Table of content

Iraqi Journal of Embryos and Infertility Researches

المجلة العراقية لبحوث الأجنة والعقم

ISSN: eISSN: 26166984 / pISSN: 22180265
Publisher: Al-Nahrain University
Faculty: Embryo research and treatment of infertility
Language: English

This journal is Open Access

About

Iraqi journal of embryos and infertility research is apeer-reviewed journal published annually by the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Al-Nahrain University,
it publishes manuscripts in the fields of reproductive medicine.

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Contact info

E-mail: haydermossa@gmail.com

E-mail: ijeir.info@ierit.nahrainuniv.edu.iq

Website : http://www.ijeir.nahrainuniv.edu.iq

Table of content: 2018 volume:8 issue:2

Article
Role of Endometrial Scratch in Enhancing Pregnancy Rate of ICSI Cycle Through Its Effect on TNF-α

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Abstract

Abstract Background:The overall success rate of assisted reproductive techniques is only about 30% due to certain limiting factors. Endometrial scratching could induce inflammatory response which manifested by the up-regulation of different cytokines and chemokines with subsequent accumulation of immune cells in the injured site. One of the most important cytokine in this regard is TNF-α which was found to induce tissue remodeling by stimulating the production of many other pro-inflammatory cytokines. Objectives:To investigate the role of endometrial injury during the luteal phase before ICSI cycles in the enhancement of pregnancy outcomes. Materials and Methods:This prospective study was undertaken in the High Institute of Infertility diagnosis and Assisted Reproductive Techniques / Al-Nahrain University. All women were undergone ICSI cycles. Women in the intervension group underwent endometrial scratching with a Pipelle catheter in luteal phase preceding cycle. Blood sample was taken before scratch. All patients undergo controlled ovarian hyperstimulation, oocyte retrieval and embryo transfer, another blood sample was taken at day of embryo transfer to measure level of TNF-α. Clinical pregnancy rate then evaluation after luteal support of two weeks. Results:The patients in scratch group has higher pregnancy rate (14/23) 60.9% than non intervention group (11/33) 33.3% although not significant (p value 0.057). The results showed that the TNF-α after scratch (54.53±10.2) was significantly higher than before scratch (39.26±14.74) in the same group, as p value was ( <0.001). In addition the TNF-α was significantly higher in scratch group (54.53±10.2) than control (25.91±9.08) as p value was (< 0.001) . Conclusion:Induced endometrial local injury is an easy, simple and cost-effective technique that can be used to improve the uterine receptivity and enhance embryo transplantation.


Article
Evaluation of Soluble L-Selectin (CD 62L)Level in Embryo Culture Media to Embryo Quality and Implantation Rate

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Abstract Background:Although progress was made in an in vitro fertilization (IVF) techniques, the majority of transferred embryos fail to implant. Morphology embryo scoring is the standard procedure for most of IVF centers for choosing the best embryo, but remains limited since even the embryos classified as (top quality) may not implant. Determining molecular mechanisms of human embryo implantation is an extremely challenging task due to the limitation of materials and significant differences underlying this process among mammalian species. L-Selectin and its ligand carbohydrate have been proposed as a system that mediates initial adhesion of human blastocysts to the uterine epithelia. Objectives:Quantitative evaluation of soluble L-Selectin molecule in an in-vitro culture media used for in vitro fertilization. Determine cut-off value of soluble L-Selectin quantity to be as qualitative predictor of successful implantation Patients and Methods: This prospective study was undertaken in the High Institute of Infertility diagnosis and assisted Reproductive Technologies/ Al-Nahrain University/ Baghdad/ Iraq, during the period from September2017 to April 2018.A total of 74 infertile women were underwent controlled ovarian hyper stimulation for intracytoplasmic sperm injection cycle. Flexible antagonist protocol was used as ovulation induction protocol in all the cases .culture media L-Selectin level were measured on the day of embryo transfer by using Enzyme linked immune sorbent assay (ELISA) for all cases . Comparison in culture media L-Selectin was done to all cases. Results: There was no significant difference between pregnant and non-pregnant groups in age , BMI, and level of basal hormone FSH, LH , AMH and E2 in the day of hCG injection, and significant difference in the level of L-Selectin in pregnant compared to non-pregnant groups. Conclusion: Level of L-Selectin concentration in embryo culture media can be used as predictor of ICSI success


Article
Male Fertility Supplements (MFS Plus) Treatment Improve Semen Quality in a Sample of Iraqi Infertile Males

Authors: Majid H. Ahmed --- Haider M. M.Dabbach
Pages: 14-20
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Abstract

Background:At least in 25% of infertile men, no identifiable cause can be attributed to the problem,so it is termed idiopathic infertility. Those men are candidates for empiric medical therapy which include antioxidant therapy. Men upplement Plus (MFS Plus) uses a powerful all-natural formula of many antioxidants in addition to Relora to improve semen quality. Objectives:To evaluate the effect of MFS Plus on sperms concentration, motility and morphology in men with oligo and/or asthenozoopermia in sample of Iraqi infertile males. Methods:Acomparative clinical trial study was conducted at High Institute of Infertility Diagnosis and Assisted Reproductive Technologies during the period from July 2015 till February 2017. Male partner of infertile couples who had one or more of the following criteria oligo, astheno, and/or teratozospermia according to criteria of WHO 2010 were involved in this study. Eighty-one males were divided randomly into two groups, the first group (group A) were given MFS Plus capsule AMS® (America Medic & Science) two capsules twice daily for three months and the second group (group B) were given vitamin E capsule (one capsule three times daily) for the same period.A second semen analysis were done after three months for each subject in both groups to show the effect of both types of treatment on semen quality. Results:There was a highly significant increase in sperms progressive motility % (14.0±11.41 vs 29.35±15.61, p value < 0.001) and a highly significant decrease in immotile sperms % (60.15±19.3 vs 41.52±18.18, p value < 0.001) in the group of patients who received MFS Plus treatment. Moreover, there was significant increase in sperm concentration and percentage of normal sperm morphology (p value = 0.027, 0.019 respectively). However, no significant change was observed regarding semen volume and percentage of non-progressive motility.Whereas there were no significant changes in any of semen analysis parameters in the group of patients (group B) who received placebo. Conclusion:MFS Plus usage for three months is very beneficial for sperm motility in addition to its valuable effect on sperm concentration and morphology and it is more efficient than vitamin E alone.


Article
The Role of Asymptomatic Bacterial Vaginosis in Women Undergoing Intracytoplasmic Sperm Injection in Predicting Successful Pregnancy

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Background:Bacterial vaginosis (BV)is a polymicrobial clinical syndrome resulting from replacement of the normal hydrogen peroxide producing Lactobacillus sp. BV is the most common lower genital tract disorder among women of reproductive age (pregnant and non-pregnant) and the most prevalent cause of vaginal discharge and malodor. Objectives:To study the role of asymptomatic bacterial vaginosis on outcome in patients undergoing ICSI. Patients and Methods:This prospective study was undertaken in the High Institute of Infertility Diagnosis and Assisted Reproductive Techniques / Al-Nahrain University. During the period from September 2017 – April 2018. A total of 100 infertile women .All of them were underwent controlled ovarian hyper stimulation for intra cytoplasmic sperm injection cycle. Antagonist oocyte maturation used as ovulation induction protocol in all the cases. Assessment of oocyte maturation and embryo quality is done to the all the cases, bacterial vaginosis smear was collected on the day of oocyte retrieval. B.V. smear diagnosis by Amsel’s Criteria and Nugent’s Scoring. Results: TThere was no significant difference in mean age of pregnant and non-pregnant ladies, 29.40 ±6.47 years versus 30.78±6.84 years, respectively (P= 0.333).In addition the frequency of women under 35 years age was comparable in the two groups with no statistical significant difference, 34 (79.1%) versus 33 (73.3%), respectively (P = 0.528). Wide variation and non-normal distribution was the role followed by the duration of infertility concerning sub-fertile women participating in this study. However, no significant difference was observed in the duration of infertility between pregnant and non-pregnant ladies, 6.00 (5.00) years versus 6.00 (5.00) years (P = 0.289). Comparison of basal hormonal levels between pregnant and non-pregnant groups revealed no significant difference despite the presence of some minor differences in mean hormonal levels between the two groups (P> 0.05). Comparison of oocytes characteristics between pregnant and non-pregnant ladies was conducted and revealed no significant difference in mean total number retrieved oocyte (TNO), ruptured oocytes (RO), abnormal oocyte (AO), germinal vesicle oocyte (GV), metaphase I oocyte and metaphase II oocytes (P > 0.05), table Mean total number retrieved oocyte (TNO), ruptured oocytes (RO), abnormal oocyte (AO), germinal vesicle oocyte (GV), metaphase I oocyte and metaphase II oocytes was 10.81 ±4.95 versus 10.42±6.30, 0.44 ±0.73 versus 0.36 ±0.65, 1.09 ±1.56 versus 0.84 ±2.00, 0.91 ±1.00 versus 0.89 ±1.47, 1.51 ±1.49 versus 2.04 ±2.09 and 6.84 ±4.01 versus 6.22 ±3.91 in pregnant and non-pregnant groups, respectively. Mean fertilization rate was higher in pregnant ladies than that of non-pregnant ladies, 62.19 ±22.23 versus 57.59 ±24.95, respectively; however, the difference was no statistically significant (P = 0.365).Mean grade I embryo number was also significantly higher in pregnant women than that of non-pregnant women, 2.53 ±1.53 versus 1.89 ±1.27, respectively (P = 0.034), Mean grade II embryo number was 0.86 ±1.52 versus 0.89 ±1.28 in pregnant and non-pregnant ladies, respectively and the difference was not significant (P = 0.925), moreover the difference in mean grade III embryo number between pregnant and non-pregnant women was insignificant (P = 0.321), 0.30 ±1.01 versus 0.31 ±0.50, respectively. Rate of asymptomatic bacterial vaginosis as determined by gram stain, whiff test, wet mount and Amsel’s criteria was 32.6 % in pregnant women compared to 73.3% in non-pregnant group, being highly significant higher in those women who failed to get pregnant (P<0.001). Conclusion: Rate of asymptomatic bacterial vaginosis was 32.6 % in pregnant women compared to 73.3% in non- pregnant group, being highly significant higher in those women who failed to get pregnant.


Article
Evaluation of Serum TNF-α in Insulin Resistant Non PCOS Pa - tients Undergoing ICSI: A Randomized Clinical Trial

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Background:With the rapid evolution of assisted reproductive technologies, more and more studies are concerned about the possible influential factors on the success rates of these procedures, with the efforts are now mainly directed toward defining these factors in a trial to increase these rates. Of these factors, inflammation is considered among the most remarkable and is in the focus of the updated studies. However, most of these studies are evaluating the role of inflammation in patients with polycystic ovarian syndrome(PCOS) , while the impact of this inflammation in insulin resistant non PCOS patients is underestimated and not well evaluated . Objectives:This study is a trial to elucidate the importance of one of the inflammatory mediators , Tumor Necrosis Factor-alpha (TNF – α) , in insulin resistant patients undergoing IVF ( ICSI ) cycles . Patients and Methods:A group of 27non-PCOS infertile patients were selected for this clinical randomized prospective study from patients attending the high institute for infertility diagnosis and assisted reproductive technologies / Al-Nahrain University and subjected to intra-cytoplasmic sperm injection (ICSI) procedure. BMI was measured for all patients and they were classified according to WHO classification into 3 groups : Acceptable , overweight and obese . Fasting plasma level of glucose and insulin was investigated and insulin resistance index (HOMA) was calculated. Serum TNF-α has been measured using ELISA and the relation with insulin resistance was investigated. Finally, the pregnancy rate, as a primary reproductive endpoint was compared according to TNF -a and insulin resistance levels between different study subjects. Results: Of the 27 infertile patients , 17(63 %) were non obese and 10 (37%) were obese , 15(55.5%) were having HOMA index < 1.6 and 12 (44.5 %) were having HOMA index ≥ 1.6 . BMI was found to be positively correlated with higher HOMA index ( P = 0.01 and R= 0.4 in spearman correlation). Investigating the relation between TNF-α with BMI revealed that TNF-α levels are increasing with the increment in BMI, However , the difference in the mean TNF-α between the three BMI groups failed to achieve statistical significance (P=0.1). In contrast to that, when stratifying for HOMA index , TNF-α was significantly correlated with it ( spearman correlation R= 0.4 , P=0.01 ) , and patients with HOMA index ≥1.6 were found to have higher levels of TNF-α (The effect of insulin resistance was also implicated on pregnancy rates , as those with high insulin resistance were shown to have significantly lower pregnancy rates when compared to those with low indices of resistance (P = 0.03) . However, the impact TNF-α on pregnancy rates was apparently less significant (P= 0.5). Conclusion: Rate of asymptomatic bacterial vaginosis was 32.6 % in pregnant women compared to 73.3% in non- pregnant group, being highly significant higher in those women who failed to get pregnant.


Article
Association of Seminal Plasma Level of NLRP3 Inflammasome Protein with Quality of Seminal Fluid Parameters Among Infertile Men

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Background:inflammasome protein govern the inflammatory process. The elevation of NLRP3 inflammasome might be related to bad seminal fluid analysis results. Objectives:This study aimed to evaluate seminal plasma NLRP3 protein and its relation with seminal fluid analysis parameters before and after in vitro sperm activation. Patients and Methods: a total of 50 infertile patients were collected form higher institute of infertility diagnosis and assisted reproductive technique, there semen samples were processed for seminal fluid analysis before and after in vitro sperm activation. NLRP3 inflammasome protein were measured in seminal plasma. Results:the mean level of NLRP3 protein was 5.12 ng/ml. the higher level of NLRP3 protein (4.5ng/ml) associated with lower sperm concentration, grade A, B, C and higher level of grade D motility. However, 50% of those patients have an improvement in their seminal fluid analysis after in vitro sperm activation. Conclusion:Elevation of NLRP3 protein in seminal plasma may be associated with the increased leukocytospermia, bad sperm quality and unresponsiveness to in vitro sperm activation among infertile male.


Article
Investigation of Azoospermia Factor Microdeletions in Infertile Men in Diyala Governorate

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Background:Y chromosomes microdeletions (YCM) are the most frequently observed structure abnormalities in the male specific region (MSY), 15% of total primary spermatogenic failure cases are related to at least 6 known major YCM patterns. These microdeletions present in 5-10% of infertile men and they are very rare in fertile and normospermia men. Objectives:This study was conducted to investigate the prevalence of Azoospermia Factor (AZF)region microdeletions in a sample of Diyala governorate infertile men. Subjects and Methods: An included 80 infertile men who had been referred to private clinics of New Baquba as a test group and 20 proven fertile men as a control group. Tests included seminal fluid analysis, sex hormones profile and polymerase chain reaction using specific tagged sites. Results: Showed that eleven infertile men (13.75%) had AZF microdeletions, while no microdeletion were found in control group. Seven (63.6%) microdeletions were in AZFc sub-region while 2(18.1%) microdeletions were in AZFbc and AZFb each. This study showed that men with sperm count below <5 millions/ ml should be evaluated for Yq11 microdeletions before attempting any surgical or hormonal treatment or attending assisted reproductive techniques. Conclusion:AZFc is the dominance pattern of microdeletions in Diyala governorate infertile males and AZFa pattern of microdeletions is the rarest pattern, also genetic screening for long arm of Y chromosome microdeletions should be listed in the routine tests for men who suffer from azoospermia prior to providing ART service or surgical treatments.


Article
Effect of Exposure to Progesterone During Intrauterine Period on Reproductive System of Female Mouse Morphological and Biochemical Study

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Background:progesterone used as a therapeutic agent in human pregnancy. The sufficient evidence to hypothesize that progesterone may have teratogeniceffect on the reproductive system of female offspring. Objectives:This study was established to explore the individual impact of different doses of progesterone during intrauterine period on reproductive system of female mouse, and on some reproductive parameters. Materials and Methods:ninety adult female mice (8-10 weeks) and weight (25- 28) gm divided into three groups. Control group (G1) was treated daily (IM) injection with sesame seed oilfrom 1-14 day of pregnancy, and other two groups that treated with different doses of progesterone G2 (0.4mg/kg. B.wt/day), G3 (0.8mg/kg. B.wt/day), daily (IM) injection of progesterone from 1-14 day of pregnancy then selecting of Female offspring and sacrificed at age zero day, one month, two month. Parameter analysis involvedanogenital distance , body and ovary weights, , length of epithelial cells, number and diameter of follicles (Primordial , Primary , Secondary and Mature antral) , corpus luteum and using histological section by (motic image plus) and hormonal assay including progesterone and Estrogen. Results: The results of this study demonstrated that at one month, two months after birth, there was a highly significant increase P< 0.01 in theanogenital distance . The statistical analysisshowed no statistical significant difference in the body and ovary weights , at one month after birth, The statistical analysisshowed highly statistically significant decreased(P< 0.01 ) in both G2 and G3 in the number of follicles . At one,two months after birth, there was a highly significant decreased (P< 0.01 ) in both G2 and G3 in the number ofcorpora lutea. At age two month, there was a highly significant decreased (P< 0.01 ) in both G2 and G3 in the height of epithelial cell layer.There was a highly significant decreased (P< 0.01 ) in both G2 and G3 in the diameter of follicles (Primordial , Primary , Secondary and Mature antral) follicles . There was a highly significant decreased (P< 0.01 ) in both G2 and G3 in Estrogen and Progesterone levelof female offspring when compared with the control group G1. Conclusion: The results showed higher doses of progesterone for long period in pregnancy can impact some reproductive parameters of female offspring mice.

Table of content: volume:8 issue:2