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مرکز اطلاعات علمی SID1
مرکز اطلاعات علمی SID
مرکز اطلاعات علمی SID
مرکز اطلاعات علمی SID
مرکز اطلاعات علمی SID
مرکز اطلاعات علمی SID
مرکز اطلاعات علمی SID
Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    1
  • End Page: 

    1
Measures: 
  • Citations: 

    0
  • Views: 

    8720
  • Downloads: 

    4247
Abstract: 

Introduction: To investigate a new method for the management of women with cervical incompetence.Materials and Methods: A laparoscopic cervical cerclage was performed before pregnancy under general anesthesia. A 5-mm Mersilene tape with straight needle in both end of the tape was used for cervical cerclage. First, we dissected the bladder flap of peritoneum and exposed the uterine isthmus. At this part, we can see the uterine artery in both side of the uterus. The needle passes through the uterine wall at the level of uterine isthmus just lateral in the uterine artery. The needle passes through the uterine wall in both side of the uterine isthmus from anterior to posterior. The tip of the needle comes out just above the uterine- sacral ligament. Hysteroscopy examination was carried out to exclude the exposure of tape in the uterine canal when the tape was placed in position. The tape was then tied posteriorly with double throws of an intracorporeal knot after hysteroscopy examination.Results: Eleven women who have unsuccessful vaginal cervical cerclage accept laparoscopic cervical cerclage. No intraoperative or postoperative complications were experienced. The average operating time is 45 minute (20-75 min). The average blood loss during surgery is 30 ml (20-50 ml).Seven women became pregnancy spontaneously after surgery. Five of them have a term pregnancy and deliver a healthy baby by cesarean section. Two women had spontaneous abortion. Four of them are still not conceived Conclusion: Laparoscopic cervical cerclage is feasible and effective. Outcomes are good in a particularly high-risk group of women with cervical incompetence who have had failed vaginal cerclage and have a history of recurrent pregnancy loss.

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Writer: 

NIELSEN H.I.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    1
  • End Page: 

    1
Measures: 
  • Citations: 

    0
  • Views: 

    9729
  • Downloads: 

    4247
Abstract: 

Oocyte maturation is generally defined as the reinitiation of the first meiotic division leading to metaphase II (MII), combined with the appropriate cytoplasmic processes, which are necessary for proper fertilization and early embryo development. Using in vitro maturation techniques, oocytes are harvested in the GV stage (germinal vesicle, prophase I), and matured in special maturation media. The maturation process in vivo and in vitro will be discussed, and the outcome of In Vitro Maturation and standard IVF will be compared. Basically, the outcome of IVM is still inferior: The pregnancy rate per oocyte-pick-up as well as per embryo transfer is lower. So is the implantation rate, while the early pregnancy loss seems to be somewhat higher. It is therefore necessary to carefully consider the reasons for carrying out maturation of oocytes in vitro and which types of subfertility may benefit from this treatment. Hence, improvements in general clinical techniques, patient selection, degree and nature of hormonal stimulation and culture media are called for. Over the years, most maturation media have been based on Medium 199 with additions of follicular fluid, serum or serum fractions. There are several good reasons for adding these protein sources, but they clearly also present problems due to their complex and undefined composition. Therefore, truly defined media should be developed. This involves a number of considerations: Medium 199 was not originally defined for IVM, and maybe we need a different formulation for the basal component of a defined maturation medium. Do we need a "protein source‟, or can it be replaced with a truly synthetic “serum replacement‟? Which cocktail of signal molecules like growth factors and hormones do we need to add in order to direct the immature oocyte-cumulus complexes to carry out a proper maturation? This should clearly involve not only the nuclear maturation of the oocyte, but also secure synchronization with the cytoplasmic maturation and proper maintenance of the oocyte-cumulus interaction. Numerous signal molecules or "active molecules‟ have been suggested as additions to maturation media and will be discussed in this lecture.

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Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    10
  • End Page: 

    11
Measures: 
  • Citations: 

    0
  • Views: 

    13011
  • Downloads: 

    4247
Abstract: 

Introduction: In the past three decades considerable improvement has been achieved in stimulation protocols. However, the efficacy of assisted reproductive technology (ART) in term of live birth rate has remained relatively constant and has showed minimal progress in embryo implantation and pregnancy rates over the years. Approximately 30% of women undergoing in vitro fertilization and embryo transfer (IVF-ET) will achieve an ongoing pregnancy and the birth rate is still 29.9-43.7% per cycle. Thus, failure to obtain pregnancy occurs at the time of implantation or a short time thereafter. It has been estimated that 30% of embryos are wasted in the preimplantation period and 30% are wasted after implantation. So implantation failure following embryo transfer is a principle problem in ART cycles.Definition of RIF: Implantation is determined as a procedure depending on several step and a continuous embryo-uterus interaction is observed at every step. The maternal immune system plays a major role in the establishment and maintenance of a normal pregnancy. Local and systemic immunological factors have been recognized that decrease the immunogenicity of the allogenic embryo and/or change the maternal immune response to facilitate implantation and the maintenance of early pregnancy. The maternal-fetal relationship is bidirectional process that immunestimulation might be more important than immunosupression. A high rate of human leukocyte antigen (HLA) loci sharing is an expression of genetic similarity and may act to prevent the appearance of anti-paternal antibodies and most couples will share no more the one loci (of 10 alleles inherited from both parents). Furthermore, implantation require coordination of multiple parameters including growing trophoblast and proper expression of numerous molecules that play essential roles in invasion of the embryo into the endometrium. Implantation failure in patients undergoing IVF is comparatively common in spite of good quality embryos transfer. Implantation failure may be a repeated event in some couples even in successful units with high pregnancy and live birth rates and it is leading to disappointment in these couples and their supervisors. Recurrent implantation failure (RIF) is defined as failure to achieve a pregnancy following 2-6 IVF cycles with more than 10 good quality embryos transfer and endometrial receptivity. Recently, the definition of RIF is not obvious and it is due to a trend for transferring only one or two embryos.Etiologies of RIF: Implantation is a complex process dependent upon many variable, most of which have not been adequately defined.Some agents have been recognized that affect success or failure of IVF-ET procedure and include decreased endometrial receptivity (due to uterine cavity abnormalities, endometrial thickness, immunological factors, thrombophilias, altered expression of adhesive molecules such as cytokines, NK cells, ILs, and integrins), embryo quality defect (due to parental age, ovarian reserve, infertility etiology, stimulation protocols) and problems in embryo transfer technique.Assessment of RIF: It depends on assumed etiologies and proper diagnosis may help select those patients who benefit from appropriate treatment. Some of these methods include repeated hysteroscopy, change in stimulation protocols, PGS, HLA typing, and identification of specific antibodies and NK cells.Treatment of RIF: whereas therapeutic options are limited and RIF is a clinical definition that include several subgroup, each patient may be have exclusive treatment. Multiple experimental treatments have been presented such as low dose aspirin, low-molecular weight heparin, intravenous immunoglobulin (IVIG), pentoxyfylline, ET under ultrasonographic guidance, blastocyst transfer and ZIFT. There is evidence to suggest that immunological factors may be involved in RIF, immunotherapy with IVIG has been introduced empirically into IVF programs. Preliminary studies found variable success with IVIG. The use of IVIG is very controversial but may be justified after many failures in specific cases and need large randomized prospective studies. IVIG therapy may not be a relevant routine treatment for failed IVF and large randomized studies are needed but these studies are extremely difficult to conduct.Conclusion: We proposed that specialized investigation should be initiated after four or more implantation failure with good quality embryos transfer and also based on our experiences, we believed that the use of surrogacy is the best choice in couples with RIF who other exclusive treatments have failed.

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Writer: 

VAFAEI H.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    11
  • End Page: 

    12
Measures: 
  • Citations: 

    0
  • Views: 

    17315
  • Downloads: 

    4247
Abstract: 

The second trimester scan is the most important sonographic evaluation during pregnancy. The second trimester ultrasound examination is not only for confirming gestational age but also it provides an ideal opportunity for assessing fetal anatomy and therefore structural normality. In addition, assessment of placental position and morphology, amniotic fluid volume, number of fetuses, evaluation of soft markers for chromosomal defects and the comparative interpretation of various measurements are all important pointers to potential problems. This examination is commonly referred to as a „routine second trimester anomaly scan‟. The optimal time at which to offer the routine anomaly scan is the earliest gestation at which the necessary measurements and a full fetal anatomy survey can be performed and the latest gestation at which an acceptable range of options can be offered to the parents if an abnormality is detected. Although the measurements required to date the pregnancy accurately can be taken after 15 weeks of gestation, and most of the fetal anatomy can be evaluated at 18–20 weeks, the optimal time for examination of fetal heart can be provided at 23-28 weeks. It is recommend that the routine anomaly scan is performed between 20 and 24 weeks but we recommend anomaly scan to be done before 20 weeks (18-20 weeks) in Iran as we have limitation for legal termination if needed. Although it is necessary to examine the entire fetus and other uterine contents in detail, it is not always feasible to do this in the order suggested. It is suggested that the measurements are always carried out early in the examination so that they are not forgotten. It is not reasonable to expect all structural fetal abnormalities amenable to ultrasound detection to be diagnosed at a routine second trimester anomaly scan. Though if the approach is systematic then no major structural abnormality should be missed. However there are several examples from anomalies such as microcephaly which might be missed in second trimester scan if there is no serial examination. In the majority of normal pregnancies, measurement of the biparietal diameter (BPD) and femur length (FL) provide the most accurate assessment of gestational age in the second trimester. It is recommended that measurements of the head circumference (HC), transcerebellar diameter (TCD) and abdominal circumference (AC) are also undertaken. They provide further confirmation of gestational age and aid in the exclusion of growth related abnormalities and spina bifida. In addition, their inclusion encourages a systematic examination of the whole fetus. An ultrasound examination is in the unique position of being both a screening test and a diagnostic test for fetal anomalies. Its clinical value is directly dependent on the skills of the sonographer, first, in obtaining the correct images for evaluation and measurement and, second, in the correct interpretation in each specific and unique clinical situation. Such examinations must only be performed by individuals who have undergone a supervised period of training that enables them to identify and distinguish between the range of normal findings, findings of uncertain significance and abnormalities at varying stages of gestation.

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Writer: 

MOSER M.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    11
  • End Page: 

    11
Measures: 
  • Citations: 

    0
  • Views: 

    10589
  • Downloads: 

    4247
Keywords: 
Abstract: 

The diagnosis of male fertility is based on microscopic assessment and analysis of sperm concentration, motility and morphology as routine indicators of human semen quality. Successful pregnancy requires a sperm with genetic integrity. Several studies have shown that male fertility is affected by sperm DNA damage. Subsequently, the assessment of DNA integrity in sperm and the study of its consequences have received considerable attention. Several clinical studies have examined the relationships between sperm DNA damage and reproductive outcomes in the context of natural and ART pregnancies. For IVF and ICSI, the true utility of sperm DNA damage assays remains to be firmly established, since the available studies are generally small, heterogeneous, with conflicting results. Current data suggest that impaired sperm DNA integrity may have the greatest effect on IUI pregnancy rates, further prospective studies are needed before testing becomes a routine part of patient management.

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Writer: 

PIRI S.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    12
  • End Page: 

    12
Measures: 
  • Citations: 

    0
  • Views: 

    9919
  • Downloads: 

    4247
Keywords: 
Abstract: 

John Langdon Down (1828-1896) described Down’s syndrome with 3 characteristics: the skin too loose for the body, flat face, and small nose.Every woman has a risk of having a baby with Down’s syndrome which depends on her age and the history of having a previous Down’s baby (background or priori risk). Diagnosis of fetal chromosomal abnormalities requires invasive testing by amniocentesis or chorionic villous sampling (CVS), both of which have a risk of miscarriage of 1%. The risk for trisomy 21 increases with maternal age and decreases with gestational age because about 30% of affected fetuses die between the 12th and 40th week of pregnancy. However the vast majority of pregnant women are young, therefore most of Down babies are in the younger age group. Screening in the second trimester by maternal age and various combinations of total or free b-hCG, AFP, uE3 and Inhibin A can identify 56-71% of trisomy 21 pregnancies for a false positive rate of 5% (Meta-analysis by H Cuckle, P Penn and D Wright, Semin Perinatol 2005; 29: 252-7). Screening in the first trimester by a combination of maternal age, fetal NT, FHR and serum free b-hCG and PAPP-A identifies about 90% of trisomy 21 pregnancies for a false positive rate of 3%. By adding other ultrasound markers: nasal bone, tricuspid regurgitation, ductus venosus Doppler and facial angle, the detection rate of 1st trimester screening increases to more than 95%.

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Writer: 

NIELSEN H.I.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    12
  • End Page: 

    13
Measures: 
  • Citations: 

    0
  • Views: 

    8680
  • Downloads: 

    4247
Keywords: 
Abstract: 

Over the years it has been an important goal to optimize the treatment of subfertility in order to obtain a better pregnancy rate and baby-take-home rate, usually combined with the goal of decreasing the rate of multiplet pregnancies. This implies optimizing the development of embryos through improved in vitro culture methods. And it also implies optimizing the methods of selection of embryos for fresh and frozen transfers, as well as the timing and location of the deposition of the embryos during transfer. This lecture will deal with embryo morphology and pre-implantation development. Automated time-lapse micro-cinematography is being used to make exact determinations of fertilization, cleavage pattern, and number of nuclei in the blastomeres, degree of fragmentation etc. As opposed to standard microscopy this method provides a continuous microscopy and can be done without interfering with temperature and pH - and without personal being present at critical times. Presently metabolomics studies are technically not possible, but such studies are part of our research plans and will briefly be mentioned.

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Writer: 

VAN DER VEEN F.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    12
  • End Page: 

    12
Measures: 
  • Citations: 

    0
  • Views: 

    12424
  • Downloads: 

    4247
Abstract: 

IVF is nowadays also initiated in couples with subfertility based upon other factors than tubal occlusion, the indication for which it was primarily developed. In contrast to women with bilateral tubal occlusion, these women still have a chance of natural conception. To prevent overtreatment, several cohort studies have identified possible predictive factors for success. A recent meta-analysis of these studies identified female age, duration of subfertility, bFSH and number of oocytes as predictors. Data on embryo quality were not available in the literature. Although in itself of value, it is equally important to know when to stop offering new IVF cycles due to futility. We developed a prediction model to predict pregnancy chances after failed previous cycles and identified female age, duration of subfertility, bFSH, total fertilisation failure, number of failed cycles and mean morphological scores day 3 embryos as independent prognosticators. As far as changes in management are concerned the independent factors were initial FSH dose and number of embryos transferred. The model calibrated extremely well, but still needs external validation. Since female age is the most important variable and women still postpone bearing their first child to higher age, IVF success rates in women of advanced age are very low. In this respect oocyte freezing could help these women to expand their natural reproductive lifespan. In view of criticisms on this approach, we performed a cost effectiveness analysis. The analysis showed that oocyte freezing is more cost effective compared to delayed natural conception and IVF at age 40, if at least 60% of the women would return to collect their oocytes and if one is willing to pay over 26.4000 Euros per additional live birth.

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Writer: 

NASR ESFAHANI M.H.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    13
  • End Page: 

    13
Measures: 
  • Citations: 

    0
  • Views: 

    9009
  • Downloads: 

    4247
Keywords: 
Abstract: 

The largest single defines etiology of human infertility is defective sperm function, resulting in failed fertilization. This phenotype has been rescued by IVF and ICSI and over 200, 000 births per annum are achieved through these techniques. Therefore, there is a price to be paid for this achievement, including, birth defects, reduced birth weight and etc. In addition the efficiency of fertilization and embryo development in these techniques are limited to sperm quality. Considering the heterogeneity of semen samples, to overcome these price and further to improve the effectiveness of these techniques, novel sperm selection procedures has been proposed, including; hyaluronic acid binding, sperm membrane surface charge, sperm organellar morphology, sperm surface markers, birefringence and sperm ability to respond to hypo-osmotic stress. During this presentation, we hope to discuss pros and cones of each technique.

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Writer: 

DANESINO C.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    13
  • End Page: 

    14
Measures: 
  • Citations: 

    0
  • Views: 

    13975
  • Downloads: 

    4247
Abstract: 

Up to about 1% of couples may experience repeated (three) pregnancy losses (RPL); if we compare this figure with the pregnancy loss rate in the general population we may calculate that it is at least two or three times higher than expected. No definite aetiology can be demonstrated in a substantial number of cases, and this frustating situation may cause the search for uncertain or un proven "causes" and/or "treatments". In general recognized causes of RPL may include i) Genetic abnormalities; ii) Hormonal and metabolic disorders, iii) uterine anatomical abnormalities, iv) autoimmune disease; v) Thrombophilia, and of course any possible combination of the above listed causes. Genetic counselling will face different issues: couples in whom no defined cause of RPL has been yet identified, and requesting suggestions as to the genetic tests to be performed, or couples in whom a (genetic) cause has already been found. The Medical Geneticist will of course deal not only with the problem of RPL, but will take into account any further genetic problem resulting from family history. In addition to the well known data about chromosomal abnormalities, new data about association of RPL with genetic polymorphisms are now being published (genes likeSYCP3, VEGF, IL-1 receptor); this data need to be evaluated carefully prior to their widespread acceptance. Finally the new methods of genetic analysis (from copy number variation to high (throuhput sequencing), are likely in the near future to discover a well defined aetiology of RPL in a relevant percentage of cases.

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Writer: 

MASTENBROEK S.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    13
  • End Page: 

    13
Measures: 
  • Citations: 

    0
  • Views: 

    11033
  • Downloads: 

    4247
Keywords: 
Abstract: 

Preimplantation genetic screening (PGS) has been proposed as a method to select embryos for transfer in an IVF treatment. In PGS, a single blastomere is aspirated from each embryo, and the copy number of a set of chromosomes is then determined in that blastomere. Embryos that are identified as abnormal are then discarded, and embryos with a normal genetic constitution are selected for transfer. Systematic review and meta-analysis of randomized controlled trials on PGS shows that there is no evidence of a beneficial effect of PGS as currently applied on the live birth rate after IVF. On the contrary, for women of advanced maternal age PGS significantly lowers the live birth rate. Detailed analysis of a cohort of 360 embryos from the largest randomized controlled trial on PGS, using FISH analysis for chromosomes 1, 13, 16, 17, 18, 21, X and Y, shows that mosaicism in these embryos is one of the reasons for the disappointing outcomes after PGS. Systematic review of the literature confirms the mosaicism rates found in this cohort of embryos, and corroborates the conclusion that diploid-aneuploid mosaicism precludes the determination of the chromosomal makeup of a human embryo by analyzing a single cell using FISH during cleavage stage development. The clinical application of PGS has been driven by the concept that embryo selection is essential to optimize the success rates of IVF, since embryos that are cryopreserved have a reduced chance of implanting after thawing. Better selection methods should thus result in higher live birth rates without an increase in multiple pregnancies. Recent developments now challenge this concept. These developments will be discussed and it will be hypothesized that the path of embryo selection is turning into a dead-end in the quest for optimal IVF success rates.

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Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    14
  • End Page: 

    14
Measures: 
  • Citations: 

    0
  • Views: 

    11049
  • Downloads: 

    4247
Abstract: 

Introduction: The aim of present study was to examine the possible relationship between sperm DNA integrity/chromatin packaging evaluated by cytochemical assays, traditional sperm parameters and recurrent spontaneous abortion (RSR) of unknown origin.Materials and Methods: In this cohort study, 40 couples with a history of RSA and 40 couples with proven fertility were considered as case and control groups respectively. The semen samples of all husbands were analyzed for sperm parameters and sperm chromatin and DNA integrity assessed using cytochemical tests including aniline blue (AB), chromomycin A3 (CMA3), toluidine blue (TB), acridine orange (AOT) and nuclear chromatin stability assay.Results: Among different sperm parameters, only slow motility was significantly different between two groups. In sperm chromatin evaluations, there were significant differences between two groups at all of the tests. In addition, the majority of semen samples in RSA patients exhibited upper percentages of abnormal spermatozoa than the cut-off values regarding different cytochemical assays.Conclusion: Our study showed that in the cases of RSA slow motility had a significant reduction in comparison with controls and also spermatozoa of men from RSA group had less chromatin condensation and poorer DNA integrity than spermatozoa which obtained from fertile men with no history of RSA.

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Writer: 

TALEBI A.R.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    14
  • End Page: 

    15
Measures: 
  • Citations: 

    0
  • Views: 

    8576
  • Downloads: 

    4247
Keywords: 
Abstract: 

Sperm DNA contributes half of the offspring genomic material and any abnormalities of chromatin/DNA can lead to failures in reproductive process. Despite association between DNA damage and male infertility, there is a detectable level of DNA damage in spermatozoa of fertile men. The causes of these anomalies, much like those of male infertility, are multifactorial and may be attributed to intra or extra-testicular factors. The exact mechanisms by which chromatin abnormalities/DNA damage arise in human spermatozoa are not exactly understood, but four main theories have been proposed at molecular level, namely defective sperm chromatin packaging, apoptosis, oxidative stress and genetic lesions. A variety of several etiological factors including intra-testicular, post-testicular, and external factors, have been correlated with increased levels of human sperm DNA damage, and in turn, can affect the potential of male fertility. Varicocele, cigarette smoking, exposure to xenobiotics, leucocytes and infections, thermal stresses, different kind of sperm preparation protocols, cancer, chemotherapy and radiotherapy, spinal cord injury, hormonal insufficiency particularly in the axis of pituitary-testis, ethanol consumption, environmental Pollution and aging are recently known as main etiologies for sperm chromatin and DNA damages influencing male fertility.In the cases of inadequate repair capacity of oocyte, fertilization failure, early embryogenesis abnormalities, implantation failure and finally pregnancy loss will be seen. Six chief strategies regarding the problem of raised sperm DNA damage have been recommended recently: Using surgically-retrieved testicular spermatozoa instead of ejaculated ones, using ejaculated spermatozoa after at least two months of oral antioxidant therapy, micro-injection (ICSI) with spermatozoa selected with the use of a high-magnification optical system (high-magnification ICSI), suitable preparation of the semen samples, in-vitro culture conditions and finally the selected type of ART programs.

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Writer: 

RIAZIMAND SH. | HEINZ K.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    15
  • End Page: 

    15
Measures: 
  • Citations: 

    0
  • Views: 

    10295
  • Downloads: 

    4247
Keywords: 
Abstract: 

Introduction: Array comparative genomic hybridization (CGH) has been developed that allows a more detailed examination of the genome when compared with a standard chromosome analysis. Array comparative genomic hybridization (CGH) is a new and exciting diagnostic tool represents a major technological step forward in cytogenetic testing and addresses many of the limitations of current cytogenetic methods. Conventional chromosome analysis, FISH and QF-PCR rapidly detect common chromosomal abnormalities but do not provide a genome wide screen for unexpected imbalances In contrast, array CGH analysis simultaneously evaluates regions across the entire genome and allows for detection of unbalanced structural and numerical chromosome abnormalities of less than one hundred kb.Materials and Methods: Fifteen fetuses ongoing pregnancies and fifteen pathogen children were studied by array CGH on targeted BAC-arrays and oligoarray.Results: all Fifteen fetuses and children were successfully by array-CGH identified and comprised with conventional karyotyping.In the 9/15 foetus ware healthy In the 5 case were found trisomy 21, 18 and 13 in 1 case unbalanced translocation 7p; 9p that were also subjected to conventional karyotyping. All fifteen pathogen Children were identified all chromosomal abnormality and microdeletions like in 1p36.33, and 22q.11 chromosomal region that were not found by conventional karyotyping which were confirmed by FISH.Conclusion: This study demonstrates the feasibility of prenatal genetic diagnosis using BAC-array CGH analysis for direct analysis of amniocytes without culturing cells and Amplification. This new method replaces conventional cytogenetics, FISH and in many cases to Multiplex-PCR for Mutation less than 100 kb in the great majority of prenatal and postnatal diagnosis cases. Furthermore, the direct analysis allows for rapid array CGH results and shorter reporting time.

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Writer: 

TAHERIPANAH R.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    16
  • End Page: 

    16
Measures: 
  • Citations: 

    0
  • Views: 

    10111
  • Downloads: 

    4247
Abstract: 

Endocrine disruptors (EDs) are dangerous chemicals widely used daily and spread in the environment and able to impair male and female fertility by interfering with the endocrine regulation of reproductive system. Endocrine disruptor is a compound, either natural or synthetic alters the hormonal and homeostatic systems that enable the organism to communicate with and respond to its environment. Endocrine disrupters have been associated with reproductive pathologies such as infertility and gynecological tumors. A number of issues have proven that affects on the consequence of the exposure such as age and latency of exposure. The effect of EDCs is non-dependent dose and even very low exposure may cause endocrine or reproductive abnormalities particularly if exposure occurs during a critical developmental window. EDCs may affect not only the exposed individual also the children and subsequent generations. Effects may be transmitted not due to mutation of DNA sequence, but rather through modifications to factor that regulate gene expression such as DNA methylation and histone acetylation.Male sexual differentiation is androgen-dependent, whereas female differentiation occurs largely independently of estrogens and androgens. In the male, cryptorchidism, hypospadias, oligospermia, and testicular cancer have been proposed to be linked as the testicular dysgenesis syndrome (TDS) arising from disturbed prenatal testicular development. In the female, premature thelarche and ovulatory disorders has been reported in girls exposed to phthalates. The early exposure to BPA produced a lower number of implantation sites in association with a defective uterine environment during the preimplantation period. There are also correlative findings of phthalate levels in plasma and endometriosis recurrent abortion and malformations.Conclusion: Endocrine disruptues are so harmful for the human and future generations and future studies are needed to find the exact effects on the reproductive health and infertility.

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  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    16
  • End Page: 

    17
Measures: 
  • Citations: 

    0
  • Views: 

    8668
  • Downloads: 

    4247
Abstract: 

In principle, mutational records make it possible to estimate frequencies of disease alleles (q) for autosomal recessive disorders using a novel approach based on the calculation of the Homozygosity Index (HI), i.e. the proportion of homozygous patients versus compound heterozygotes. The rarer the disorder, the higher will be HI. To test this hypothesis, we used mutational records of Italian individuals affected with Congenital Adrenal Hyperplasia (CAH), born to either consanguineous or apparently unrelated parents. CAH is caused in most cases (>90%) by deficiency of 21-hydroxylase, determining excessive adrenal androgen biosynthesis resulting in virilization in all individuals and salt wasting in some. Our model produced a q ranging within the interval [3.505-7.0] x 10-3 and a prevalence (P=q2) in the range [1.23-4.92] x 10-5 on a sample of 53 Italian CAH patients (based on the estimated inbreeding range in the Italian general population [0.0005-0.001]). These estimates are highly consistent with the results reported by previous observational studies, which indicate a CAH prevalence of 1: 15000-16000 in Europe and 1: 21380 in North-Eastern Italy, especially if we consider that inbreeding estimates for the general population are a strong source of bias. Further development of the model (e.g. more precise genomic-based inbreeding coefficient F estimation, keeping into account complex alleles and the presence of affected heterozygous individuals) will allow to eliminate several sources of bias and to refine the epidemiological estimates. Finally, we inferred from simulation studies that the minimum sample size needed to use this approach is of 25 patients either with unrelated or first cousins parents. These results show that the HI can be used to produce a ranking order of prevalence of autosomal recessive disorders, especially in populations with high frequencies of consanguineous marriages. This could be of great help in designing screening of genetic disorders in the general population.

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Writer: 

MOEIN M.R.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    17
  • End Page: 

    18
Measures: 
  • Citations: 

    0
  • Views: 

    9522
  • Downloads: 

    4247
Keywords: 
Abstract: 

From about 3 decades ago, when microinjection revolutionized treatment of infertile men with azoospermia, many different methods of sperm recovery in these groups of patients were used. These methods vary according to type of azoospermia, which can be obstructive or non-obstructive azoospermia.For sperm retrieval in obstructive azoospermia we can do percutanous epididymal sperm aspiration (PESA) or microscopic epididymal sperm extraction (MESA) through small scrotal incision. In patients with non-obstructive azoospermia sperm must be recovered from testis and the usual methods of sperm retrieval are fine needle sperm aspiration (FNA) of testis or testicular sperm extraction (TESE) through small surgical incision of scrotum and testis. With these methods, it is not possible to get sperm in all cases and so some modifications and recommendations were made, for example getting more than one sample and getting samples from both testicles. Later experience showed that focal area of spermatogenesis might be existed in testis, which with conventional TESE could not be found. It showed that using microscope during TESE could improve significantly sperm retrieval in a significant percentage of patients with non-obstructive azospermia. In this method, which was named micro TESE, and can be done by local anesthesia testis is longitudinally incised and then with guidance of surgical microscope seminiferous tubules in different areas of testis evaluated and samples are taken only from that areas that looks well and contain more dilated tubules. So, it is possible to get sperm more efficiently with the minimal amount of tissue extraction. With this method sperm retrieval become possible in patients with even Sertoli cell only syndrome and or patients with Kleinfelter syndrome.

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Writer: 

JEDDI P.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    17
  • End Page: 

    17
Measures: 
  • Citations: 

    0
  • Views: 

    9321
  • Downloads: 

    4247
Keywords: 
Abstract: 

Numerical chromosomal abnormalities, a condition termed aneuploidy, are presumed to be a major cause of infertility. Identification of cells with aneuploidy has the potential to significantly improve IVF success rates. Until now; however, the technical challenge of reliably counting chromosomes in single cells has made it very difficult to rigorously test this hypothesis. Fluorescence in situ Hybridization (FISH) is the technique most commonly applied to Preimplantation Genetic Screening (PGS).This technique, however, has got limitations as only a limited number of chromosomes can be analysed in sequential FISH. The fixation of nuclei is an important step in FISH, which, if it is not done properly, may lead to the loss of micronuclei and a poor quality chromatin. In the case of doubtful signals, additional probes may be required for a different locus of the same chromosome.A long duration of the test necessitates the cryopreservation of the biopsied embryos. It is also probable that the high level of chromosomal mosaicism at cleavage stages, which FISH is usually performed, result in the tested cell not being representative of the embryo. Single cell aCGH has emerged in the field of PGS as a new technique to analyse aneuploidies from all the human chromosomes.Biopsy can be performed on oocytes (polar bodies), cleavage stage (blastomere) or blastocyst stage (trophoectoderm). Whole genome amplification is necessary to obtain good quality DNA to perform aCGH. The analysis can be completed within a time period that allows for fresh transfer. Results from the study by ESHRE confirm that the new PGS method can predict chromosomal abnormalities in 89% of all cases. Moreover, the study confirmed that results are available within the timescale suitable for use within a fresh IVF cycle (1). It is now also possible to detect unbalanced translocations, as aberrant chromosome copy numbers, in single cells. The enhanced genome coverage, including subtelomeric and pericentromeric regions, enables the detection of arm-level aneuploidy and other large scale sub chromosomal structural imbalances.Results from this study and by others (2-7) provide evidence for the single cell aCGH being a more reliable technique for PGD analysis. Clinical validation in form of a randomized control trial will conclude on its diagnostic performance and future clinical applications in PGD.

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Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    19
  • End Page: 

    19
Measures: 
  • Citations: 

    0
  • Views: 

    9438
  • Downloads: 

    4247
Abstract: 

Introduction: Frozen embryo transfer (FET) has no clear negative impact on neonatal outcome compared with fresh embryo transfer (ET) and appears to result in similar or even better neonatal outcome. The objective of this study was to compare early pregnancy outcome and neonatal health of children born after FET and fresh ET. In this study early pregnancy and neonatal outcomes after FET (n=200) and fresh ET (n=500) were compared.Materials and Methods: In this study early pregnancy and neonatal outcomes after FET (n=200) and fresh ET (n=500) were compared.Results: For early pregnancy, biochemical pregnancy was comparable between FET and fresh ET groups. Spontaneous abortion was significantly higher in FET (14.5%) than fresh ET group (9%). Neonatal outcome was comparable between both groups except for lower live birth rate in FET (55%) versus fresh ET group (66%).Conclusion: FET has similar neonatal outcome in terms of prematurity, low birth weight, stillbirth, neonatal death and major malformation compared with fresh ET.

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Writer: 

ABOUSSAHOUD W.S.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    19
  • End Page: 

    19
Measures: 
  • Citations: 

    0
  • Views: 

    9718
  • Downloads: 

    4247
Keywords: 
Abstract: 

Introduction: Embryo implantation in the uterus involves the trophoblast cells apposing and adhering to, then invading across the epithelium lining of the endometrium. However, ethical concerns regarding experimentation with primary human tissue during this period of life necessitates creation of in vitro models for understanding the basic mechanisms involved. Toll-like receptors (TLRs) play a crucial role in defense against pathogens invading the female reproductive tract.Objective: To establish and optimize an in vitro model for studying human endometrial embryonic interactions and to understand the effect of TLR5 stimulation on the attachment of trophoblast cells to endometrial cells.Materials and Methods: By using a human telomerase immortalized endometrial epithelial cell line (hTERT-EECs) and choriocarcinoma human trophoblast cells (JAr cells), an in vitro assay of human implantation was established. In order to investigate the impact of TLR5 stimulation on attachment in this assay, bacterial flagellin was applied to the endometrial and trophoblast cells. In order to block TLR5 in the endometrial and trophoblast cells, TLR5 function-blocking antibody was applied to the cells prior to flagellin treatment.Results: The results demonstrated that JAr spheroids attached to hTERT-EECs in a time and concentration-dependent manner.Our results also demonstrated that treatment of endometrial cells with flagellin, suppressed the attachment of JAr spheres to the endometrial cells.Application of TLR5 function-blocking antibody significantly restored the attachment of JAr spheres to the endometrium.Conclusion: These data suggest a novel mechanism by which the presence of intrauterine infection through TLR5 activation may result in implantation failure. These data may provide a new opportunity in the management of infertility cases.

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Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    19
  • End Page: 

    20
Measures: 
  • Citations: 

    0
  • Views: 

    11817
  • Downloads: 

    4247
Keywords: 
Abstract: 

Introduction: To compare the IVF outcome of clomiphene citrate/gonadotropin/antagonist and microdose GnRH agonist flare protocols for poor responders undergoing in vitro fertilization.Materials and Methods: 159 poor responder patients were randomized and ovarian stimulation were performed with clomiphene citrate, gonadotropin and antagonist (group I) or microdose GnRH agonist flare (group II) protocols.Main outcomes was clinical pregnancy rate and doses of gonadotropin administration and duration of stimulation were secondary outcomes.Results: Although the cancellation, fertilization, and clinical pregnancy rates were similar in both groups. The endometrial thickness, number of retrieved oocytes, mature oocytes and implantation rate were significantly higher in mild protocol. The doses of gonadotropin administration and duration of stimulation were significantly lower in mild protocol.Conclusion: We recommend mild protocol in ART cycles for poor responders based on the our results regarding less doses of used gonadotropin and a shorter duration of stimulation.

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Writer: 

ASEFJAH H.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    2
  • End Page: 

    2
Measures: 
  • Citations: 

    0
  • Views: 

    9470
  • Downloads: 

    4247
Keywords: 
Abstract: 

Endometriosis is an inflammatory disease characterized by the presence of endometrial glandular and stromal cells in areas outside of the uterine corpus. The disease is most commonly found in the gravity dependent portions of the pelvis, and can involve adjacent organs such as ovaries, fallopian tubes, bladder, and recto-sigmoid colon. The reported disease prevalence varies widely depending on the population and the method of sampling. Among women who seek tubal ligation, the prevalence of endometriosis appears to range from 2% to 18%, whereas within infertile populations it has been reported to be as high as 50%. Endometriosis is the third leading cause of gynecologic hospitalization in the United States. This disease affects both a woman’s physical and mental well being and fertility as well. The impacts are often compounded by the frequent delay from the onset of symptoms to a confirmed diagnosis, which may average 6 years or more or incomplete operation. The etiology of endometriosis remains an enigma; however, earlier studies have shown a familial predisposition to development of this disease. The gold standard for the diagnosis of endometriosis has been visual inspection by laparoscopy, preferably with histological confirmation. Because there is no good noninvasive test for endometriosis, there is often a significant delay in diagnosis of this disease. Endometriosis can be associated with infertility or pain symptoms, including cyclic pelvic pain, dysmenorrhea, dyspareunia, dysuria, and dyschezia. The correlation between lesions and pain symptoms or infertility in endometriosis is poorly understood. There is a wide spectrum of symptom severity, and the stage of endometriosis on laparoscopy correlates poorly with the extent and severity of pain. Some patients with minimal disease have debilitating pain, whereas other women with severe stage III to IV disease are asymptomatic. Without the knowledge of pelvic anatomy and skills for delicate and careful dissection of pelvis, successful operation is impossible. Technique of resection of endometrioma, dissection of ureter, pararectal space, and resection of DIE will be demonstrated by a video clip.

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Writer: 

ASHRAFI M.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    2
  • End Page: 

    2
Measures: 
  • Citations: 

    0
  • Views: 

    8883
  • Downloads: 

    4247
Abstract: 

Infertility is a condition affecting approximately 10-15% of reproductive age couple. Although in 1978 the first baby was born from in vitro fertilization in a normal cycle with developing of IVF procedures, nowadays there are many protocols that we use for controlled ovarian hyper stimulation in order to increase the pregnancy rate. Although these gonadotropins produce many oocytes, but changing of hormonal pattern in these women, alter the endometrial receptivity. On the other hand, there are inadequate researches about it and after 50 years of gonadotropin administration, lack of understanding of consecutive steps leading to embryonic implantation, remains. The endometrial changes that were occurred during controlled ovarian hyper stimulation may compromise implantation, for example supra physiologic level of estradiol, progesterone or increasing of the expression of some apoptosis related genes. As well as many of these protocols produce luteal phase defect that needs support of this phase with some drugs like HCG or progesterone. In this lecture, we will speak about these drugs and things that we should do.

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Writer: 

ESFANDIARI N.

Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    2
  • End Page: 

    3
Measures: 
  • Citations: 

    0
  • Views: 

    14120
  • Downloads: 

    4247
Abstract: 

cycles were cancelled in about one-third of these cases due to failed fertilization. The introduction of micromanipulation techniques such as zona drilling, partial zona dissection, and subzonal insemination reduced the incidence of failed fertilization and salvaged many IVF cycles. However, there was little improvement on fertilization and pregnancy outcome because these procedures required a relatively high number of progressive motile sperm, which in turn frequently resulted in a high incidence of polyspermy in inseminated eggs. To overcome these limitations, microinjection of a single sperm into the ooplasm (intracytoplasmic sperm injection, ICSI) was developed. ICSI resulted in a dramatic improvement in fertilization rates and revolutionized the treatment of infertile couples with severe male factor. ICSI however, is a labor intensive procedure where a highly trained embryologist uses a hydraulic micromanipulation system to pick up a single sperm and inject it under high power magnification into a human oocyte in order to fertilize the oocyte. This process is technically challenging, and consequently there is a long learning curve of up to 6 months for a trained embryologist to be able to become skillful with this procedure. We developed a robotic ICSI system featuring fast oocyte positioning, automated sperm tracking and immobilization, and adaptive oocyte injection with minimal human involvement. A cell holding device is developed to hold many oocytes into a regular pattern. A sperm tail tracking algorithm robust to the low-contrast appearance and the nonlinear fast movement of the sperm tail is developed. In addition a computer vision algorithm is developed to recognize oocyte structures for adapting injection parameters. The robotic system is able to inject 6-9 oocytes at a time markedly reducing the time the oocytes are out of the incubator and exposed to cooling or changes in PH of the culture medium that can be detrimental to embryo development. Finally, the system performs the injection the same way for each oocyte resulting in more uniform results and fewer damaged oocytes. Different from conventional ICSI setups that consist of two micromanipulators and use both a holding micropipette and an injection micropipette, our system contains only one micromanipulator and uses a single injection micropipette for the complete ICSI task.

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Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    20
  • End Page: 

    20
Measures: 
  • Citations: 

    0
  • Views: 

    11094
  • Downloads: 

    4247
Abstract: 

Introduction: Regenerative medicine has enjoyed the potential of Mesenchymal adult Stem Cells (MSCs) in therapeutical levels.Reproductive impotency as a major medical problem is being approached by stem cell therapy in recent years. Azoospermia caused by torsion in testis is a common source of impotency, which has not been touched by this approach yet.Materials and Methods: MSCs were extracted from rat bone marrow, cultured and transplanted into azoospermed testis to investigate the regenerative capacity of the cells in torsioned testis. We used germ cell specific markers (Oct4, Dazl, Vasa and c-Kit) to assess the differentiation of MSCs after transplantation into the azoospermed testis.Results: The extracted MSCs were shown to grow well in the cultured flasks. Following the successful labeling with DiI, the testis injected cells were proven to last for long time post transplantation. While expression of Oct4 and Dazl were detected 45 days after the cell treatment, Vasa and c-Kit proteins were not detectable after this period of time.95 days after MSC transplantation, Oct4, Dazl and Vasa expression were detectable, but c-Kit remained undetectable yet. Meanwhile in predicted positions of the implanted cells it did not seem to have c-Kit expression 180 days after transplantation, and consequently the biopsies did not show any sperm formation.Conclusion: In this study, for the first time, regenerative capacity of stem cells in torsion induced azoospermia in rats was evaluated. We used MSCs transplantation to revive the spermatogenesis in torsion testis. This capacity was monitored using different molecular markers.

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Issue Info: 
  • Year: 

    2011
  • Volume: 

    9
  • Issue: 

    SUPPL 2
  • Start Page: 

    20
  • End Page: 

    21
Measures: 
  • Citations: 

    0
  • Views: 

    9735
  • Downloads: 

    4247
Keywords: 
Abstract: 

Introduction: Immature oocytes collected in ART cycles may be cryopreserved further for use in in-vitro maturation (IVM) program. The aim of this study was to determine maturation capacity, morphometric parameters and morphology of human immature oocytes in both fresh IVM (fIVM) and vitrified-IVM (vIVM) oocytes.Materials and Methods: 93 women aged 21-49 year old who underwent controlled ovarian stimulation for ART were included. The immature oocytes (n=203) were divided into two groups: (I) immature oocytes (n=101) that were directly matured in vitro; (II) immature oocytes (n=102) that were first vitrified, then matured in vitro. All oocytes underwent IVM in Ham's F10 supplemented with 0.75 IU LH and 0.75 IU FSH and 40% human follicular fluid (HFF). After 48 h of incubation, the oocyte maturation rates, as well as morphometric assessments and extra and intracytoplasmic morphology evaluation, were assessed using Cornus imaging program and then were compared.Results: Oocyte maturation rates were significantly reduced (p<0.001) when oocytes were vitrified at immature stage followed by IVM (40.4%) in comparison with, fIVM assess (59.4%). Following morphometric assessment, there was no difference in the mean oocyte diameters (mm) between fIVM and vIVM, 156.3±6.8 and 154.07±9.9 respectively. Other parameters of perimeters, egg areas, as well as oocyte and ooplasm volumes were similar in two groups. In addition, more morphologic abnormalities, such as, vacuole, dark oocyte was observed in vIVM oocytes.Conclusion: Because fIVM was more successful than vIVM groups, morphometric parameters cannot be applied as prognosis factor in oocyte maturation outcome in IVM program.

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