https://www.jri.ir/ "Journal of Reproduction & Infertility" is owned, published, and copyrighted by ©2009 Avicenna Research Institute. No parts of this journal may be reproduced in any form or by any means unless properly referenced or sent a notification letter through www.jri.ir en Comparison of Letrozole versus Tamoxifen Effects in Clomiphen Citrate Resistant Women with Polycystic Ovarian Syndrome <p>Background: The objective of this prospective randomized study was to make a comparison between the effects of letrozole and tamoxifen (TMX) in ovulation induction in clomiphene (CC)-resistant women with polycystic ovarian syndrome (PCOS).<br /> Methods: The study comprised a total of 60 infertile women (180 cycles) with CC-resistant PCOS selected from the clinics affiliated to the Department of Obstetrics and Gynecology of Tanta University. Patients were randomized to treatment with 2.5 mg of letrozole daily (30 patients, 90 cycles) or 20 mg of TMX daily (30 patients, 90 cycles) for 5 days from day 5 of menses and 10000 IU hCG when mature follicles become &ge;18 mm in diameter. The chi-square and t-test were used for comparing two groups and p&lt;0.05 was considered significant.<br /> Results: The total number of follicles (&ge;18 mm) in the letrozole group was more than TMX group. The endometrial thickness at the time of hCG administration was significantly higher (p&lt;0.05, at 95% CI) in the letrozole group than that of TMX group (10.2&plusmn;0.7 vs. 9.1&plusmn;0.2 mm). Ovulation occurred in 23.33% of cycles in the letrozole group and in 8.89% in the TMX group, whereas pregnancy occurred in 5.56% of the letrozole group and 2.22% of the TMX group.<br /> Conclusion: Both letrozole and TMX should be considered as optional therapies for CC-resistant women. In addition, letrozole was superior to TMX in achieving a higher pregnancy and ovulation rate and also lesser side effects in comparison to tamoxifen.</p> https://www.jri.ir/article/602 Effects of Anethum graveolens L. (dill) on Oocyte and Fertility of Adult Female Rats <p>Background: Our previous studies revealed <em>Anethum graveolens L. </em>caused some changes in female reproductive system that induced infertility. Therefore, in this study, oocyte changes as one of probable reasons of infertility were investigated.&nbsp; &nbsp;<br /> Methods: In this study, 59 adult female rats were divided into 3 groups of control, low dose (0.5 g/kg) and high dose (5 g/kg) of dill seed aqueous extract (LDE and HDE) treated groups that were gavaged with 1 ml of each dose for 10 days (2 estrous cycles). Vaginal smears were prepared daily. Oocytes of superovulated animals were extracted and their morphometrical changes were measured (n=5). Oocyte cell membrane glycoconjugates were stained with UEA, PNA, and DBA-FITC lectins (n=5). Ultrastructural studies of oocytes were performed using TEM (n=5). The number, weight, and crown-rump length of newborns were examined in three groups after mating with untreated males (n=5). Data were analyzed using SPSS software.<br /> Results: Results demonstrated that the duration of the estrous cycle, the diestrus phase and progesterone concentration in the experimental groups increased significantly compared to the control group (p&lt;0.05). Granulosa cells of corpus luteum in HDE-treated group were larger and clearer. The intensity reactions of galactose/N-acetylgalactoseamine terminal sugar of oocyte decreased insignificantly in experimental groups compared to the control group p&gt;0.05. Duration of mating to pregnancy increased and the weight and crown-rump length of newborns decreased in experimental groups significantly (p&lt;0.05).<br /> Conclusion: Dill seed aqueous extract can induce infertility without any effect on oocyte structure.</p> https://www.jri.ir/article/608 Expression Patterns of VEGF and Flk-1 in Human Endometrium during the Menstrual Cycle <p>Background: The VEGF is essential in the process of tissue remodeling and angiogenesis. Limited data is available on the expression and regulation of VEGF and its receptors in the human endometrium. The aim of this study was evaluation of expression patterns of VEGF and Flk-1 in human endometrium during the menstrual cycle.<br /> Methods: Sixty paraffin-embedded blocks of endometrial tissues from the patients with normal menstrual cycles were obtained. Tissue samples were assembled into tissue microarray slides and classified by histological dating into five phases: the proliferative (n=14), peri-ovulatory (n=9), early-secretory (n=12), mid-secretory (n=11) and late-secretory (n=14) phases. Immunohistochemical staining was performed using VEGF or Flk-1 monoclonal antibodies. The intensity of immunostain-ing was evaluated by the semi-quantitative scoring method (HSCORE). Kruskal-Wallis one-way analysis of variance and Scheff&rsquo;s post-hoc test were used for statistical analysis. A p-value of &lt;0.05 was considered statistically significant.<br /> Results: VEGF and Flk-1 were expressed in the three components of the endometrium at various phases of the menstrual cycle. In the stroma, the expression of VEGF varied among the phases (p&lt;0.05). The expression of Flk-1 in the luminal and glandular epithelium revealed stronger intensity of immunostaining as compared with the stroma at the different phases (p&lt;0.05). The level of Flk-1 expression also showed significant differences among the phases in the glandular epithelium with greatest expression at late-secretory phase (p&lt;0.05).<br /> Conclusion: Temporal and spatial distribution of VEGF and Flk-1 expression in the three components of human endometrium during menstrual cycle suggests the functional role of angiogenesis in the remodeling process of endometrial tissue.</p> https://www.jri.ir/article/609 A Rare Case of Bilateral Ectopic Pregnancy and Differential Diagnosis of Gestational Trophoblastic Disease <p>Background: Bilateral ectopic pregnancy is a rare condition and is divided in two subgroups, primary and secondary, based on history of assisted reproductive technology.<br /> Case Presentation: A 30 year old primigravid woman with history of infertility and ovulation induction presented to a hospital in Kashan in year 2013. She had vaginal bleeding, abdominal pain and ultrasound findings suggested early pregnancy. Due to high titer of &beta;-HCG, gestational trophoblastic disease was proposed and D8C was done in referral and admission to gyneco-oncology ward in Tehran. Repeat sonography suggested ectopic pregnancy in left side and repeat &beta;-HCG level showed an increase of 19435 mIU/ml. Laparotomy findings revealed bilateral ampullary ectopic pregnancy. Bilateral salpingostomy followed by one course of methotrexate was prescribed.<br /> Conclusion: Bilateral ectopic gestation should be considered as a rare differential diagnosis for ectopic pregnancy. In this study, bigger size and rupture in left side was observed.</p> https://www.jri.ir/article/612 Attitudes about Sex Selection and Sex Preference in Iranian Couples Referred for Sex Selection Technology <p>Background: Gender preference is prevalent in some communities and using medical techniques to choose the baby&rsquo;s sex may cause the gender discrimination and gender imbalance in communities. Therefore, evaluating the gender preferences and attitudes towards using sex selection technologies seems to be necessary.<br /> Methods: This cross-sectional study was conducted in Avicenna Fertility Center. Participants were 100 women with one child who were referred for sex selection. Data were collected through self-developed questionnaires. The questions were designed by the researchers at the experts&rsquo; panel. To determine the validity of the questionnaire, the viewpoints of professors specialized in these issues were obtained. The statistical analysis of the data was performed using SPSS software (Version 11.5), and p&lt;0.05 was considered significant.<br /> Results: Tendency toward the male was more than female sex (55.5% male, 15.5% female and 28.5% no tendency). Majority of participants agreed with sex selection with medical reason and sex selection in order to balance the family. Women&rsquo;s level of education had positive effect on agreements to fetal sex selection with medical and non-medical reasons (p&lt;0.001).<br /> Conclusion: Although gender preferences were toward the male sex but this preference was not very strong. Most participants agreed with non-medical sex selection for balancing the sex composition of their children. It doesn&rsquo;t seem that non-medical sex selection for family balancing causes severe sex imbalance in Iran.</p> https://www.jri.ir/article/613 Sexual and Reproductive Behaviors among Undergraduate University Students in Mashhad, a City in Northeast of Iran <p>Background: The incidence of sexual transmitted infections (STIs) and HIV/AIDS is globally higher in young people. This study evaluated the prevalence of sexual reproductive behaviors among undergraduate students of Mashhad, Iran.<br /> Methods: The study was conducted on 605 students in twelve non-medical faculties of a great university of Mashhad. A self-administered questionnaire was completed on demographic information, sexual contact in the lifetime and during the last three months, and age of first sex. Kaplan-Meier statistic was used to calculate the mean age of initiation of sex. A p&lt;0.05 was considered statistically significant.<br /> Results: After exclusion of individuals over 25 years of age, among 590 students with a mean age of 20.8&plusmn;1.5 years included in the analysis, 71.4% were female and 85.3% were single. Prevalence of at least one sexual contact in life was 15.1% and 35.3% of single sexually experienced students reported to have sex in the last three months. The lifetime prevalence of sexual relationship in males was significantly higher than females (32.9% vs. 7.6%, p&lt;0.001). The mean age of first sexual experience was 23.7 years with a significant difference between both sexes (p&lt;0.001). In single sexually experienced students, the mean age at first sex was 17.6&plusmn;3.3 years, 24% started sexual activity at &lt;15 years, 34.3% had at least 3 partners and only 40.6% stated using condom in their last sex.<br /> Conclusion: Although very small proportion of females reported premarital sex, a significant minority of male students experienced sexual and risky behaviors.&nbsp; Therefore, the use of educational programs on related issues to reduce the risk of STIs/ HIV among youth including university students seems to be a necessity.</p> https://www.jri.ir/article/620 Replacement Therapy for Gaucher Disease during Pregnancy: A Case Report <p>Background: Gaucher disease is a lysosomal storage disorder due to deficiency of glucocerebrosidase enzyme. In this study, a case of enzyme-treated woman during her pregnancy was reported.<br /> Case Presentation: A 27-year old woman with type I Gaucher disease was managed for pregnancy until delivery. She underwent elective splenectomy at age 26 years and was treated with 19-38 units/kg of imiglucerase. A conservative approach with close monitoring of both mother and baby was planned.<br /> Results: In the 39th week of pregnancy, a healthy male baby of 3180 g was delivered via cesarean section.<br /> Conclusion: Apart from mild hematological complications, the pregnancy, the delivery and the puerperium were uneventful. In this case report, the issue of therapy and risk assessment in pregnancy in patients with type I Gaucher disease was discussed.</p> https://www.jri.ir/article/624 Induction and Determination of Apoptotic and Necrotic Cell Death by Cadmium Chloride in Testis Tissue of Mouse <p>Background: Cadmium chloride which is potentially toxic is currently used in industry. The toxic effects of cadmium on testes have been reported to range from apoptosis to necrosis, with different effects on fertility. This research aimed to study the effect of different doses of cadmium on testicular tissues at acute stage by light and electron microscopy.<br /> Methods: Cadmium chloride was injected into mature Balb/c mice intraperitoneally in 7 doses. Five mice were studied in each group. After 48 hr, the testes were extracted and prepared for light microscopy. Then two concentrations (15 and 25 &micro;M/kg) of them were selected for electron microscopic study based on histological changes. The cellular changes of luminal epithelium of seminiferous tubules were studied under an electron microscope. Histological and ultrastructural changes were reported.<br /> Results: The absence of sperm in the tubules was observed at 20 &micro;M/kg concentration. At 25 &micro;M/kg, histological destruction and epithelial damages were observed. Histological changes were not remarkable at 5 and 10 &micro;M/kg. However, ultrastructural changes of seminiferous tubules at 20 &micro;M/kg included spermatogonial cell death. At 25 &micro;M/kg, vacuolation of Sertoli cells and death of spermatids as well as spermatocytes were observed. Cell death in the tubules was limited to germ cells. However, Sertoli cells exhibited architectural alterations without any cell death.<br /> Conclusion: Both apoptosis and necrosis occurred in testicular tissue by exposure to cadmium in a concentration-dependent manner. Gonadal cells were sensitive to cadmium administration. Supportive cells such as Sertoli cells in seminiferous tubules did not exhibit sensitivity to cadmium.</p> https://www.jri.ir/article/625 Can Hyaluronan Binding Assay Predict the Outcome of Intrauterine Insemination in Couples with Unexplained or Mild Male Factor Infertility? <p>Background: The purpose of this study was to evaluate the prognostic effect of Hyaluronan Binding Assay (HBA) which has been used as a method of sperm selection for intracytoplasmic sperm injection procedure, on the outcome of intrauterine insemination (IUI) in couples with unexplained or mild male factor infertility.<br /> Methods: 77 infertile couples were enrolled in our study. On the day of IUI procedure, HBA test was performed by using fresh semen samples, and the rates of sperm binding to HBA were calculated. HBA values and semen parameters were compared. Fisher exact test was used to evaluate the relationship between HBA ratio and pregnancy status. Mann-Whitney U test was used to compare quantitative variables between pregnant and non-pregnant groups. The p&lt;0.05 was considered statistically significant.<br /> Results: In this study, HBA ratio was 69(29.25%) and pregnancy rate was 14.29%. A significant positive correlation between HBA and total motile sperm count, inseminating sperm count, progressive motility, morphology, and sperm concentration (p&lt;0.001, p&lt;0.001, p:0.007, p&lt;0.003, p:0.003 respectively) was observed. Although HBA values in pregnant group were higher than those in non-pregnant group, this result did not reach the statistically significant level (HBA: 67(20%) for non-pregnant group, 80.5(21.3%) for pregnant group). Also, no relationship between HBA values and pregnancy status was found. Moreover, there was no significant correlation between pregnancy status and HBA ratios based on the suggested cut-off value of 60 in literature (p=0.425).<br /> Conclusion: HBA does not predict the IUI outcome in couples with unexplained infertility or mild male factor infertility, but it can be used together with semen parameters to verify sperm quality.</p> https://www.jri.ir/article/626 Unexplained Infertility, the Controversial Matter in Management of Infertile Couples https://www.jri.ir/article/628