Subfertile Patients Research Articles

P-750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2-6min), compared to 4min50 in the control group (range 1-12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p > 0.05) between the VR group and the control group, or within time 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p < 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

P–747 Implementation of the ESHRE Congenital uterine anomaly classification into practice and clinical pregnancy outcomes at a Tertiary University Teaching Hospital Fertility department

Abstract Study question What’s the incidence of class U1-U6 CUAs in subfertile women? What’s the clinical pregnancy rate in women with the most common anomaly, a septate uterus? Summary answer The incidence of CUAs is 5.9% in our subfertile population, with a septate uterus (U2) being the most common abnormality in 4.2% of the population What is known already Congenital uterine anomalies (CUAs) are common. A systematic review suggested an estimated overall prevalence of 5.5% in an unselected population, 8.8% in the subfertile population, 13.3% in those with a history of recurrent miscarriage and 24.5% in those with a history of subfertility and recurrent miscarriage. A septate uterus (U2) is the most common CUA and is amenable to surgical intervention although at present there is a lack of evidence suggesting benefit in subfertile patients. Women with a septate uterus are known to have poorer reproductive outcomes, including reduced conception rate and increased first trimester loss. Study design, size, duration All patients referred to our department for subfertility had a 2D pelvic ultrasound scan as part of their baseline investigations. Since it was established in 2016, all patients with a suspected CUA based on clinical history and investigations, were referred to the clinic and data collected prospectively. Prior to this, women with suspected CUAs required a hysteroscopy or MRI scan for confirmation of diagnosis, often leading to long waiting lists and treatment delays. Participants/materials, setting, methods Out of the 4716 patients referred to the department for subfertility from 2016–2018, 302 women were referred to the 3D clinic due to suspicion of a CUA. Transvaginal 3D-ultrasound scan was performed and CUAs classified according to the ESHRE/ESGE working groups. Patients diagnosed with a septate uterus were given options of conservative versus surgical treatment, in the light of unclear benefits of hysteroscopic septum resection. Clinical pregnancy data were collected about this cohort. Main results and the role of chance Of the 302 women referred to the service, the uteri of 25 patients were unable to be assessed accurately, most commonly as the cavity was unclear due to a thin endometrium. The remaining 277 patients were classified as having the following CUAs; Normal (U0) 63 patients, Dysmorphic (U1) 5 patients, Septate (U2) 199 patients, Bicorporeal (U3) 6 patients and Hemi uterus (U4) 4 patients. No women were classified as having an aplastic uterus (U5) or unclassified (U6). Of the 199 women with a septate uterus, 15 women opted for surgical intervention, 143 women decided to have conservative management and 41 women were lost to follow up. The women who had hysteroscopic resection of the septum had a mean age of 35 years, 6/15 had primary subfertility and 6/15 had a history of recurrent miscarriage. The women who had conservative management had a mean age of 32.5 years, 100/143 had primary subfertility and 20/143 had a history of recurrent miscarriage. At present, 89/143 women who have had conservative management and 12/15 women who had surgical interventions have had a clinical pregnancy, 72/89 and 6/12 of these pregnancies were IVF/ICSI pregnancies respectively. Limitations, reasons for caution This is an observational study, these findings can be useful for patient counselling. However, ideally randomised controlled trials are needed as evidence for the different treatment options for the cohort of patients with septate uterus, which are largely lacking in the current literature, as their feasibility remains a challenge. Wider implications of the findings: Three-dimensional transvaginal ultrasonography clinics are cost-effective one-stop services, successfully providing a diagnosis and management plan in 92% of patients referred with a suspected CUA. They increase patient satisfaction by providing an opportunity to discuss risks in future pregnancies and reducing reliance on hysteroscopy and MRI scans. Trial registration number Not applicable

P–580 Levels of the constitutive heterochromatin (cHC) mark H3K9me3 in human sperm in relation to IVF outcome and preimplantation embryo development

Abstract Study question Can we quantify the variation in epigenetic signature of constitutive heterochromatin (cHC) in human sperm using Western blot analysis and correlate this with pregnancy outcome after IVF? Summary answer Variation in the quantified H3K9me3 to H3 showed an association with embryo morphokinetics and a H3k9me3/H3 ratio <0,5 is negatively associated with pregnancy outcome. What is known already In human sperm, 5–15% of the DNA remains associated to histones. We previously showed that human mature spermatozoa still exhibit the canonical marks H3K9me3 and H4K20me3 on cHC regions and transmit these nucleosomes to the embryo after fertilization. Additionally, other groups reported an increase in the nucleosome/protamine ratio when sperm from male factor subfertility patients were compared with sperm from fertile men, indicating that incomplete chromatin remodelling during spermatid elongation may affect fertility. Thus, variations in sperm chromatin occur during human spermatogenesis that go undetected by current sperm quality tests and may have clinical significance for IVF treatment outcomes. Study design, size, duration An observational study of patient couples (n = 53) undergoing IVF treatment at the Erasmus MC, Rotterdam, between 2017 and 2018. Inclusion criteria were normospermia according to the WHO criteria, at least 4 oocytes harvested after ovum pickup and an embryo-transfer. After routine insemination, resulting embryos from 38 cycles were cultured in the EmbryoScopeTM and developmental timings up to the 8-cell stage were recorded. The primary outcome measure was ongoing pregnancy (ultrasound at 12 weeks of gestation). Participants/materials, setting, methods Surplus sperm samples from 53 IVF cycles were lysed at a concentration of 200x106 spermatozoa/ml in RIPA buffer. Lysates were loaded and separated on SDS-PAGE gels and transferred onto blotting membranes. After incubation with antibodies against H3 and H3K9me3 and fluorescent detection, signal intensity was quantified using Image Studio Lite (LI-COR Biotechnology)). Additionally, time-lapse developmental kinetics of 130 transferred and cryopreserved embryos of 38 patient couples were analyzed. Main results and the role of chance No significant differences were found in patient characteristics between the pregnant and non-pregnant group. However, fertilization rate was found to be a confounding factor; no pregnancies occurred below a fertilization rate of 40% and only 4 occurred below a fertilization rate of 60%. The median H3k9me3/H3 ratio in the pregnant group was 1.01 (interquartile range (IQR): 0.69–1.16) and in the non-pregnant group 0.896 (IQR: 0.54–1.06), this difference was not significant. When using logistic regression analysis, adjusted for the fertilization rate (dichotomized as ≤ 60% or > 60%), we observed a positive association between the H3k9me3/H3 ratio and ongoing pregnancy (odds ratio (OR) 6.43 (95% confidence interval (CI): 1.12–36.8; p-value 0.037). More importantly, none of the samples with a ratio of 0.5 or lower resulted in an ongoing pregnancy (n = 7). After classifying sperm samples into quartiles according to the H3K9me3/H3 ratio, we observed that resulting embryos reached the 4-cell stage faster with sperm from to the lowest quartile of H3K9me3/H3 ratio, compared to the highest quartile (beta –4.4 hours, p-value 0.05). Our results point to an association between the H3k9me3/H3 ratio, embryo development and pregnancy outcome. Limitations, reasons for caution This initial analysis is performed with a relatively low number of samples. The OR of 6.43 has a wide 95% CI, probably due to low statistical power. Our observations await confirmation in a larger data set. Wider implications of the findings: Semen analysis remains the cornerstone of male infertility diagnosis, despite its low prognostic value. Sperm epigenetic cHC inheritance likely has an important impact on early embryo development. Therefore, the H3k9me3/H3 ratio could serve as a parameter for sperm quality and aid in the prediction of pregnancy outcome. Trial registration number Not applicable

A kaleidoscopic view of ovarian genes associated with premature ovarian insufficiency and senescence.

Ovarian infertility and subfertility presenting with premature ovarian insufficiency (POI) and diminished ovarian reserve are major issues facing the developed world due to the trend of delaying childbirth. Ovarian senescence and POI represent a continuum of physiological/pathophysiological changes in ovarian follicle functions. Based on advances in whole exome sequencing, evaluation of gene copy variants, together with family-based and genome-wide association studies, we discussed genes responsible for POI and ovarian senescence. We used a gene-centric approach to sort out literature deposited in the Ovarian Kaleidoscope database (http://okdb.appliedbioinfo.net) by sub-categorizing candidate genes as ligand-receptor signaling, meiosis and DNA repair, transcriptional factors, RNA metabolism, enzymes, and others. We discussed individual gene mutations found in POI patients and verification of gene functions in gene-deleted model organisms. Decreased expression of some of the POI genes could be responsible for ovarian senescence, especially those essential for DNA repair, meiosis and mitochondrial functions. We propose to set up a candidate gene panel for targeted sequencing in POI patients together with studies on mitochondria-associated genes in middle-aged subfertile patients.

The precise determination of the window of implantation significantly improves ART outcomes

The human endometrium is receptive to the embryo for a specific period of time known as the window of implantation (WOI). During this period, the endometrium shows a specific gene expression profile suitable for endometrial function evaluation. ER Map is a molecular tool able to accurately predict endometrial receptivity status by transcriptomic analysis. In this retrospective study, including 2256 subfertile patients undergoing ART treatment, the clinical value of precise WOI determination is studied in detail. Results obtained when single embryo transfers (sET) were scheduled either within the WOI timeframe as established by ER Map, or deviating from this WOI, are assessed and compared. Data obtained showed that 34.18% (771/2256) of patients had a displaced WOI. Analysis of ART outcomes showed significantly higher pregnancy rates in transfers scheduled within the WOI predicted compared to transfers that deviated more than 12h from this WOI (44.35% vs 23.08%, p < 0.001). The deviation from the WOI had also an impact on the progression of pregnancy, with a significant increase in pregnancy loss (~ twofold) observed in transfers that deviated more than 12h from the WOI predicted. These results indicate that the precise determination of the WOI and personalised embryo transfer can significantly improve clinical outcomes.

Human sperm functioning is related to the aquaporin-mediated water and hydrogen peroxide transport regulation

Aquaporins (AQPs) are transmembrane water channels and some of them are permeable in addition to water to other small solutes including hydrogen peroxide. The sperm cells of mammals and fishes express different AQPs, although there is no agreement in the literature on their localization. In humans, AQP3 and AQP11 are expressed mainly in the tail, AQP7 in the head and AQP8 in the midpiece. Thanks to the results of experiments with KO mice and to data obtained by comparing sub-fertile patients with normospermic subjects, the importance of AQPs for the normal functioning of sperms to ensure normal fertility emerged. AQP3, AQP7 and AQP11 appeared involved in the sperm volume regulation, a key role for fertility because osmoadaptation protect the sperm against a swelling and tail bending that could affect sperm motility. AQP8 seems to have a fundamental role in regulating the elimination of hydrogen peroxide, the most abundant reactive oxygen species (ROS), and therefore in the response to oxidative stress. In this review, the human AQPs expression, their localization and functions, as well as their relevance in normal fertility are discussed. To understand better the AQPs role in human sperm functionality, the results of studies obtained in other animal species were also considered.

Economic perspective of evaluating fertility treatment in obese and overweight infertile women.

Objectives:To evaluate direct cost of in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle and reproductive outcomes among infertile women with different body mass index (BMI).Methods:A retrospective study of 826 subfertility patients who had IVF or IVF-ICSI in 2017 to 2018 were reviewed. The patients were divided into 4 groups bestowing to BMI to normal weight (18.5-24.9 kg/m2), underweight (<18.5 kg/m2), overweight(25-29.9 kg/m2), and obese(≥30 kg/m2). Data on treatment costs of IVF/ICSI and reproductive outcomes were collected and analyzed. A total of 338 patients (40.9%) were overweight, and 300 (36.3%) patients were obese. A bottom-up methodology was used to measure the resource utilization. The capital inputs needed for individual procedures were defined and calculated by consulting with appropriate clinicians and priced using market prices for 2017-2018.Results:There was no statistical significant difference for live birth rate (LBR) among the BMI groups, with the occurrence of LBR in 23 women with normal BMI (13.1%), in 48 (14.2%) women who were overweight, in 48 (16%) in women who were obese (p=0.7). The median cost for IVF/ICSI treatment cycle did not differ across BMI groups; the cost was 10,380 SAR for women of normal weight, 10,440 SAR for women who are overweight and obese (p=0.6).Conclusion:Our results suggest that costs of IVF/IVF-ICSI is not significantly affected in women who are overweight or obese.

Endometrial delay is found to be part of a normal individual dynamic transformation process

PurposeLimited information is clinically available concerning endometrial receptivity; assessing endometrial transformation status is therefore an urgent topic in assisted reproductive technology. This study aimed to investigate individual endometrial transformation rates during the secretory phase in subfertile patients using personal endometrial transformation analysis.MethodsMonitoring was carried out during the secretory phase to obtain endometrial receptivity profiles. For the investigation, two endometrial biopsies were taken within one menstrual cycle. The extended endometrial dating was based on the Noyes criteria, combined with immunohistochemical analyses of hormone receptors and proliferation marker Ki-67. Biopsies were taken mainly at days ovulation (OV, n = 76)/hormone replacement therapy (HRT, n = 58) + 5 and + 10.ResultsThe results of the two biopsies were correlated with the clinically expected day of the cycle and showed temporal delays or hypercompensations, diverging from the expected cycle days by 0.5–5 days. In comparison with the first biopsies, the transformation rate in the second biopsies showed compensation, augmented delay, or constant transformation in 48.69, 22.37, and 28.94% of cases for ovulation in natural cycles and 56.89, 25.85, and 17.26% for HRT cycles, respectively.ConclusionThe study revealed an individually dynamic transformation process of the endometrium, with the ability to compensate or enlarge an initial “delay”, which is now identified as a normal individual transformation process during the secretory phase. This information is of great importance for the scientific investigation of dynamic changes in endometrial tissue, as well as for the timing of embryo transfers.

Estudio comparativo de los parámetros del seminograma en una población de varones subfértiles consumidores de marihuana

IntroductionThe aim of this work, is to find the prevalence of marijuana use in a subfertile population, and to carry out a comparative prospective study of the seminogram parameters of a group of subfertile patients, who are habitual marijuana users, versus a group of nested control cases of non-users. Material and methods2320 men were studied, 70% of patients from Primary Care Centers and 30% from hospital outpatient consultations. The analysis of sperm concentration and motility was carried out with a SCA® automated semen analyzer. The comparative study has been carried out, by applying a novel statistical methodology called «case-control nested», which is a hybrid case-control variation. ResultsThe prevalence of marijuana use has been calculated in a population of subfertile men. Statistical analysis of the semen values of the group of marijuana users versus the control group shows that there are no significant differences between them. ConclusionsIn the group of subfertile men studied, a prevalence of 10.26% of habitual marijuana users was observed. In our results, no significant differences were observed between the two groups studied, so we are considering the additional performance of new sperm functionalism tests, to explain the subfertility that has been observed in some of these patients who use marijuana, who present a normal seminogram.

Annexin A2 acts as an adherent molecule under the regulation of steroids during embryo implantation.

We previously showed that annexin A2 (Axna2) was transiently expressed at the embryo-uterine luminal epithelium interface during the window of implantation and was involved in mouse embryo implantation. At the same time, Axna2 was reported to be upregulated in human receptive endometrium, which was critical for embryo attachment as an intracellular molecule. Here, we identified Axna2 as a membrane-bound molecule on human endometrial epithelial cells and trophoblast cells, and the outer surface membrane-bound Axna2 was involved in human embryo attachment. In addition, physiological levels of estrogen and progesterone increased the expression of overall Axna2 as well as that in the extracellular surface membrane protein fraction in human endometrial cells. Furthermore, p11 (or S100A10, a member of the S100 EF-hand family protein, molecular weight 11 kDa) was involved in the translocation of Axna2 to the outer surface membrane of endometrial epithelial cells without affecting its overall expression. Finally, the surface relocation of Axna2 was also dependent on cell-cell contact and calcium binding. A better understanding of the function and regulation of Axna2 in human endometrium may help us to identify a potential therapeutic target for subfertile and infertile patients.

The anti-Mullerian hormone as a predictor of early pregnancy loss in subfertile women

ABSTRACT The aim of this study was to evaluate the predictive value of the anti-Mullerian hormone (AMH) level for early pregnancy loss and to compare the significance of AMH level to age as prognostic factors of pregnancy loss in subfertile women. The outcome of 848 subfertile patients confirmed with intrauterine pregnancies by ultrasound within 1 year of measuring serum AMH level were retrospectively analyzed. Among 848 patients, 206 women were diagnosed with early pregnancy loss. The mean age of the 848 patients was 35.66 ± 3.61 years (range: 26–46 years), and the mean AMH level was 2.95 ± 1.89 (range: 0.14–8.82 ng/mL). There were no significant differences in gravidity, parity, body mass index (BMI), and previous abortion history depending on early pregnancy loss. However, multivariable logistic regression analysis confirmed that the probability of early pregnancy loss is significantly affected by age (odd ratio, 1.079: 1.025–1.135, P = 0.004) and AMH (odd ratio, 0.885: 0.797–0.982, p = 0.022). According to this study, AMH level and age are both powerful predictors of early pregnancy loss. While chronological age is already well known as a factor related to early pregnancy loss, AMH was also considered when individualizing risk prediction for early pregnancy loss.

Anti-Mullerian Hormone as A Diagnostic Tool for PCOS Patient : Study in a Tertiary Level Hospital

Polycystic ovary syndrome (PCOS) is a frequently encountered problem affecting 6-11% women of reproductive age.1 Purpose of the study was to determine whether serum AMH level can be used to diagnose PCOS.&#x0D; Methods: It was a cross sectional study conducted among 55 sub-fertile women of reproductive age (18-35 year) in a tertiary level hospital during the period of January 2018 to December 2018. The study subjects were divided into group I (PCOS patient with subfertility by Rotterdam Criteria 2003) and group II (non PCOS subfertile patients of reproductive age). Menstrual history, obstetrical history, physical examination, clinical assessment of androgenesis, ovarian ultrasound assessment and level of AMH, FSH, LH were collected.&#x0D; Result: Twenty five PCOS &amp; 30 non PCOS sub-fertile patients were recruited. Mean age in PCOS &amp; non PCOS were 25.24±4.03 years and 27.8±5.01 years respectively. The mean serum AMH in PCOS was 11.03±3.78 ng/ml and in non PCOS was 3.93±1.92 ng/ml, their difference was statistically significant.&#x0D; Conclusion: AMH can be used as a diagnostic aid for PCOS.&#x0D; J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 142-146

THE IMPACT OF THE COVID-19 PANDEMIC IN TERMS OF QUALITY OF LIFE AND DISTRESS IN INFERTILITY, A QUESTIONNAIRE STUDY

The COVID-19 pandemic has an impact on daily life as well as fertility care. Evidence supports the notion that infertility causes substantial emotional distress and has a significant impact on a person’s quality of life. The effects of the COVID-19 pandemic on experiencing emotional distress in subfertile patients compared with their pre pandemic situation are unclear. In this study the impact of the restrictive consequences of COVID-19 in terms of emotional distress and infertility related quality of life is investigated, by comparing the pre pandemic emotional distress in a cohort of men and women at time of the first consultation in our fertility clinic with distress and quality of life during the COVID-19 pandemic.

Annexin A7 Regulates Endometrial Receptivity.

A limited window of receptivity is a prerequisite of reproductive success. Indispensable receptivity genes include cyclooxygenase 2 (COX2), an enzyme accomplishing formation of prostaglandin E2 (PGE2). A powerful regulator of PGE2 formation is Annexin A7 (ANXA7). The present study thus explored whether ANXA7 impacts on implantation and fertility. Here we show that ANXA7 is expressed in endometrial tissue and increases upon decidual transformation of human endometrial stromal cells (HESCs) in a time-dependent manner. Silencing ANXA7 significantly decreased the expression of PRL and IGFBP1, canonical decidual marker genes, but enhances COX2 and PGE2 levels. Genetic knockout of AnxA7 in mice significantly increases the number of implantation sites and litter sizes. Further, analysis of human endometrial biopsies showed that ANXA7 transcript and protein levels are decreased during the midluteal window of implantation in women suffering from recurrent pregnancy loss (RPL) when compared to subfertile patients. Taken together, the data indicate that ANXA7 has a conserved role in regulating endometrial receptivity and implantation.

An open study of valproate in subfertile men with epilepsy.

The aim of the study was to assess whether, male patients with epilepsy, switching from valproic acid (VPA) to levetiracetam (LEV) or lamotrigine (LMG) critically improves sperm counts and parameters, increasing chance of patients' female partners to spontaneously conceive. This is an observational prospective study recruiting all consecutive infertile male patients with epilepsy followed up at the outpatient Epilepsy Clinic of University Hospital of Ioannina, Northwest Greece. Infertile couples were referred to the Laboratory of Assisted Reproduction and Treatment of the University Hospital of Ioannina to conduct semen analysis. The first sample was collected while the patients were receiving VPA, and the second semen sample was collected after the patients were switched to LEV or LMG. Seventeen infertile male patients were recruited in the study. Nine patients were switched to LEV, and eight patients were switched to LMG. The mean sperm count increased after VPA withdraw P=.06. Motility was improved with an increase of total motility and non-progressive motility (P=.02 and P=.03, accordingly), whether sperm defects were decreased, mainly head defects (P=.03). Differences between patients switched to LEV or LMG were minimal and showed no significant findings. Spontaneous pregnancies were reported in three of the patients' partners, without any other clinical intervention offered to the couple. Switching from valproic acid to levetiracetam or lamotrigine improved sperm counts and other sperm parameters in subfertile male patients and increased the chance of spontaneously conceiving in subfertile couples.

313 - The profile of human sperm oxysterols in normal and subfertile patients: A prospective multicentre study

313 - The profile of human sperm oxysterols in normal and subfertile patients: A prospective multicentre study

Genetic Explanations for Fertility Disorders

This article reviews the genetic testing of infertility disorders. Genetic abnormalities can lead to disturbances of sexual development and hamper reproduction by influencing gamete production and maturation, fertilization, and embryonic development. Until now, the vast majority of detectable genetic abnormalities causing infertility were chromosomal abnormalities in both males and females. However, the number of monogenetic disorders, which play a role in disturbing fertility, such as single gene defects or complex disorders involving multiple genes in combination with environmental factors, is increasing. The common genetic causes of infertility in males are sex chromosomal abnormalities, Robertsonian translocations, cystic fibrosis transmembrane conductance regulator (CFTR) mutations, and Y chromosome microdeletions. In females, Turner syndrome, genetic causes of premature ovarian failure, such as fra(X) and complex disorders like polycystic ovary syndrome (PCOS), and endometriosis are the most prevailing. However, insight into the total impact of genetic abnormalities is increasing. This is because a growing number of mutations are detected among subfertile patients with an unknown etiology. Genetics is one of the most important yet under-emphasized causes of subfertility. Improved understanding of the genetics of infertility holds promise to define the etiology and counsel cases that were previously diagnosed with idiopathic infertility.

Date Palm Pollen Grains as a Potential Manager for Male Sub-fertility: A Clinical Trial

Medicinal plants are identified and used throughout human history; it has a great economic value especially in drugs discovery. Date palm pollen (DPP) is used traditionally in Sudan for treating sub-fertile male patients. Male infertility is heterogeneous group of disorders, most of them are idiopathic. This study is aimed to investigate the role of pharmaceutical preparation of DPP in amelioration of male sub fertility with detection of any possible adverse effects on the major body system functions, through blood picture, liver enzymes and kidney function. This study is a single group pretest-posttest experimental prospective comparative self-control. Sub-fertile men with Idiopathic oligoasthenozoospermia or azoospermia were received 500 mg capsules of DPP twice daily for three months after conducting their safety profiles to detect any toxic effects on hematological, hepatological and nephrological functions, Blood samples were taken from the patients for serum level of FSH (for azoospermic patients), FSH and Testosterone (for oligoasthenozoospermic patients). Finally, Semen sample have been obtained for computerized assisted semen analysis (CASA) report I and II. DPP administration induced significant increase (p≤0.001) in testosterone level (in oligoasthenozoospermic patients) and FSH level (in azoospermic patients). DPP induced significant changes (p≤0.001) towards improvement in the total and progressive sperm motility percentages measured in oligoasthenozoospermic patients by CASA dynamic analysis report I and II. The toxicological studies for DPP approved their safety use in human.

Analysis of balanced reciprocal translocations in patients with subfertility using single-molecule optical mapping

Approximately 1% of individuals who carry a balanced reciprocal translocation (BRT) are subfertile. Current karyotyping does not have the resolution to determine whether the breakpoints of the involved chromosomes perturb genes important for fertility. The aim of this study was to apply single-molecule optical mapping (SMOM) to patients presenting for IVF (in vitro fertilization) to ascertain whether the BRT disrupted any genes associated with normal fertility. Nine subfertile patients with different BRTs were recruited for the study. Methyltransferase enzyme DLE1 was used to fluorescently label their genomic DNA samples at the recognition motif CTTAAG. The SMOM was performed on the Bionano platform, and long molecules aligned against the reference genome hg19 to identify the breakpoint regions. Mate-pair and PCR-Sanger sequencing were used to confirm the precise breakpoint sequences. Both breakpoint regions in each of the nine BRTs were finely mapped to small regions of approximately 10Kb, and their positions were consistent with original cytogenetic banding patterns determined by karyotyping. In three BRTs, breakpoints disrupted genes known to be associated with male infertility, namely NUP155 and FNDC3A [46,XY,t(5;13)(p15;q22)], DPY19L1 [46,XY,t(1;7)(p36.3;p15), and BAI3 [46,XY,t(3;6)(p21;q16)]. The SMOM has potential clinical application as a rapid tool to screen patients with BRTs for underlying genetic causes of infertility and other diseases.

The Prevalence and Pattern of Abnormal Hysteroscopy Findings among Subfer-tile Patients at Albayda Fertility Centre/Libya

To estimate the prevalence and types of intrauterine abnormalities in subfertile women: a prospective study was carried out at Albayda Fertility Teaching Centre-Libya. The study was conducted on 115 infertile women attending Albayda Fertility Centre between January and May 2019. Diagnostic hysteroscopy was conducted after initial basic infertility assessment workup to assess the presence and types of uterine cavity pathologies. The duration of infertility ranged from 1-17 years, and the majority of the patients were presented with primary infertility (62.6%), 64.3% of the women had abnormal findings, and the most common lesion detected was endometrial polyp representing 44.6% of the lesions, followed by endometritis 17.6%. Seven cases had septum, and 20 patients had more than one pathology. Corrective measures were taken accordingly. 6.1% of the patients had a spontaneous pregnancy within three months of follow up. The prevalence of abnormal hysteroscopy findings among the studied population was high. Intrauterine endometrial polyps, endometritis, and uterine septum were the most frequent abnormality detected. These findings may indicate a need to incorporate hysteroscopy in the routine evaluation of infertility.