Sperm DNA is known to contribute one half of the genomic material to the offspring. The integrity of sperm DNA is important in fertilization, embryonic and fetal development, and postnatal child well being. The nature has created multiple barriers that allow only the fittest sperm to reach and fertilize an oocyte. However, Assisted reproductive techniques (ART), like IVF and ICSI, may allow sperms with abnormal genomic material to enter the oocyte with minimal effort. This article describes structure of sperm DNA and different mechanism involved in sperm chromatin anomalies and DNA damage. Furthermore, this study elaborates possible sperm selection methods that may improve the outcome of ART.

Cumulative embryo score (CES) is one of the many embryo scoring methods which have been developed to help clinicians to transfer high quality embryos and predict pregnancy rate in Assisted reproductive techniques (ART) cycles. Regarding the existing difference in CES calculation this study was done to compare two methods in order to determine the more practical and preferable one. In a retrospective, cross sectional descriptive analytical study, a total of 508 ART cycles in infertile patients treated from November 2002 until March 2004, were evaluated using two methods of CES calculation in embryonic scoring to predict ART outcome. According to one method, CES was obtained by adding the individual scores of all transferred embryos. Whereas in the other reference method, CES was calculated by the sum of each embryo score multiplied by its number of blastomeres on the day of transfer. The mean score of transferred embryos (MSTE) was referred to CES divided by the total number of embryos transferred in either method. A total of 109 clinical pregnancies (pregnancy rate 21.5%) including 96 singletons, 10 twins and triplets occurred in the 508 ART cycles. The pregnancy rate was strongly correlated to CES & MSTE. According to one method, CES was 12.6±6.4 in pregnant versus 9.2±5.8 in non-pregnant group (P<0.0001). According to the other one, in the pregnant group CES was 86.7±48 versus 68.7±55 in the non-pregnant group (P<0.002). Both methods showed a significant difference. Regarding MSTE, using the first method, in the pregnant group it was 3±0.6 versus 2.8±0.7 in the non-pregnant group (P<0.011) whereas with the other approach it was 21.3±8.6 in the pregnant group versus 19.9±9.07 in non-pregnant (P<0.152) showing that the first method can also predict pregnancy outcome with MSTE. Considering that both MSTE and CES in the first method can significantly predict outcome in ART cycles, it seems this method is preferable and more useful in practice. Moreover, sometimes due to continuous division, on the third post oocyte retrieval day the blastomere number cannot be counted precisely which can be misleading if taken into account according to the method introduced by Steer.

Objective: Metabolic syndrome is a risk factor affecting reproductive health and pregnant outcomes. So far, the effect of this syndrome on the success rate of Assisted reproduction techniques (ART) has not been investigated. The aim of this study was to investigate the relationship between metabolic syndrome and the success rate of ART in infertile women in Isfahan. Materials and methods: A prospective cohort study performed on 147 women candidates using in-vitro fertilization/ intra cytoplasmic sperm injection (IVF/ICSI) and/or ICSI methods referred to Isfahan Infertility Center in two groups with metabolic syndrome(n=49) without metabolic syndrome(n=98), by convenience sampling methods in Isfahan, Iran in 2018. Body mass index (BMI) and waist, abdominal circumference, Serum triglyceride (TG), cholesterol and FBS were measured. If β, HCG test was positive (day 15-16 after ART), transvaginal sonography (TVS) was done 15 days later. Pregnant women were followed up to the 20th week of pregnancy. To analyze, t-test, chi-square and logistic regression tests were used. Results: The frequency of metabolic syndrome was 33. 4% (n=49). The frequency of ART was not significantly different between women with and without metabolic syndrome (p=0. 321). The relative frequency of pregnancy (p=0. 907) and abortion (p=0. 896) did not show a significant difference between the two groups. Independent t-test showed that the mean FBS, HDL, TG, systolic and diastolic BP, abdominal circumference and BMI in the studied units did not differ significantly based on the occurrence of pregnancy and abortion. Conclusion: According to the results of this study, there was no significant difference between the indicators of metabolic syndrome and the success rate of ART in achieving, pregnancy and pregnant outcomes in the first twenty weeks of pregnancy.

Background: In vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI) are recognized as established and increasingly successful forms of treatment for infertility, yet significant numbers of couples discontinue treatment without achieving a live birth. This study aims to identify major factors that influence the decision to discontinue IVF/ICSI treatments.Materials and Methods: We studied the data of 338 couples who discontinued their infertility treatments after three cycles; based on medical records and phone contact. The main measure was the reason for stopping their treatments. Results: Economical problems were cited by 212 couples (62.7%), as their mean income was significantly less than other couples (p<0.0001). Lack of success was reported as a reason by 229 (67.8%), from whom 165 (72%) also had economical problems. Achieving independent-ART pregnancy was the reason for discontinuation in 20 (5.9%) couples. Psychological stress, depression and anxiety were reported as other cessation factors by 169 (50%), 148 (43.8%) and 182 (53.8%) couples, respectively.Conclusion: This survey suggests that the most common reasons for Assisted reproductive technique (ART) discontinuation after three cycles are: prior unsuccessful cycles, economical and psychological problems. Therefore, the substantial proportion of couples could benefit from psychological intervention, increasing awareness of ART outcomes and health funding to cope more adequately with failed treatments.

Heterotopic pregnancy (HP) is the simultaneous occurrence of intra- and extrauterine pregnancies. It is a rare event in spontaneous pregnancies with an incidence of less than 1:15000, however the frequency has increased to 1% in accordance with the widespread use of Assisted reproductive techniques (ART).The pre-operative diagnosis of this condition is generally difficult and it would be life threatening for mother and the intrauterine pregnancy. In this report, we present three cases of HP following ART. All cases underwent a standard long protocol and embryo transfers (ET) were performed 48 hours after oocyte retrievals. Finally, two viable intrauterine gestations ended in miscarriages and the third resulted in the delivery of a healthy infant.The possibility of a heterotopic pregnancy following tubal pathologies, endometriosis and pelvic adhesions should be considered by gynecologists during IVF procedures. Moreover by implantation of a single embryo, the incidence of this risky condition will be dramatically reduced.

Background: To evaluate the outcomes of using in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI cycle) techniques in hypogonadotropic hypogonadism women and comparing them to women with tubal factor infertility.Materials and Methods: Data from 81 hypogonado tropic hypogonadism (HH) patients treated with IVF/ICSI in the period from early 2009 until the end of 2010 were analyzed and compared with treatment results from 89 patients with Tubal factor infertility. Moreover, data from hypogonadotropic hypogonadism patients were analyzed with respect to the age factor. P<0.05 was considered statistically significant.Results: Despite a higher fertilization rate and higher number of grade A/B embryos transferred in the Tubal factor group, the implantation, pregnancy and live birth rates were found to be similar between the two groups (p=0.3, p=0.1, p=0.6, respectively). When HH patients were evaluated according to the age factor, no significant difference was found regarding outcome parameters (p=0.2).Conclusion: HH women that were treated with IVF/ICSI cycles were found to have a good chance for pregnancy, even in coexistence with age factor.

Background: Individualized Assisted reproductive techniques (ART) can improve ART outcomes. Some studies suggested using insulin-like growth factor-1 (IGF-1) level on cycle day 2 for individualized ART. Objective: To investigate the relationship between serum levels of IGF-1 on day 2 of the cycle and ART outcomes. Materials and Methods: In this cross-sectional study, cycle day 2 serum levels of IGF, 1 were measured in 175 women aged between 18-44 yr as candidates for in vitro fertilization or intracytoplasmic sperm injection. All participants received antagonist protocol, and the relationship between serum levels of IGF-1 and ART outcomes according to the number of oocytes were investigated,poor responders (oocytes < 5), normal responders (oocytes 5-15), and hyper responders (oocytes > 15). Results: Poor responders had higher serum level of IGF-1 when compared with normal and hyper-responders,however, this difference was not statistically significant (p = 0. 41). The serum levels of IGF-1 in women with zero retrieved oocytes and those cycles that were canceled for the inappropriate ovarian response were not significantly different compared to other women in the group of poor responders. An inverse relationship was observed between the serum level of IGF-1 and anti-Mullerian hormone. Furthermore, no significant relationship between serum level of IGF-1 with age, body mass index, number of 2 pronucleus, and number of embryos was observed. Conclusion: According to our results, the serum levels of IGF-1 may not be able to predict ART outcomes. It seems necessary to conduct more studies with larger sample size.

Backgrounds and Objectives: In Assisted reproductive technology it is necessary to use and measure hormones for induction and maintaining the pregnancy. Oxytocin that is secreted by hyophysis has a great role in biology of reproduction. This study was conducted to measure the relation between follicular oxytocin and reproduction outcome.Materials and Methods: In this cross sectional study, in 110 women, candidates of Assisted reproduction the follicular fluid oxytocin was measured. All recruties were selected randomly from Alzahra hospital infertility center of Tabriz university of medical sciences and in all of them HCG was used for induction of ovulation.Results: The average age of Women was 28.28 years. 84.5 percent of their infertility was a primary type. The most common causes of infertility were male factors followed by anovulation for each women averagely 13.47 oocyte were obtained and average of follicular fluid oxytocin was 230.7 mIu/ml.19.1 percent of women became pregnant.Conclusion: Follicular oxytocin amount was different in various phases of follicle development and there wasn’t relation between follicular oxytocin and chance of pregnancy outcome.