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 <p>Background: Growth of Mycoplasma in genital tract can cause problems such as infertility, pelvic inflammatory disease (PID), and preterm labor. This study was designed to evaluate the role of these bacteria in preterm labor among individuals in Gorgan city which is located in north of Iran.<br /> Methods: The study included 100 women with complaints of pain in preterm labor before 37 weeks of pregnancy (case group) and 100 women with term labor (control group) who were referred to Shahid Sayyad Shirazi Teaching Hospital in Gorgan city, north of Iran. Vaginal swabs, collected from all of these women, were evaluated for genital Mycoplasma sp. by molecular method using specific primers with poly-merization chain reaction (PCR). The comparison of results was done by conducting X 2 and p&lt;0.05 was considered significant.<br /> Results: Genital Mycoplasma was detected in 78 cases (39%) of 200 vaginal samples. Genital Mycoplasma colonization rates in the preterm and term samples were 60% and 18%, respectively, with relative risk of 2.05 (1.78-2.37) (p=0.001). The proportion of Ureaplasma parvum (44% and 15%), Ureaplasma urealyticum (11%, 3%), and Mycoplasma homins (5%, 0%) was significantly higher in women with preterm birth (PTB) than term labor. No cases of Mycoplasma genitalum were detected in this study.<br /> Conclusion: There is a significant relationship between presence of genital Mycoplasma in vaginal secretion and the risk of preterm labor.</p> https://www.jri.ir/article/615 <p>Background: The purpose of the current study was comparing pregnancy outcomes for natural cycle in vitro fertilization (IVF) per fresh embryo transfer (ET) and oocyte pick-up (OPU) in intrauterine insemination (IUI).<br /> Methods: This was a retrospective cohort study of women who underwent either IUI (n=246) or OPU with fresh ET for natural cycle IVF (n=291), conducted between April 2017 and February 2018 at the Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan. Patients in both groups did not receive ovarian stimulation and luteal support; gonadotropin-releasing agonist spray was administered 35 hr before OPU or IUI. The clinical pregnancy rate was compared between the IUI and IVF groups. Data analysis was based on the number of cycles. The p≦0.05 was considered significant.<br /> Results: The clinical pregnancy rate per OPU in the IVF group was higher than the one in IUI group (20.6% vs. 10.1%), and the difference was significant (p&lt;0.01). The pregnancy rate for natural cycle IVF calculated per fresh ET was 36.8%. The miscarriage rate did not significantly differ between the IVF (4.1%) and IUI (8.0%) groups.<br /> Conclusion: Fresh ET in natural cycle IVF provides a higher implantation rate than IUI.</p> https://www.jri.ir/article/120129 <p>Background: Varicoceles are a major cause of infertility. The purpose of this study was to determine the relationship of the clinical and ultrasonographic grades of varicocele with the semen analysis profile and testicular volume among men undergoing scrotal ultrasonography.<br /> Methods: This cross-sectional analytical study involved 109 males undergoing scrotal ultrasonography for various indications in Shiraz, Iran, between January 2019 and January 2020. Varicoceles were graded with color Doppler ultrasonography (CDU) by an expert radiologist (Sarteschi&#39;s criteria) before an experienced urologist determined the clinical grade (Dubin and Amelar criteria) and requested further investigations. Next, the demographics, reasons for referral, testicular volumes, and semen analysis profiles across the different clinical/ultrasonographic grades were compared. Key statistical measures included Cohen&#39;s kappa coefficient, the Mann&ndash;Whitney and Kruskal-Wallis tests, and Spearman correlation. Data were analyzed using SPSS v. 21 with p-values &lt;0.05 indicating statistical significance.<br /> Results: Ultrasonographic grades 1 and 2 provided the highest correlation with subclinical cases, while ultrasonographic grades 3, 4, and 5 corresponded with clinical grades 1, 2, and 3, respectively. Further comparisons were made between subclinical and clinical cases, which were similar in terms of reason for referral, total testicular volume, testicular volume differential, and semen analysis profile. Notably, total testicular volumes below 30 ml were associated with oligoasthenoteratospermia.<br /> Conclusion: The present study showed a relatively high correlation between varicocele grading based on clinical evaluation and CDU. However, the grades were similar in testicular volume parameters and semen analysis indices. Hence, decision-making should be guided by the infertility history, testicular atrophy, and abnormal semen analysis.</p> https://www.jri.ir/article/120138 <p>Background: The main cause of hemolytic disease of the fetus and newborn (HDFN) is the incompatibility of the RHD antigen between mother and fetus. Following the discovery of cell-free fetal DNA (cffDNA), noninvasive fetal RHD genotyping also became possible, which will help in the better management of immunized RHD negative mothers and in the targeted prenatal injection of Rho(D) immune globulin (RhIG). The objective of this study was to establish a reliable method with high accuracy to determine the fetal RHD genotype.<br /> Methods: The project was a prospective observational cohort study. After cell-free DNA (cfDNA) extraction from maternal plasma, fetal RHD genotyping was performed by duplex real-time polymerase chain reaction (PCR) and exons 5, 7, and 10 of the RHD gene were examined. SRY and RASSF1A genes were used as internal controls to confirm the presence of cffDNA in maternal plasma.<br /> Results: Out of 40 samples, 33 were RhD positive heterozygous mothers and 7 cases were RHD negative. In three cases where both the fetal RHD and SRY genotypes were negative, RASSF1A was amplified in cell-free DNA sample treated with the BstUI enzyme, and the presence of cffDNA was confirmed.<br /> Conclusion: The findings reveal that the strategy used in this study is reliable and it is possible to determine the fetal RHD status with high accuracy. The strategy can help targeted injection of RhIG and prevent unnecessary injection in RhD negative mothers who carry an RhD negative fetus.</p> https://www.jri.ir/article/120140 <p>Background: Oocyte donation has facilitated couples to achieve pregnancy in conditions like diminished ovarian reserve, premature ovarian failure, and inheritable disorders. However, it is unclear whether pregnancy complications are due to oocyte donation per se or due to confounding factors such as maternal age or the allogenic fetus. In this retrospective comparative cohort, an attempt was made to evaluate and compare multiple obstetric and perinatal outcomes.<br /> Methods: The present study comprised all women in the age range of 20-45 years who conceived from oocyte donation (n=102) between 1/12/2011 to 30/09/2017. Control group consisted of spontaneous conception cases (n=306) in ratio of 1:3 with no previous medical or surgery comorbidity. Obstetric and perinatal outcomes were compared between two groups.<br /> Results: Mean maternal age was significantly higher in the donor oocyte IVF group (group 1; 35.13 years) as compared to spontaneous conception group (group 2; 31.75 years). Parity between the two groups was comparable. Pregnancy induced hypertension (PIH) was seen in 33.33% of cases in group 1 as compared to 7.18% in group 2. Moreover, gestational diabetes mellitus was seen in 34.31% of cases in group 1 as compared to 9.47% in group 2 (p=0.001). By the same token, there was significant difference in perinatal outcomes between the two groups.<br /> Conclusion: Oocyte donation should be treated as an independent risk factor for miscarriage, hypertensive disorder, and gestational diabetes mellitus in pregnancy.</p> https://www.jri.ir/article/120141 <p>Background: The COVID-19 pandemic has been shown to impact the lifestyle of couples of reproductive age and, in particular, their desire for parenthood. The purpose of this study was to carry out an evaluation on the potential changes of desire for parenthood among infertile couples waiting for assisted reproduction during the pandemic.<br /> Methods: In this multicenter cross-sectional study, the quality of sexual life in Ital-ian infertile couples was assessed and their well-being was evaluated before the pandemic and during the quarantine. All couples were asked to fill out a ques-tionnaire, in which their desire for parenthood, sexual life, and well-being were in-vestigated.<br /> Results: Out of 1650 cases, 300 patients were finally enrolled. COVID-19 nega-tively impacted the well-being of individuals, leading to significantly reduced scores of happiness, feeling energetic, and interest in life (p&lt;0.05). Although most couples had prolonged infertility, a small number of cases (4.0%) achieved a spontaneous natural pregnancy during the lockdown, probably due to more intimacy and longer time spent together. However, major concerns about the consequential effects of the virus on pregnancy and the risk of contagion in the hospital led a small number of infertile couples (5.0%) to decide to postpone their parenting project.<br /> Conclusion: The COVID-19 pandemic may have created a further negative impact on couples, reducing their desire for parenthood. This attitude could result in a decrease in births in the near future.</p> https://www.jri.ir/article/120142 <p>Background: Chemotherapeutic agents such as cyclophosphamide and busulfan have been shown to have a negative impact on the spermatogenesis process. Based on this fact, the objective of this study was to investigate the effects of edaravone on spermatogenesis in busulfan-induced mice.<br /> Methods: Forty adult male mice were equally divided into the four groups: 1) control, 2) edaravone, 3) busulfan, and 4) busulfan + edaravone. Then, the sperm parameters, histopathological examinations, and serum levels of testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were also assessed. Caspase-3, Beclin-1, and ATG-7 mRNA levels were also determined using real-time PCR.<br /> Results: Our results revealed that treatment of mice with edaravone in busulfan-induced azoospermia significantly improves sperm parameters, including total count, morphology, and viability (p&lt;0.05). Furthermore, edaravone administration led to a significant increase in serum testosterone (p&lt;0.0001) and FSH (p&lt;0.001) levels, as well as testis weight (p&lt;0.05) and volume (p&lt;0.01). Edaravone also prevented a decrease in the number of testicular cells including spermatogonia (p&lt;0.0001), primary spermatocytes (p&lt; 0.001), round spermatids (p&lt;0.0001), Sertoli (p&lt;0.01), and Leydig cells (p&lt;0.0001) in busulfan-treated mice. Additionally, in busulfan-induced azoospermia, edaravone significantly reduced the percentage of sperm with immature chromatin (p&lt;0.0001). Following treatment with edaravone, a decrease in reactive oxygen species (ROS) and an increase in glutathione (GSH) production were noted compared to busulfan-treated mice. Further-more, caspase-3 (p&lt;0.05), Beclin-1, and ATG-7 (p&lt;0.001) genes expression decreased significantly in treatment groups compared to busulfan-induced azoospermia.<br /> Conclusion: According to our findings, edaravone can improve spermatogenesis in busulfan-induced azoospermia through free radical scavenging and autophagy modulation in testicular tissue.</p> https://www.jri.ir/article/120143 <p>Background: The purpose of the current study was to evaluate the ability of three protocols to triage women presenting with pregnancy of unknown location (PUL).<br /> Methods: Women with pregnancy of unknown location were recruited from Aziz Medical Centre from 1st August, 2018 to 31st July, 2020. The criterion of progesterone, human chorionic gonadotrophin (hCG) ratio, and M4 algorithm were used to predict risk of adverse pregnancy outcomes and classify women. Finally, 3 groups were established including ectopic pregnancy, failed pregnancy of unknown location, and intrauterine pregnancy (IUP). The primary outcome was to assign women to ectopic pregnancy group using these protocols. The secondary outcome was to compare the sensitivity and specificity of the three protocols relative to the final outcome.<br /> Results: Of the 288 women, 66 (22.9%) had ectopic pregnancy, 144 (50.0%) had intrauterine pregnancy, and 78 (27.1%) had failed pregnancy of unknown location. The criterion of progesterone had a sensitivity of 81.8%, specificity of 27%, negative predictive value (NPV) of 83.3%, and positive predictive value (PPV) of 25% for high risk result (ectopic pregnancy). The hCG ratio had sensitivity of 72%, specificity of 73%, NPV of 90%, and PPV of 44% for high risk result (ectopic pregnancy). However, model M4 had sensitivity of 86.4%, specificity of 91.9%, NPV of 95.8%, and PPV of 76% for high risk result.<br /> Conclusion: Based on the findings of the study, it was revealed that prediction model of M4 had the highest sensitivity, specificity, negative predictive value and positive predictive value for high risk result (ectopic pregnancy).</p> https://www.jri.ir/article/120148 <p>Background: Pseudo-TORCH syndrome (PTS) is a group of autosomal recessive disorders that clinically and radiologically mimic TORCH congenital infections. The prevalence of pseudo-TORCH syndrome 2 is 1 in 1,000,000 cases worldwide. This novel disorder is extremely rare, and is generally detected by prenatal diagnosis through next generation sequencing (NGS) during pregnancy. In this study, a familial case of pseudo-TORCH syndrome 2 with novel non-sense mutation in the ubiquitin-specific peptidase 18 (USP 18) gene in the parents was reported, who are heterozygous asymptomatic carriers; however, all children have inherited a homozygous pathogenic form of USP18, which is an important negative regulator of type I interferon (IFN) signal transduction. To the best of our knowledge, this is the first case of a novel mutation of USP18 seen in a family with pseudo-TORCH syndrome 2 (PTS 2) from India<br /> Case Presentation: A 23-year-old pregnant woman with bad obstetric history, including intrauterine and neonatal mortality was referred to the Institute of Genetics in the year 2021 for clinical and genetic evaluation. Advanced clinical exome sequencing of the parents and the fetus revealed heterozygous carrier status in parents and homozygous mutation in USP 18 gene in the progeny leading to pseudo-TORCH-2 syndrome.<br /> Conclusion: The present case highlights the significance of carrier screening, prenatal diagnosis, and genetic counseling in couples with bad obstetric history for the detection of rare genetic disorders with poor prognosis.</p> https://www.jri.ir/article/120154 https://www.jri.ir/article/130160