Male Factor Group Research Articles

Investigation of FF-MAS oxysterole’s role in follicular development and its relation to hedgehog signal pathway

The Hedgehog signaling pathway plays a crucial role in folliculogenesis; however, the association between FF-MAS oxysterol activity in folliculogenesis and the Hedgehog signaling pathway has not been revealed. The evaluation of FF-MAS activity in polycystic ovary syndrome (PCOS) with folliculogenesis disorder might provide a new approach to tackle follicular and oocyte maturation failure. The question is: does FF-MAS oxysterol affect granulosa cell (GC) proliferation? If so, is this effect facilitated through the Hedgehog pathway? To answer these questions, GCs were isolated from follicle fluids obtained from patients undergoing oocyte retrieval during in vitro fertilization (IVF) treatment. After the isolated GCs were incubated in different cell culture media, the levels of Hedgehog pathway components (SMO, Gli1) were measured by using immunohistochemical methods, cytoELISA, and qRT-PCR. Meanwhile, cell proliferation rates were determined. Significant increases (p < 0.001) in SMO and Gli1 expressions and cell proliferation were observed in the FF-MAS-treated subgroups of both PCOS and male factor participants compared to the FF-MAS deficient subgroup. Remarkably, FF-MAS positively affected the pathway components despite the pathway inhibitor cyclopamine. Although the increase in Hedgehog pathway components was slightly higher in the male factor group (MF), it was not statistically significant. In our study, we demonstrated for the first time the molecular effect of FF-MAS on human GCs in folliculogenesis. Since FF-MAS is already used in assisted reproductive techniques in animals and is known to be synthesized in the human body, it could be considered a new approach in human IVF treatments.

Histopathologic characteristics of term placentas in singleton pregnancies in women with endometriosis-related infertility after ART treatment: case-control study

Objectives Endometriosis is one of the leading causes of infertility, due to negative impact on ovarian folliculogenesis and endometrial receptivity. Literature show that endometriosis could be associated with perinatal complications such as preterm birth (PTB) and preeclampsia (PE). Authors hypothesized that women with endometriosis-related infertility conceived by assisted reproductive technology (ART) treatment have higher frequency of placental disorders. Main outcome is the occurrence of histopathologic alterations of term placentas in singleton pregnancies of women with endometriosis conceived by ART treatment, compared to healthy women with infertility due to male factor (MF) conceived by ART and to healthy women with spontaneous pregnancies. Secondary outcome include the occurrence of perinatal complications and the relationship of endometriosis and placental histopathologic characteristics. Methods Single-center, case-control study of term placentas that were collected within Department of Obstetrics and Gynecology of University Hospital Center (UHC) Split and analyzed in the Pathology department of the same hospital, by one senior perinatal pathologist. Histopathologic analysis was reported using Amsterdam Placental Workshop Group Consensus. All the noted placental lesions were divided into following categories: anatomic, inflammatory, villous maturation and vascular malperfusion disorders. Required sample size was 80 placentas, and study results were reported with descriptives, and analyzed with chi-squared, Fisher’s exact test and Kruskal-Wallis ANOVA. Multivariate regression analysis was carried with adjustment for confounding factors. Ethics approval: Class n. 520-03/24-01/83. Results Study included term placentas of 107 women, of which 36 were women with endometriosis conceived by ART, 31 were healthy women with MF infertility conceived by ART and 40 healthy women with spontaneous pregnancies. Endometriosis women were predominantly primiparas, with longer infertility duration. Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Endometriosis and MF groups had higher occurrence of Cesarian delivery (CS), while endometriosis group had newborns with lowest birthweight. Endometriosis group had shorter placental cords (PC), higher rates of increased syncytial knotting and vascular malperfusion disorders (subchorionic and perivillous fibrin, intervillous thrombosis, high grade fetal vascular malperfusion). Finally, endometriosis is showed to be associated with increased syncytial knots’ formation and PC hypercoiling, after adjustment for confounding factors in the multivariate regression analysis. Conclusions Despite low rates of perinatal complications, we report endometriosis to have higher occurrence of increased syncytial knotting and vascular malperfusion placental disorders, compared to control groups. Endometriosis is also associated with increased syncytial knotting and PC hypercoiling. Further studies are needed to elucidate the endometriosis impact on endometrial receptivity and immunopathogenesis in placental disorders and perinatal complications. Highlights Endometriosis women were predominantly primiparas, with longer infertility duration. Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Moreover, endometriosis and MF groups had higher occurrence of Cesarian delivery, while endometriosis group had newborns with lowest birthweight. Endometriosis group had shorter placental cords, higher rates of increased syncytial knotting and vascular malperfusion lesions. Endometriosis is showed to be associated with increased syncytial knots formation and hypercoiling of placental cord, after adjustment for confounding factor.

O-057 Prevalence of T-shaped uterus among women undergoing fertility treatments based on ESHRE/ESGE and Congenital Uterine Malformation by Experts (CUME) criteria.

Abstract Study question What is the prevalence of a T-shaped uterus among women undergoing fertility treatments based on ESHRE/ESGE (Grimbizis et al.,2013) and CUME (Ludwin et al.,2020)? Summary answer The prevalence of T-shaped uterus was 4.1% according to the ESHRE/ESGE, and according to the CUME, 1.1% T-shaped uterus and 0.9% borderline T-shaped uterus. What is known already The definition of a T-shaped uterus by the ESHRE/ESGE consensus (Grimbizis et al., 2013) was based on three-dimensional ultrasound (3D-US) images, defining it as a narrow uterine cavity caused by thickened lateral walls with a ratio of two-thirds uterine body and one-third cervix. This definition is subjective and therefore makes giving an objective diagnosis difficult. The CUME group (Ludwin et al., 2020) described practical diagnostic criteria for a T-shaped uterus according to 3D-US images. As there is no consensus regarding the definition, the overall prevalence according to different studies varied from 0.2 to 10.0%. Study design, size, duration A retrospective cohort study with prospective analysis of 3D-US images was conducted. All women who were admitted to our unit for fertility treatments and underwent 3D-US between 12/2017-12/2021 were included. Women were grouped according to infertility type. All 3D-US images of uteri suspected to be T-shaped according to ESHRE/ESGE were assessed according to the CUME criteria, based on the following three measurements: lateral indentation angle ≤130°, lateral indentation depth ≥7 mm, and T-angle ≤40°. Participants/materials, setting, methods The study was conducted in a single university-affiliated hospital. Women who underwent fertility treatments due to various indications were included. The exclusion criteria were women undergoing fertility preservation, egg donation and oocyte recipients. All 3D-US were performed by well-trained ultrasound technicians. We first screened all images and calculated the prevalence of T-shaped uteri in our population based on the ESHRE/ESGE consensus. Next, we performed the three measurements according to the CUME criteria. Main results and the role of chance Altogether 451 women were admitted to our fertility unit. Nine cases were excluded due to unsatisfactory 3D-US images because of technical difficulties. Finally, 442 women were included in the study and divided into in the following groups: anovulation 10.6% (n = 47), mechanical factor 11.1% (n = 49), male factor 38.7% (n = 171), and unexplained infertility 39.6% (n = 175). The prevalence of T-shaped uterus according to the ESHRE/ESGE was 4.1% (n = 18). Among them, 3.2% (n = 3) were from the female factor groups (anovulation + mechanical), 4.1% (n = 7) from the male factor group, and 4.6% (n = 8) from the unexplained infertility group. Afterwards, the 3D-US images were analyzed according to the CUME criteria. T-shaped uterus was defined when all three criteria were met, and borderline T-shaped uterus was defined when two out of three criteria were met. According to CUME criteria, the prevalence of T-shaped uterus was only 1.1% (n = 5), three being from the male factor group and two from the unexplained infertility group. No T-shaped uteri were found in the female factor groups. Additionally, 0.9% (n = 4) were considered borderline T-shaped. Limitations, reasons for caution The ESHRE/ESGE consensus is subjective and may lead to either under- or over-diagnosis. On the other hand, the CUME criteria are objective and well-defined, but due to their strictness, dysmorphic uteri with very narrow uterine cavities and thickened lateral walls may not be diagnosed as T-shaped uteri. Wider implications of the findings Diagnosis and management of women with T-shaped uteri are very controversial topics. Therefore, making the diagnosis more precise and objective can help us to screen for the most significant cases and tailor the management accordingly. The similar prevalence among different infertility groups reflects the incidental nature of this diagnosis. Trial registration number Not applicable.

P-251 Differences in fertilization, blastocyst, and ploidy rates in intracytoplasmic sperm injection (ICSI) versus conventional insemination for patients undergoing in vitro fertilization (IVF)

Abstract Study question Are there differences in fertilization, blastocyst development, or euploidy rates when comparing ICSI versus conventional insemination among patients with male and non-male factor infertility? Summary answer Fertilization rate was lower for male factor ICSI. There were no differences in blastocyst development. Euploidy rate was lower for non-male factor ICSI. What is known already ICSI was developed for male factor infertility due to its requirement for a very small number of viable sperm. Its use has expanded beyond male factor due to some studies suggesting enhanced fertilization, and lower risks of failed fertilization or inadvertent contamination of embryo biopsy specimens. There are potential risks associated with ICSI, including imprinting disorders, birth defects, and significantly increased cost. It is also unclear whether ICSI contributes to genetic abnormalities by bypassing the egg’s natural sperm selection and potentially disrupting the meiosis apparatus. Study design, size, duration This retrospective cohort study of 576 patients was conducted at a single clinic from January 2021 to December 2021. Patients were grouped into (1) ICSI with male factor (n = 201), (2) ICSI with non-male factor (n = 160), and (3) conventional insemination with non-male factor (n = 215). Primary outcome was ploidy status, determined by calculating the percentage of euploid, aneuploid, and mosaic (both low and high mosaic) among the three groups. Secondary outcomes included fertilization and blastocyst development rates. Participants/materials, setting, methods Patients undergoing autologous IVF at a single clinic, with PGT-A performed at a single lab were included. Fertilization rate was defined as the percentage of 2PNs per number of mature eggs injected/inseminated. Blastocyst rate was defined as the percentage of blastocysts per 2PNs. Ploidy rate was defined as the percentage of euploid/aneuploid/mosaic blastocysts per total biopsied blastocysts for which a result was obtained. Percentage data was compared using N-1 Chi-squared test. Main results and the role of chance There were no significant differences in patient age, number of oocytes retrieved, or number of mature oocytes among the three groups. Fertilization rate for male factor ICSI was significantly lower compared to both non-male factor ICSI (74.2% vs 77.8%, p = 0.005) and conventional insemination (74.2% vs 76.8%, p = 0.018). There was no significant difference in fertilization rate between non-male factor ICSI and conventional insemination. There were no significant differences between blastocyst rates on Day 5, 6, or 7, or total blastocyst rate among the three groups. The euploidy rate for conventional insemination was significantly higher than that for non-male factor ICSI (53.4% vs 46.8%; p = 0.008). Non-male factor ICSI yielded lower euploidy rate than male factor ICSI (46.8% vs 52.4%, p = 0.034). Aneuploidy rate for non-male factor ICSI was significantly higher than both male factor ICSI (36.1% vs 31.0%, p = 0.041) and conventional insemination (36.1% vs 31.0%, p = 0.030). Mosaicism levels were similar between the three groups. There were no significant differences in number of biopsied embryos with no results: 5 for ICSI male factor group (0.59%), 6 for ICSI non-male factor (0.96%), and 10 for conventional insemination (0.89%). Limitations, reasons for caution This was a retrospective analysis of patients from a single clinic, with a relatively small sample size so results may not be generalizable to all populations. Extensive demographic information and baseline characteristics (including reason for ICSI performed among non-male factor patients) were not analyzed so there may be confounding factors. Wider implications of the findings This is the first study that we are aware of to investigate the ploidy status of embryos created among non-male factor patients undergoing ICSI. Conservative use of ICSI can significantly decrease the cost of IVF. Larger studies are needed to further elucidate the role for ICSI among these patients. Trial registration number not applicable

The prevalence of endometrial polyp in women with tubal factor infertility is higher than male factor infertility: Is PID one of the causes of endometrial polyp?

Previous studies have shown an association between chronic endometritis and endometrial polyps, and only one study in infertile women reported an association between tubal obstruction and polyps. This study aimed to compare the prevalence of endometrial polyps in two groups of women with tubal factor infertility and male factor infertility to assess if is there any association between tubal factor infertility and endometrial polyps. This case-control study was performed on infertile women. The case group included women with tubal factor infertility and the control group included all women with male factor infertility. In all patients, vaginal ultrasound was performed between days 8 and 12 of the menstrual cycle to diagnose endometrial polyp, its size, and number. Demographic and obstetrics variables were recorded. Patients underwent hysteroscopy and polypectomy and the diagnosis of the polyp was confirmed by pathology report. In the present study, 245 people participated in two groups. There was a statistically significant difference between the two groups in terms of demographic and obstetric characteristics like type of infertility, duration of infertility, and gravidity. The prevalence of polyps in the tubal factor group was higher than in the male factor group (63 [60%] vs. 12 [9.8%]), and this difference was statistically significant (p=0.0001). In addition, the prevalence of chronic endometritis in the tubal factor group was higher than in the male factor group (19 [18.8%] vs. 4 [3.3%]), and this difference was statistically significant (p=0.001). In the present study, a strong association was observed between endometrial polyps and tubal obstruction, and considering that the most common cause of tubal obstruction is pelvic and genital infections, after confirmation with more studies, it may be possible to consider antibiotic treatment in these patients, especially in patients with recurrent polyps.

A comprehensive evaluation of pre- and post-processing sperm parameters for predicting successful pregnancy rate following intrauterine insemination with the husband’s sperms

BackgroundTo determine the predictive values of sperm parameters pre- and post-processing by density gradient centrifugation for clinical pregnancy rates (CPRs) following artificial insemination by husband (AIH) in infertile Chinese couples.MethodsA total of 3,522 AIH cycles from 1,918 couples were retrospectively analyzed. The parameters were compared between the pregnant and non-pregnant groups and further between different etiological groups (Male-factor, Both-male-and-female-factor, and Other-factor). Multivariate logistic regression analysis was performed to create models for predicting the CPRs of each etiological group.ResultsThe overall CPR was 13.3%. There were significant improvements for most sperm parameters after DGC. Multivariate logistic regression analysis indicated that, in overall AIH cases, the top parameters significantly influencing the CPR of AIH were pre-STR (OR = 1.037; P = 0.048) and post-VSL (OR = 1.036; P = 0.011). In the Male-factor Group, the top influencing parameters were pre-VCL (OR = 2.096; P = 0.008), pre-LIN (OR = 1.930; P = 0.002) and post-VSL (OR = 1.316; P = 0.023). In the Both-factor Group, the top influencing parameters were pre-VCL (OR = 1.451; P = 0.008) and post-motility (OR = 1.218; P = 0.049). In the Other-factor Group, the top influencing parameters were pre-VAP (OR = 1.715; P = 0.024), pre-STR (OR = 1.20; P = 0.011) and post-VSL (OR = 1.04; P = 0.017). Moreover, receiver operating characteristic analysis showed that the logistic regression models of the Male- and Both-factor Groups had greater powers for prognostic classification than those of other groups.ConclusionsThis study demonstrated that some sperm parameters have a collinearity relationship in predicting the CPR following AIH. Moreover, the predictive capacity of a multivariate logistic regression model is better than those of individual parameters, especially for the Male- and Both-factor Groups. In these cases, pre-VCL is the common top influencing factor.

Evaluating the Serum Levels of Inflammatory Cytokines in Women with Various Causes of Infertility during Controlled Ovarian Stimulation Cycles

Introduction: Concentration of inflammatory cytokines in serum levels and their role in the success of reproductive cycles with female infertility factors is unknown, so the aim of this study was to evaluate the serum levels of inflammatory cytokines in women with different causes of female infertility during controlled ovarian stimulation cycles.&#x0D; Methods: In this case-control study, 25 infertile women with female infertility or unknown causes (case group) and 24 infertile women with male infertility causes (control group) participated in controlled ovarian stimulation cycles. 5 cc of blood was taken from them on the day of ovulation and after serum isolation, serum IL6 and TNFα levels were measured by ELISA.&#x0D; Results: In this study, there was no significant difference in TNFα and IL6 levels between case and control groups (P&gt; 0.05). There was also no significant difference in TNFα levels in terms of causes of infertility (P&gt; 0.05). However, there was a significant difference in IL6 level in terms of various causes of infertility (P = 0.02). There was a significant difference between polycystic ovarian as well as unknown group and male factor group considering serum levels of interleukin-6 (P = 0.008, P = 0.02, respectively). Furthermore, the highest level of IL6 (28.3 ±20.36) belonged to the infertility group with unknown cause and a significant relationship was found between IL6 level and the number of oocytes and embryos (P &lt;0.01).&#x0D; Conclusion: Higher serum IL6 levels in the infertility group with unknown cause could be considered as a factor in the pathogenesis of infertility in the patients with unknown causes and a parameter affecting the number of oocytes and embryos in this group. However, studies with a larger target population are needed to explain this potential indicator.

Male factor infertility and placental pathology in singleton live births conceived with in vitro fertilization.

We sought to determine whether pregnancies conceived in those with male factor infertility have unique placental pathology profiles compared to those undergoing infertility treatments for other indications. This was a retrospective cohort study of placental pathology from 464 live births conceived from autologous fresh IVF cycles at an academic fertility center from 2004 to 2017. Placental pathology was compared between live births arising from patients with male factor infertility alone and those with another infertility diagnosis. Placental outcomes were compared with parametric or non-parametric tests; logistic regression was performed to account for potential confounders. Compared to cycles performed for a non-male factor diagnosis, male factor infertility cycles had a higher mean paternal age (38.2years vs. 36.5years, p < 0.001), a higher female mean BMI (24.3 vs. 23.3kg/m2, p = 0.01), and a lower day 3 follicle stimulating hormone (FSH) level (6.8 vs. 7.3IU/mL, p = 0.02). The mean numbers of embryos transferred, and day of transfer were similar between groups, and more cycles used ICSI in the male factor infertility group (90.6% vs. 22.5%, p < 0.001). Placental pathology in our adjusted model was similar between the male factor and non-male factor groups. In our unadjusted subgroup analysis, cycles for male factor using ICSI appeared to lead to more small placentas by weight compared to cycles performed with conventional insemination (45.8% < 10th percentile vs. 18.8%, p = 0.04). Male factor infertility is not associated with significantly different placental pathology compared to other infertility diagnoses.

Obstetrical outcomes of ART pregnancies in patients with male factor infertility.

Pregnancies conceived by in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are associated with an increased incidence of obstetrical and neonatal complications. With the growing rate of male factor infertility, which is unique by not involving the maternal milieu, we aimed to assess whether obstetrical outcomes differed between IVF/ICSI pregnancies due to male factor infertility and those not due to male factor infertility. A retrospective cohort study of women receiving IVF/ICSI treatments at a single hospital over a five-year period was involved in the study. Inclusion criteria were women with a viable pregnancy that delivered at the same hospital. Pregnancies were divided into male factor only related and non-male factor-related infertility. The groups were compared for several maternal and neonatal complications. In total, 225 patients met the study criteria, with 94 and 131 pregnancies belonging to the male factor and non-male factor groups, respectively. Demographic and clinical characteristics were comparable, except for younger maternal age and higher incidence of twin pregnancies in the male factor group. A sub-analysis for singleton pregnancies revealed a less likelihood of cesarean delivery, preterm birth, and male gender offspring in the male factor group (p < 0.05). These differences were not observed in the sub-analysis for twin pregnancies. Other outcome measures were similar in both groups, both for singleton and twin pregnancies. Singleton IVF pregnancies due to male factor infertility are associated with a reduced incidence of some adverse outcomes, likely due to lack of underlying maternal medical conditions or laboratory conditions related to ICSI. Our findings require validation by further studies on larger samples.

Fertility-Related Problems and Ways of Coping of Couples With Primary Infertility in Urban India

Objective: To study the impact of infertility in terms of fertility-related problems and ways of coping among male organic factor, female organic factor, and unexplained factor infertility groups suffering from primary infertility. Infertility is defined as an inability to become pregnant after 1 year of regular sexual relations without use of contraceptives. This study compared coping strategies and specific fertility problems among the 3 infertile groups. Methods: This was a clinic-based cross-sectional comparative study based on consecutive sampling method. Sixty couples were taken, of which 10 couples were from the male factor, 10 from the female factor, and 10 from the unexplained factor group. Fertility Problem Inventory and Ways of Coping Questionnaire were the tools that were administered. Results: The female factor group had greater social and relationship concern and need for parenthood. Seeking social support was used more by the unexplained factor group, whereas positive reappraisal coping style was used more by the female factor group. The male factor group used confrontative and self-controlling strategy to deal with the infertility problem. Conclusion: Men and women had different fertility-related concerns and used different coping methods to address these issues. Mental health professionals can address these concerns with specifically devised psychotherapy module.

Prevalence of thyroid dysfunction and thyroid autoimmunity in infertile women

Aim: This study aimed to determine the prevalence of thyroid autoimmunity (antithyroglobulin and antithyroid peroxidase)and thyroid dysfunction (hypo- or hyperthyroidism) among women with different causes of infertility.Materials and Methods: A cross-sectional study was carried out among 255 patients with infertility who were recruitedfrom the gynecology clinic, Kasr Al Ainy Hospitals, Cairo University, Egypt. Patients were divided into 4 groups. Group A including infertile women with either unexplained or anovulatory infertility with/without associated male factor,group B including infertile women with a tubal (mechanical) factor of infertility with/without associated male factor,group C including infertile women with both anovulation and tubal factor with/without associated male factor and acontrol group including women with exclusive male factor. Serum levels of TSH, antithyroid peroxidase (anti-TPO) andantithyroglobulin (anti-TG) were measured in all patients.Results: The TSH level was abnormal in 22 out of 255 women (9.8%). 44 (17.3%) were positive for anti-TPOantibodies, 26 (10.2%) were positive for anti-TG antibodies. Seventy patients (27.5%) had TSH levels above 2.5 mIU/L.No significant difference was found between different causes of infertility in TSH or antithyroid antibodies. There was apositive correlation between frequencies of both positive anti-TG and secondary infertility in group B.Conclusion: There is no significant relationship between thyroid dysfunction and the type of infertility (functional ormechanical), or its duration. According to our study, the prevalence of antithyroid antibodies seems to be the same ininfertile women and control. Antithyroglobulin might be associated with secondary infertility due to tubal factor.

Identification of factors related to fertilization failure in in vitro fertilization-embryo transfer.

To investigate the possible factors relevant to fertilization failure in in vitro fertilization-embryo transfer (IVF-ET). The medical records of 4 205 infertile patients undergoing IVF-ET treatment at the Reproductive Medicine Center, Xiangya Hospital, Central South University from January 2016 to December 2017 were collected. The patients were divided into a complete fertilization failure group, a low fertilization rate group, and a control group based on fertilization rate. We examined the associations among the 3 groups in terms of female age, duration of infertility, duration of stimulation, gonadotropin (Gn) dosage, follicle-stimulating hormone (FSH) dosage, and total number of retrieved oocytes. According to theincidence factors, the patients were divided into a single female factor group, a single male factor group and a unisex factor group, and the correlation analysis of incidence factor among the 3 groups was performed. The patients were divided into a primary infertility and a secondary infertility in accordance with the type of infertility. We analyzed the correlation of infertility type among the three groups. Risk factors for complete fertilization failure and low fertilization rate in IVF-ET were obtained by stepwise multiple linear regression analysis. Primary infertility, long infertility duration, total number of retrieved oocytes, and unisex factor were associated with completefertilization failure and low fertilization rate in IVF-ET (P<0.05), but female age, duration of stimulation, FSH dosage as well as Gn dosage were not correlated with complete fertilization failure and low fertilization rate in IVF-ET (P>0.05). Stepwise multiple linear regression analysis showed that the incidence factor, type of infertility, and infertility duration were independent influential factors for complete fertilization failure and low fertilization rate. Complete fertilization failure and low fertilization rate in IVF-ET are related to duration of infertility, total number of retrieved oocytes, cause of onset, and type of infertility, but they are not relevant to female age, duration of stimulation, and Gn and FSH dosage.

Ovulasyon indüksiyonu ve intrauterin inseminasyon sonrası infertil kadınlarda gebelik hızlarının değerlendirilmesi

Purpose: The aim of this studywas to investigate the effects of these factors on pregnancy rates in infertile patients following ovulation induction and intrauterine insemination. Materials and Methods: The study was performed retrospectively that investigated examination reports and laboratory results of 201 infertile patients with unexplained infertility, male factor and anovulation. Women were subdivided into two groups according to the ovary-stimulating agent used as gonadotropin or clomiphene citrate. A semen sample was obtained from all men participants. Results: There were 239 cycles of unexplained infertility (77.9%), 39 cycles in ovulatory dysfunction (12.7%) and 29 cycles in male factor (9.4%) groups. The clinical pregnancy rates per cycle according to infertility type were found as 18.4% (n:44) for unexplained infertility, 17.9% (n:7) for ovulatory dysfunction and 13.8% (n:4) for malefactor. In regression analyses, follicle (diameter&amp;gt;10mm) count on the day of hCG administration and inseminated total motile sperm count (ITMSC) were independently affected pregnancy rate. ITMSC area value under the curve (0.63) was significantly different from 0.5. Conclusion: Follicle count on the day of hCG administration and ITMSC independently affect the pregnancy rate. Additionally, the intrauterine insemination method should be attempted in appropriate cases that have an acceptable successful pregnancy rate.

Combined Preimplantation Genetic Testing for Autosomal Dominant Polycystic Kidney Disease: Consequences for Embryos Available for Transfer.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease and presents with genetic and clinical heterogeneity. ADPKD can also manifest extra-renally, and seminal cysts have been associated with male infertility in some cases. ADPKD-linked male infertility, along with female age, have been proposed as factors that may influence the clinical outcomes of preimplantation genetic testing (PGT) for monogenic disorders (PGT-M). Large PGT for aneuploidy assessment (PGT-A) studies link embryo aneuploidy to increasing female age; other studies suggest that embryo aneuploidy is also linked to severe male-factor infertility. We aimed to assess the number of aneuploid embryos and the number of cycles with transferable embryos in ADPKD patients after combined-PGT. The combined-PGT protocol, involving PGT-M by PCR and PGT-A by next-generation sequencing, was performed in single trophectoderm biopsies from 289 embryos in 83 PGT cycles. Transferable embryos were obtained in 69.9% of cycles. The number of aneuploid embryos and cycles with transferable embryos did not differ when the male or female had the ADPKD mutation. However, a significantly higher proportion of aneuploid embryos was found in the advanced maternal age (AMA) group, but not in the male factor (MF) group, when compared to non-AMA and non-MF groups, respectively. Additionally, no significant differences in the percentage of cycles with transferable embryos were found in any of the groups. Our results indicate that AMA couples among ADPKD patients have an increased risk of aneuploid embryos, but ADPKD-linked male infertility does not promote an increased aneuploidy rate.

Evaluation trace minerals and oxidative status in follicular fluid for unexplained infertile female undergoing Intra-cytoplasmic sperm injection program.

Objective: To evaluate the level of zinc and 8-OHdg in follicular fluid and determine the correlation of both with Intracytoplasmic sperm injection outcome.Aim: The aim of this study is. To evaluate the Level of zinc and oxidative stress biomarker 8-OHdg in follicular fluid for unexplained female and compare with male factor. Study the correlation between zinc and 8-OHdg with ICSI outcome. Material and method: eighty eight subfertile couples were involved in this study. They divided into two groups. First group male factor and second group unexplained female factor. Both were interred in ICSI program. Result: The study showed that the mean follicular fluid level of zinc in pregnant group (17.47) and non-pregnant group (16.62). However, not different level of zinc in follicular fluid in both group unexplained female factor and male factor (16.66) and (16.97), respectively. The level of zinc significantly with No. of the oocyte (p=0.004), MII (p=0.033), No. of 2PN (p=0.035), Fertilization rate (p=0.001), Embryo G1 (p=0.044) and Embryo G2 (p=0.026). No significant statistical difference between level of 8- OHdg in follicular fluid in two groups regarding the cause of infertility unexplained female factor and male factor mean (2.20) and (2.25), respectively. But significant with pregnant status in pregnant group mean (1.37) and non pregnant group mean (2.54). The level of 8-OHdg non-significantly with ICSIoutcome. Conclusion: zinc level is statically significant and positively correlated with ICSI outcome, as the number of oocytes, mature oocyte (MII), fertilized oocytes 2PN, fertility rate, embryo G1 and embryo G2.The level of 8-OHdg in follicular fluid statically non- significant with ICSI outcome and not found a correlation between zinc and 8-OHdg.

The association between male serum anti-mullerian hormone and the outcomes of intracytoplasmic sperm injection

To evaluate the correlation between male serum anti-mullerian hormone and ICSI outcomes ( fertilization rate, cleveage rate, quality of embryos and pregnancy rate ). The type of study was controlled randomized study on fifty five infertile couples undergoing ICSI procedure at fertility center in Al-Sadder medical city in Al Najaf Al Ashraf. The research was included two groups are unexplained (n=24) and male factor infertility ( n=31)who underwent intracytoplasmic sperm injection programme. blood samples were taken from husbands to assessment of anti-mullerian hormone at day of retrieval of follicles. The results of ICSI were reported in both two groups. The correlation between male serum anti-mullerian hormone with fertilization rate, cleavege rate, and quality of embryos was studied. The current research results were revealed significant increase ( P <0.001), in concentration of male serum anti-mullerian hormone in unexplained group (7.29 ± 0.73) compared to male factor (2.36 ± 0.19 ) group. good quality embryos had significant increase (P value0.053)in unexplained group (5.70 ± 0.94) compared to male factor group(3.70 ± 0.5). Pregnancy rate was also found to be not significantly differed but the higher percentage of pregnancy (32.3%) occurred in male factor group compared to unexplained group(25%).There was positive correlation (r=0.293 p=0.03 ) between good quality embryos and male serum anti-mullerian hormone. Results of this study showed found positive correlation between male serum anti-mullerian hormone and good embryos which may lead to improvement in pregnancy rates.

Predictive factors for oocyte retrieval failure in treatment cycles with assisted reproductive technology: a retrospective cohort study using the nation-wide art registry of Japan

The purpose of this study was to evaluate the prognostic factors for oocyte retrieval failure in patients undergoing assisted reproductive technology (ART) treatment cycles. A retrospective cohort study. The present study was approved by the Ethical Committee on human subjects. The data analyzed in this study were part of the Japanese ART registry database, which was collected by the Japan Society of Obstetrics and Gynecology from 2010 to 2012. We analyzed the data of 464,480 fresh cycles with transvaginal oocyte aspiration. The cycles with oocyte retrieval failure and those with one or more oocytes retrieved were compared to determine predictive factors for oocyte retrieval failure using multivariate logistic regression analyses. The number of cycles with oocyte retrieval failure was 36,600 (7.9%). According to the multivariate analysis, age, cause of infertility, and controlled ovarian hyperstimulation (COH) were the independent prognostic factors for oocyte retrieval failure. The percentages of oocyte retrieval failure in the age groups of 29 years old and under, 30-34 years old, 35-39 years old, 40-44 years old, and over 45 years old were 3.2%, 4.2%, 5.9%, 10.2%, and 18.6%, respectively. The odds ratios of patients in their 30’s and 40’s were 1.7 and 4.0 times those of the patients in their 20’s, respectively. The percentages of oocyte retrieval failure that corresponded to infertility caused by a male factor, tubal factor, endometriosis, and unknown factors were 5.6%, 7.3%, 8.0%, and 9.2%, respectively. The odds ratios for oocyte retrieval failure in the tubal factor, endometriosis, and unknown groups were 1.3, 1.4, and 1.7 times those in the male factor group, respectively. The percentages of oocyte retrieval failure in the COH cases using aromatase inhibitor or clomiphene (AI+CC), GnRH agonist, and GnRH antagonist were 10%, 1.5%, and 3.5%, respectively. The odds ratios for oocyte retrieval failure in the GnRH antagonist and AI+CC protocols were 2.4 and 5.3 times those for the GnRH agonist protocol, respectively. The percentage of oocyte retrieval failure in the natural cycles was 21%. The predictive factors for oocyte retrieval failure might be related to a patient’s age, particular causes of infertility, and COH protocols. These results provide information that may be useful for counseling patients before ART treatments.

Does paternal age influence the fertilization rate of egg donation cycles with male factor?

Evaluate the impact of paternal age in egg donation cycles with male factor. Observational, analytical, retrospective, transversal. In vitro fertilization cycles from the egg donation program in a private fertility center from January 2012 through December 2016 were reviewed. The cycle outcomes were assessed in relation to semen samples to analyze the impact of male factor and paternal age. Cycles were divided into two groups: Group 1, those who had male factor (oligo, terato, asthenospermia of any degree) and Group 2, those who had normal seminal parameters. Male age, fertilization rate, embryo development, and pregnancy rate were compared between groups. From 472 samples, 213 (45.13%) had male factor (Group 1), and 259 (54.87%) had normal seminal parameters (group 2). Overall, male patients from group 2 were younger (mean 38.2 yr, ± 5.8, P = 0.002) and had a higher fertilization rate (68.22%, P = 0.005). In this group, fertilization rates didn’t fluctuate with age (r2 = 0.010). However, patients from group 1 were older (mean age 40.5 a, ± 4.85, P = 0.002) and paternal age was slightly correlated with fertilization rate (r2=-0.126) with lower fertilization rates (62.51%, P=0.005) and a low probability of pregnancy when normal forms were less than 6% (AUROC = 0.677, SEN 57%, SPE 76.7%). Male age mildly reduces fertilization rates in IVF cycles with male factor. In cycles without male factor, age did not correlate with fertilization rates or any seminal parameter.

Is early embryo cleavage a factor to increase success in all types of ICSI indications?

The authors aimed to compare early embryo cleavage with pregnancy rates in intracytoplasmic sperm injection/embryo transfer (ICSI/ET) cycles due to male infertility or tubal factor infertility (TFI). 412 ICSI/embryo transfer cycles undergoing treatment for over two years were prospectively analyzed; 337 of the cycles were due to male infertility, whereas 75 suffered from tubal factors. Non-early cleaved (NEC) embryos were used for ET in 271 male factor and 67 tubal factor cycles, whereas early cleavage embryos were used for embryo transfer in 66 male factor and eight tubal factor cycles. In 66 out of 337 cycles (19.58 %) in male factor group and in eight out of 75 tubal factor cycles (10.66%), early cleavage (EC) embryos were obtained (p = 0.069). The clinical pregnancy rate was significantly elevated in EC subgroup (34.8%) compared to NEC subgroup (20.6%) (p = 0.015) in the male factor infertility group. The clinical pregnancy rate was non-significantly elevated in EC subgroup (37.5%) compared to NEC subgroup (23.8%) (p = 0.410) in the TFI group. The authors found that the implantation and pregnancy success of EC embryos vary with the therapeutic indication. The success rate would be low even with usage of EC embryos in untreated cycles of TFI.

Follicular fluid levels of vascular endothelial growth factor and its receptors and pregnancy outcome of women participating in intracytoplasmic sperm injection cycles

The intracytoplasmic sperm injection (ICSI) outcome is depended mainly on oocyte quality. Cytokines and their receptors play a critical role in oocyte maturation, fertilization, and embryo implantation. The purpose of the study was to study the levels of vascular endothelial growth factors (VEGFA, VEGFR1, VEGFA) in follicular fluids (FF) women participating in ICSI-in vitro fertilization (IVF) cycles in relation to cycle's outcome.One hundred and fifty three samples of 70 women participating in ICSI cycles were classified in three infertility groups: male factor, female factor, and low responders. For controlled ovarian stimulation in male and female factor group, the long agonist protocol with leuprolide and recombinant follicle stimulating hormone (FSH) was employed, while the antagonist cetrorelix was used in low responders. Cytokines levels were evaluated with enzyme-linked immunosorbent assay (ELISA).In a total of 153 samples, the overall pregnancy rate was 51.6%, the higher one observed in female factor group (59% vs. 37.5% and 28.6% in male a factor and low responders group, p = 0.013. VEGFR2 differed statistically significantly between the two groups, being higher in the pregnancy group [median (IQR): 5,630 (4,870 - 6,651) vs. 4938 (4,068 - 6,020) in the non-pregnancy group, p = 0.003]. There were significant correlations between VEGF receptors, differentiated depending on infertility groups.The VEGFA/VEGFR2 system is important in human reproduction and the association pattern between VEGFA receptors may serve as a marker for ICSI outcome. Examination for spermatozoa functional defects may increase pregnancy rate in male factor group.