Role of Kisspeptin Gene Polymorphism in Idiopathic Male Infertility in Iraq

This case control study aimed to determine single nucleotide polymorphisms (SNPs) in the Kisspeptin (KISS1) gene in males with idiopathic infertility and their association with sex hormones and semen quality. The study included a total of 60 infertile and 30 healthy fertile males. Our results show that the level of the measured hormones (LH, FSH, Testosterone, Prolactin and Kisspeptin-54) were higher in the control group than in the male infertile group at p<0.05. We used polymerase chain reaction restriction fragment length polymorphism (PCR-RELP) for the genotyping of KISS1 position rs35431622 (Q36R) KISS1, which showed three different genotypes of different sizes; a wild-type homozygous AA of 233 bp and a heterozygous AG that has digestion products of 233, 161, and 72 bp. The AG was more frequent in the patients group which also had high OR value of G allele (3.105). While for the rs4889 (C/G(, there was a correlation between the CC genotype and the patients group, but it was non-significant. Patients had an OR value of 2.5 for the CC genotype with 95% CI: 0.21 – 29.26, whereas the OR value for the C allele was 1.14 with 95% CI: 0.613 – 2.135. In conclusion, variations in SNPs of the KISS1 gene may be considered as a risk factor for idiopathic male infertility in Iraqi population.

CORRELATION OF CYCLICAL CHANGES IN ENDOMETRIUM AND UTERINE BLOOD FLOW WITH OVULATION, AND TO PREDICT THE APPROXIMATE TIME OF OVULATION

Background & Method: The study was carried out in the Department of Radio diagnosis, Index Medical College, Hospital & Research Centre, Indore with an aim to correlate of cyclical changes in endometrium and uterine blood flow with ovulation, and to predict the approximate time of ovulation. Result: The study shows maximum numbers of cases (78%) have endometrial thickness more than 7 mm and most of them belongs to fertile group, while 22% cases have endometrial thickness less than 7mm and they all belong to infertile group. The study shows 66% of cases have 5 layered endometrial appearance and almost all of them were fertile and 34% cases have hazy 5 layered or no layering and most of them (14 out of 17) belongs to infertile group. In this study 68% patients have multifocal endometrial blood supply and almost all of them are fertile while 32% patients have absent or sparse endometrial blood flow. Conclusion: The advent of color flow imaging has enabled the detection of neovascularization and change in blood flow in endometrium and myometrium. In the study it was noted that 5 layered endometrium was present in almost all fertile cases while in infertile cases endometrium was single layer or hazy 5 layered, so it can be postulated that distinct 5 layered endometrium is associated with fruitful pregnancy outcome. It was also noted frequently in the study that endometrium thickness less than 7mm was commonly seen in infertile cases while patients having more than 7mm thick endometrium were from fertile group, so it can be postulated that good endometrial thickness provides more chances for fruitful pregnancy outcome. Keywords: Endometrium, Uterine & Ovulation.

A Retrospective Analysis of the Correlation between Trichomonas Vaginalis Infection and Infertility

Background: Trichomonas vaginalis (T. vaginalis) is an extracellular flagellated protozoan parasitizing the human genital and urinary tracts. T. vaginalis infection impacts human reproductive function, but whether it causes infertility is still a matter of debate.Methods: In this work, we consulted 237 relevant articles, which were classified into three categories: epidemiological investigations (104), review articles (40), and research articles (62). RevMan 5.4 was used to conduct a meta-analysis of the articles reporting epidemiological investigations comparing the incidence of T. vaginalis infection between infertile and fertile groups.Results: The results indicated that rate of T. vaginalis infection in the infertile group was lower than that in the fertile group. However, an epidemiological survey showed that the infertility rate of population infected with T. vaginalis was significantly higher than that of population without T. vaginalis infection. Most review articles stated that T. vaginalis infection causes infertility, while a small fraction of these articles were inconclusive. The conclusion that T. vaginalis infection can lead to infertility is supported by the research articles, which indicated the main pathogenic mechanisms are as follows: T. vaginalis impairs sperm quality, resulting in infertility; the immune response triggered by T. vaginalis infection impacts human reproductive function; and T. vaginalis impairs ovum quality, resulting in infertility.Conclusion: Our study confirmed that T. vaginalis infection can lead to infertility and provides a foundation for further investigations into its pathogenesis.

Correlation of Sperm Mitochondrial DNA 7345 bp and 7599 bp Deletions with As-thenozoospemia in Jordanian Population

Background: Alterations in sperm mitochondrial DNA (mtDNA) affect the functions of some OXPHOS proteins which will affect sperm motility and may be associated with asthenozoospermia. The purpose of this study was to investigate the correlation between 7599-bp and 7345-bp sperm mtDNA deletions and asthenozoospermia in Jordan. Methods: Semen specimens from 200 men including 121 infertile and 79 healthy individuals were collected at the Royal Jordanian Medical Services In-vitro fertilization (IVF) units. The mtDNA was extracted followed by mtDNA amplification. Polymerase chain reaction (PCR) was conducted for the target sequences, then DNA sequencing was performed for the PCR products. Chi-square, Fisher's and Spearman's tests were used to calculate the correlation. Results: The results showed a significant correlation between the presence of 7599-bp mtDNA deletion and infertility where the frequency of the 7599-bp deletion was 63.6% in the infertile group compared to the fertile 34.2% (p<0.001, (OR=3.37, 95% CI=1.860 to 6.108)). Additionally, the sperm motility showed a significant association with the frequency of the 7599-bp deletion (p=0.001, r=-0.887). The 7345-bp mtDNA deletion showed no assoctiation with the infertility (p=0.65, (OR=0.837, 95% CI= 0.464-1.51)) or asthenozoospermia (p=0.98, r=0.008). Conclusion: We demonstrated a significant correlation between asthenozoospermia and the 7599-bp mtDNA deletion but not the 7345-bp mtDNA deletion in the infertile men in Jordan. Screening for deletions in sperm mtDNA can be used as a pre-diagnostic molecular marker for male infertility.

P–361 Endometrium optical coherence tomography (OCT) and histomorphometry in implantation window and their relationships with reproductive failure and implantation outcome

Study question How do endometrium OCT image characteristics during peri-implantation window correlate with histomorphometry and associate with implantation outcomes in women with reproductive failure? Summary answer Endometrium OCT intensity correlated with stromal cell density and gland size. Endometrium with recurrent implantation failure had low OCT intensity but reversed in successful implantation. What is known already OCT is a non-invasive imaging technique using low energy near-infrared light to capture micrometer-scale resolution images from optical scattering media. An image produced by OCT resembles tissue architecture observed in histology, so OCT imaging has been regarded as “optical biopsy”. Our previous findings demonstrated OCT is better than ultrasound to identify endometrial pathology. We also showed association of OCT signal with microvessel density in peri-implantation endometrium. However, other histomorphometry were not evaluated. It is still unclear whether endometrium OCT image characteristics are different in reproductive failure and can predict implantation outcomes. Study design, size, duration This was a prospective study conducted at teaching hospital of The Chinese University of Hong Kong from Jan 2018 to Dec 2019. 46 infertile women with or without recurrent miscarriage (RM) and implantation failure (RIF) were recruited in this study. Endometrium OCT imaging and subsequent biopsy were performed on the seventh day after luteal hormone surge (LH + 7) in natural cycle prior to the consecutive natural conception or embryo transfer (ET) cycle. Participants/materials, setting, methods At least 5 systematic random endometrium OCT images from uterine fundus, body and lower segment of each subject were included for intensity analysis by two independent observers. OCT intensity of each image was classified as low, moderate, high based on optical range and then average OCT intensity in each uterine region was calculated for group comparison. Endometrium glandular epithelial, stromal, endothelial, uNK cells were defined by standard H&E and specific immunostaining for histomorphometry and correlation. Main results and the role of chance OCT intensity significantly correlated with endometrial cell and gland parameters regardless classifications of reproductive failure and implantation outcome. Higher OCT intensity indicated higher stromal cell density, gland to stromal (G/S) ratio and average gland area, but fewer microvessel and uNK cells. None of the endometrium histomorphometry were significantly different among different reproductive failure types and implantation outcomes, suggesting it may not be sensitive enough to detect the abnormal histological features. However, OCT intensity was significantly lower in the uterine fundus and body of RIF group than in that of infertile and RM groups. There was no significant difference of OCT intensity in the lower part of the endometrium among three groups. It indicates that OCT intensity is a sensitive marker to differentiate endometrium with RIF from the endometrium with other conditions and also endometrium with RIF is characterized with less stromal cells and smaller glands. Compared with infertile group with unsuccessful implantation, OCT intensity was higher in all three parts of the uterus from the infertile group with successful implantation, but the results were not statistically different. The results further implied that endometrial cells and gland size may potentially contribute to the endometrium receptivity for implantation. Limitations, reasons for caution Current endometrium OCT imaging depth is within 3mm, change beyond this thickness is inaccessible but still the most important layer for implantation. This is a pilot and small study with lack of normal fertile control. Endometrium OCT imaging in the same natural conception or ET cycle will be more accurate. Wider implications of the findings: OCT imaging could be used as a potential noninvasive modality to evaluate peri-implantation window endometrium. It enables real-time and in-situ visualization of endometrium structure and pathology with no additional biopsy risk and examination delay. Larger clinical trials are needed to confirm its clinical applications and utilities. Trial registration number CREC 2016.160

Mean Platelet Volume Increase in Endometriomas and Benign Ovarian Cysts: A Prospective Case-Controlled Study

Objective: The aim of this research is to compare mean platelet volumes (MPV) among women with ovarian endometriomas, women with benign ovarian cysts and infertile women who were otherwise healthy. Material and Methods: Women were selected for the ovarian endometrioma and benign ovarian cyst group after laparoscopic ovarian cyst excision and confirmed histopathologic evaluation. The control group was assigned from women with male partner infertility or unexplained infertility but who were otherwise healthy. Mean platelet volume calculated as a part of complete blood count, which collected in potassium ethylenediaminetetraacetic acid tubes Results: There were 98 women in the endometrioma group, 94 in the benign cyst group and 99 in the control group. Mean platelet volume was different among the groups (p<0.01). The mean platelet volume in the infertile group was statistically different than in the endometrioma and benign cyst groups and was similar between the endometrioma and benign cyst groups. When compared with the infertile group, the area under the curve and predictive value of the mean platelet volume for the endometrioma and the benign cyst group were 0.73 ±0.03 fl (p<0.01, CI 0.65-0.80) and 0.72±0.06 fl (p<0.01; CI 0.64-0.79), respectively. Mean platelet volume had a sensitivity of 74% and specificity of 63% for endometrioma and sensitivity of 72%, and specificity of 63% for benign cysts at a cut-off point of 9.05 fl. Conclusion: The present study demonstrated that mean platelet volume was increased in women with ovarian endometriomas and benign cysts and showed predictive values for endometriomas and benign ovarian cysts.

Glutathione Content and Glutathione Peroxidase Activity of Sperm in Males with Unexplained Infertility

Summary The study aimed to investigate glutathione peroxidase (GPx) activity and glutathione (GSH) levels in the sperm of patients with unexplained infertility. The sperm samples were collected from subjects with normal semen parameters divided into fertile and infertile groups. Sperm analysis was performed according to the 2010 WHO criteria. Measurement of the GPx activity and GSH were performed by enzymatic assay kits. The higher enzymatic activity recorded in spermatozoa and seminal plasma in the infertile group was close to the significant one – p=0.054 for seminal plasma andp= 0.086 for the spermatozoa.GSH levels were higher in the fertile group in the seminal plasma (p=0.045). Defining the causes of unexplained infertility requires the addition of oxidative stress. In patients with unexplained infertility, the level of glutathione is reduced, and the activity of one of the significant enzyme antioxidants GPx is not changed significantly and even shows a tendency to rise.

Morphological Features of the Secretory Phase Endometrium in Women With Unexplained Infertility

Background: In this study, we evaluated the structural features of the endometrial tissues, the immunohistochemical expression of MUC-1, which plays an important role in implantation, and the biochemical markers during the implantation window. Methods: Randomly chosen 18 fertil and 18 infertil women, that have 27-32 days long menstrual cycle, normal hormonal values, normal USG findings of ovary and endometrium were included. Five, six, and seven days after ovulation, endometrial biopsies were taken and prepared in accordance with light and electron microscopy tissue preparation methods. Immunohistochemical methods were used to determine MUC-1 expression in the tissues. Serum hormone levels were determined. Results: The MUC-1 immunoreactivity, as well as the serum levels of FSH, LH, TSH, estrogen, progesterone, and total testosterone did not differ significantly between the two groups; however, prolactin levels were higher in the infertile group. In the infertile samples intraepithelial lymphocytes were frequently observed, the microvilli of the surface columnar epithelium were widespread, cells with pinopodes as well as vesiculated cells were minimal, pinopode development was insufficient, the development of the endometrial glands was deficient. Conclusions: Considering all these findings, it was concluded that these structural differences observed in the surface and glandular epithelium of the endometrium in infertile patients may be due to the insufficiency of these cells in responding to steroid hormones; therefore, these changes may affect the implantation of the blastocyst in the endometrium.

Comparison of the Quality of Life in Fertile and Infertile Women Admitted to Shiraz’s Healthcare Centers During 2017-2018

Background: Infertility, as an individual and social problem, affects couples’ quality of life and family functioning, job relationships, sexual skills, and marital satisfaction. Objectives: The present study aimed to investigate the relationship between infertility and the quality of life in fertile and infertile women. Methods: In this cross-sectional study with a convenience purposive sampling method, 220 eligible women (110 fertile and 110 infertile) admitted to Shiraz’s healthcare centers were selected. Data collection was conducted using a demographic information questionnaire and the World Health Organization Quality of Life questionnaire. Results: In this study, a total of 220 fertile and infertile women were studied. Our findings showed that the quality of life WHOQOL-BREF score was higher in the fertile group (72.21 ± 12.74) than in the infertile group (69.86 ± 12.58), although not significant. However, the physical area of the quality of life was significantly higher in the fertile group (17.55 ± 3.62) than in the infertile group (16.57 ± 3.55) (P = 0.04). There was no statistically significant difference between the groups concerning other quality of life areas (P > 0.05). Conclusions: The results showed that infertility could reduce the quality of life of infertile women in all areas, and this reduction was significant in the physical area. It appears that infertility diagnostic and therapeutic interventions can affect the quality of life of women in the physical area. Further research is recommended in this field.

Interactions of Cortisol and Prolactin with Other Selected Menstrual Cycle Hormones Affecting the Chances of Conception in Infertile Women

One of the major problems of success in infertility treatment could depend on the understanding how the potential factors may affect the conception. The aim of this study was to evaluate present understanding of such factors or hormonal causes that may induce infertility. We studied the interactions between the two menstrual cycle hormones i.e., cortisol (COR) and prolactin (PRL), along with the ultrasonographic ovulation parameters in a group of N = 205 women with diagnosed infertility. The control group consisted of N = 100 women with confirmed fertility. In both groups, follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), thyroid stimulating hormone (TSH), PRL, COR were examined on the third day of the cycle, and estradiol (E2), progesterone (P), and COR were examined during ovulation and 7-days afterwards. In the infertile group, higher levels of PRL and COR were observed than that of in the control group. Cortisol levels at all phases of the menstrual cycle and PRL negatively correlated with E2 secretion during and after ovulation, thus contributed to the attenuation of the ovulatory LH surge. Infertile women who conceived presented with higher levels of E2 during and after ovulation, higher P after ovulation, and thicker endometrium than that of the women who failed to conceive. In conclusion, elevated secretion of COR and PRL in infertile women impairs the menstrual cycle by decreasing the pre-ovulatory LH peak and E2 and postovulatory E2 levels that affect the endometrial growth, and consequently reduce the chances to conceive.