiotics-2, four women underwent IMB (Group 3). Statistical analysis of the number of plasma cells with CD138 before and after treatment was conducted using Fisher’s exact test and p-values <0.05 were considered statistically significant.

Results: CE was treated in 60% of patients (6/10) in Group 1; however, the reduction in CD138 count was not statistically significant (p=0.13). In Groups 2 and 3, CE was treated with a significantly reduced CD138 count (Group 2, p<0.01; Group 3, p=0.04). CE was treated in 100% of cases in Group 2 and 3 (15/15 and 4/4, respectively).

Conclusion: Based on the findings of this study, administration of IMB may be effective in treating CE, especially following antibiotic treatment.

Cytogenetic Evaluation and Clinical Correlation: A Retrospective Analysis of East Indian Patients with Diverse Amenorrhea Profiles

Sunny Kumar Jignesh Kumar Patel , Birendranath Banerjee — Tue, 11 Mar 2025 10:13:57 +0000

Background: Amenorrhea is defined as the absence of menstruation in women at reproductive age, caused by imbalanced hormonal interactions. The genes located on X chromosome are linked to the physiology of menstruation and reproduction. Early detection of major chromosomal conditions can be facilitated through karyotyping. The purpose of the current study was to identify and establish the frequency and spectrum of chromosomal anomalies in amenorrhea patients of Eastern Indian population, and to correlate their clinical features with cytogenetic findings.

Methods: From September 2022 to September 2024, 231 women with confirmed amenorrhea were included in the study conducted at inDNA Life Sciences, India. Clinical features of women with amenorrhea were recorded and cytogenetic investigation was carried.

Results: It was revealed that 20.35% of amenorrhea cases exhibited chromosomal anomalies. Among them, 38.30% were classified as numerical anomalies, 25.53% as sex reversal, 19.15% as structural anomalies, and 17.02% as mosaic karyotypes, with X-monosomy identified as the most prevalent anomaly.

Conclusion: The findings emphasize the importance of karyotyping in diagnosis, highlighting its role in early detection and management of female infertility. Karyotyping has a resolution limit of 4-5 Mb, which disables identification of submicroscopic chromosomal abnormalities. In contrast, chromosomal microarray (CMA) analysis can examine the entire genome at higher resolutions, allowing for the identification of genetic abnormalities that may not be detected by karyotyping. While CMA was excluded from this investigation, it could serve as a valuable technique for future research aimed at identifying submicroscopic chromosomal abnormalities in cytogenetically normal women with amenorrhea.