Anti-endometriotic Effects of Ceratonia Siliqua L. Pod on Endometrial Mesenchymal Stromal/stem Cells Isolated from Women with Endometriosis-associated Infertility

This study investigated the effects of carob (Ceratonia siliqua L.) pod extract (CPE) on human endometrial stem cells (ESCs) viability and to examine its impact on mRNA expression of methyltransferase (DNMT-1, DNMT-3A and DNMT-3B), histone deacetylase-1 (HDAC-1), matrix metalloproteinase-2 (MMP-2) and cyclooxygenase-2 (COX-2) in endometriotic patients. The ESCs were derived from endometrium of patients with endometrioma (OMA-ESCs) and deep infiltrative endometriosis samples of 10 women with endometriosis associated infertility (E-ESCs) were compared to the ESCs derived from endometrium of endometriosis free, normal women as control group (C-ESCs). The metabolic activity of control and case groups was evaluated by treating them with different concentrations of CPE. In the E-ESCs, treatment with 0.8 and 2 µg/mL of CPE resulted in downregulation of COX-2 and HDAC-1 compared to the control group (p = 0.02 and p = 0.02, respectively). Treatment with 0.8 µg/mL of CPE decreased MMP-2 and DNMT-3B genes expression (p = 0.02 and p = 0.03, respectively). Furthermore, COX-2 and DNMT-3A genes were significantly upregulated after treatment with 2 µg/mL of CPE. Expression of the COX-2, HDAC-1, DNMT-1, DNMT-3A, and DNMT-3B peptides decreased in E-ESCs, OMA-ESCs and C-ESCs after treatment with 0.8 and 2 µg/mL concentrations of the CPE. The GC analysis of the CPE resulted in 14 compounds with interactions with the target proteins through the docking process. In vitro CPE treatment significantly downregulated cell inflammatory pathway involved in the pathophysiology of endometriosis and may be a potential agent for treatment of endometriosis.

Assessment of The Burden of, and Women’s Experience With Screening For, Maternal Perinatal Depression in Kuwait

Background Perinatal depression can have a devastating impact upon the health and lives of the mothers and their children. Although guidelines are in place to properly screen women for perinatal depression in high income countries, there still is a possibility that some women may be missed. Identifying women with or at high risk of perinatal depression is even more important during COVID-19 pandemic. This study was aimed to measure prevalence and associated factors of perinatal depression, and to understand the women’s experience of screening for perinatal depression in Kuwait. Methods Women who​ ​had recently attended antenatal and postnatal clinics in Kuwait during COVID-19 pandemic were approached through snowball sampling with the help of physicians in Kuwait in a cross-sectional online survey. They answered an online self-administered questionnaire consisting of Edinburgh postnatal depression scale, sociodemographic characteristics, and items about their experience of screening during antenatal and postnatal checkup. Out of the 158 women who answered this questionnaire, 75.3% were in their third trimester of pregnancy and the rest were in the postpartum period. Results Perinatal depression was possible in 31 (19.6%) highly possible in 23 (14.6%), and probable in 52 (32.9%) women in our study, indicating an alarming prevalence of the condition in the sampled population. A large proportion of the sample (66.5%) said that they were not aware of a screening process for perinatal depression, whereas only 5.7% said that they were screened for it. In the sample, 65.1% who were not screened for perinatal depression had perinatal depression (P<0.05). The mean scores for variables representing family support and help were higher among the normal women than with perinatal depression (P<0.001). Similarly, women with perinatal depression had scores towards disagreement when they were asked if they could easily talk about their problems and thoughts with their friends (P<0.01). Conclusions Maternal perinatal depression was high in Kuwaiti women who were either in their third trimester or had just given birth to a baby. The lack of awareness about the screening process and extremely low levels of screening for perinatal depression indicates the need to improve these women’s access to adequate screening services during and after pregnancy.

Pregnancy and perinatal outcomes in women with polycystic ovarian syndrome

Background: To study the pregnancy and perinatal outcomes in women with PCOS with normal women and to study the incidence of complications like menstrual irregularities, mode of conception, gestational diabetes mellitus, pre eclampsia, preterm labour and NICU admissions in women with PCOS.Methods: It was prospective comparatives study done in 100 women to compare outcome in pregnancy with PCOS and normal women. A detailed history, general and obstetric examination, antenatal investigations, routine dating scan, glucose challenge test at 24 to 28 weeks in study and control groups, blood pressure recording and urine for proteinuria after 20 weeks to evaluate preeclampsia. After delivery, birth weight and APGAR score at 1 and 5 minutes were recorded. Body mass index was calculated and pregnancy outcome studied and compared.Results: Out of 50 women with PCOS 13 developed GDM, 10 developed pre eclampsia, 6 had abortion, 4 went into preterm labour. 15 babies required NICU admission.Conclusions: Pregnancy complications like GDM, pre eclampsia, preterm labour, abortions and neonatal complications like NICU admissions are higher in women with PCOS when compared with normal women. Hence PCOS needs to be diagnosed early and treated accordingly to prevent pregnancy complications.

Characterisation of peri-implantation endometrial Treg and identification of an altered phenotype in recurrent pregnancy loss

Recurrent Pregnancy Loss (RPL) affects 2–4% of couples, and with increasing numbers of pregnancy losses the risk of miscarrying a euploid pregnancy is increased, suggesting RPL is a pathology distinct from sporadic miscarriage that is due largely to lethal embryonic aneuploidy. There are a number of conditions associated with RPL including unspecified “immune” pathologies; one of the strongest candidates for dysregulation remains T regulatory cells as depletion in the very early stages of pregnancy in mice leads to pregnancy loss. Human endometrial Treg and conventional CD4T cells were isolated during the peri-implantation period of the menstrual cycle in normal women. We identified an endometrial Treg transcriptomic signature and validated an enhanced regulatory phenotype compared to peripheral blood Treg. Parous women had an altered endometrial Treg transcriptome compared to nulliparity, indicating acquired immune memory of pregnancy within the Treg population, by comparison endometrial conventional CD4T cells were not altered. We compared primary and secondary RPL to nulliparous or parous controls respectively. Both RPL subgroups displayed differentially expressed Treg gene transcriptomes compared to controls. We found increased cell surface S1PR1 and decreased TIGIT protein expression by Treg in primary RPL, confirming the presence of altered Treg in the peri-implantation RPL endometrium.

Reproductive tract microbiota of women in childbearing age shifts upon gynecological infections and menstrual cycle

Background This study was undertaken to discover whether the vaginal microbe of women at childbearing age is different among groups defined by urogenital tract infections, childbearing history and menstrual cycle, respectively. Results This was a multiple case-control study of women at childbearing age who were assigned to case or control groups according to their states of urogenital tract infections. The participants were also grouped by childbearing history and menstrual cycle. Vaginal swabs were collected and stored at − 70 °C until assayed. The V3-V4 region of 16S rRNA gene was amplified using PCR and sequenced on the Illumina MiSeq platform. We tested the hypothesis of whether the relative abundance of microbial species in vaginal microbiota was varied with urogenital tract infections, childbearing history and menstrual cycle. The vaginal microbial richness (Alpha diversity measured by PD_whole tree) was decreased in normal women (without reproductive tract infections) than in those with bacterial vaginosis (BV), and decreased in pregnant women than in other groups of non-pregnancy. Similarly, women from groups of normal and in pregnancy had lower beta diversity on measure of unweighted_unifrac distance in comparison to those of infected and non-pregnant. The top 10 genus relative abundance, especially Lactobacillus, which was the most dominant genus with the relative abundance of 71.55% among all samples, did not differ significantly between groups of childbearing history and menstrual cycle analyzed by ANOVA and nonparametric kruskal_wallis. Lactobacillus iners and Lactobacillus helveticus have the most abundance, totally account for 97.92% relative abundance of genus Lactobacillus. We also found that a higher L.helveticus/L.iners ratio is more likely to present in normal women than in the infected and in pregnant than in non-pregnant, although these comparisons lack statistical significance. Conclusions The relative abundance of dominant bacterial taxa in vaginal microbial communities of women at childbearing age were not different among groups of childbearing history and menstrual cycle. Women from groups of in pregnancy and without reproductive tract infections had lower alpha and beta diversity. The composition of the main lactobacillus species may shift upon phases of a menstrual cycle and the status of reproductive tract infections.

Genetic Variation of Glutathione S-Transferase M1 Is Associated with Patients with Ovarian Endometriosis and Endometriosis-Related Primary Infertility

<b><i>Background:</i></b> The aim of the study was to investigate the role of the genetic variation of glutathione S-transferase M1 (<i>GSTM1</i>) in the development of ovarian endometriosis and endometriosis-related primary infertility risk. <b><i>Methods:</i></b> This case-control study included 564 women with ovarian endometriosis and 576 normal women in the control group in northern China. The polymorphism of GSTM1 was genotyped by polymerase chain reaction (PCR)/ligase detection reaction method. To assess the biological significance of polymorphisms, the level of GSTM1 mRNA expression in patients’ endometrial tissues with different genotypes was detected by quantitative real-time PCR (qRT-PCR). <b><i>Results:</i></b> Compared with the positive genotype, the null genotype of <i>GSTM1</i> was associated with the risk of developing ovarian endometriosis (OR = 1.29, 95% CI = 1.02–1.62). Further analysis showed that patients with a null genotype also had a significantly higher risk of primary infertility than patients with positive genotypes (OR = 1.59, 95% CI = 1.01–2.49). In addition, we found that <i>GSTM1</i> mRNA expression was present in the endometrial tissue of all patients, but the expression level of patients with a positive genotype was nearly 10 times higher than that of patients with a negative genotype. <b><i>Conclusion:</i></b> Our results suggest that the <i>GSTM1</i> polymorphism is not only related to the genetic susceptibility to ovarian endometriosis but also a potential molecular marker of primary infertility in patients with ovarian endometriosis.

A Successful ART Treatment of Advanced Maternal Age Pregnancy with HRT Along with Donor Oocytes: A Case Study at Wardha Test Tube Baby Centre

Introduction: This case report refers to 54 years old infertile woman who visit ACHARYA VINOBABHAVE RURAL HOSPITAL for her ARTHRITIS PROBLEM with her husband (age 61-year-old). During her treatment, she got to know about IVF/ART procedures. As she belongs to a rural area and is not so educated, she was not aware of this and start investigating it and found it interesting. After knowing about all these procedures, a new ray of hope was awakened in her that, she can also give birth to her baby after so much waiting and facing so much criticism by society as a barren woman. In the 36th week of gestation, one healthy baby girl has been delivered by Cesarean section. In this way, the faith between patient and doctor was built-up and inevitably, we can appreciate this case of postmenopausal gestation (Geriatric Pregnancy) As A Therapeutic Victory For Wardha Test Tube Baby Centre and for the patient as well. This infertile couple was not that financially strong and even this all procedure is too much unaffordable to them still after all these, their urge to having a baby is so high that, they invest financially as well as emotionally and also mother put her health in peril while going through IVF/ART procedure. Being an infertile woman, she has to face a lot, and in such conditions, women go through psychological torture, and from this depressive phase, many health issues arise. Main Symptoms and/or Important Clinical Findings: Menopausal woman, qualitative analysis of AMH show 0 ng/ml, means diminished ovarian reserve (DOR). The Main Diagnoses, Therapeutic Interventions, and Outcomes: The woman is pinpointed with primary infertility for 26 years. The couple suggested going for IVF/ICSI treatment with donor oocytes(frozen) and self-sperm sample, ICSI is performed and sequential embryo transfer is done and gets conceived in the first cycle of ART. As being a menopausal woman, the dose of oral intake of estrogen hormone tablets doubles as an HRT treatment. Conclusion: Intake of the double dose of estrogen orally (hormone replacement therapy, HRT) than the normal women whose age is not much and who is not menopausal, increases the endometrium thickness and its receptivity which helps the woman to conceive in the first cycle through ART.

A Critical Analysis of Vitamin D and Calcium in Women during Pregnancy

Aim: To find out the frequency of vitamin D and calcium in pregnant women and their effects on fetus as well as mothers. Study Design: Retrospective study. Place and Duration of Study: Darul Shifa Clinic & Maternity Home Karachi Pakistan from 1st July 2020 to 31st December 2020. Methodology: One hundred and twenty patients with proper evidence of pregnancy were enrolled. All patients from age 18 years to age 35 years with no other disease were included and those women who have some other diseases or age outliers were excluded. Results: There is a significance difference in the vitamin D and calcium during the period of pregnancy. In the group A (18 years to 25 years) the significance difference of vitamin D was (P=0.000) while the calcium was (P=0.200). In the group B (26 years to 30 years) the significance difference of vitamin D was (P=0.000) while the Calcium was (P=0.071) and in the group C (30 years to 35 years) there was no significant change of vitamin D and calcium (P=0.000). The result of group C is different from the results of the above two groups, because in this age majority of the women were living in a congested houses as well as were spending a depressive life due to home problems, husband wife compromise problems, children problems, financial problems etc. and all such problems have a direct impact on their pregnancy Conclusion: It was statistically found that the Vitamin D and calcium values show significances changes during pregnancy in contrast to the normal women. Key words: Vitamin D, Calcium, Pregnant women

To Compare the Frequency of Chlamydial Infection in Infertile Women Compared to Normal Women

Background: A better understanding of the role of persistent C. trachomatis infections in tubal factor subfertility may be useful in optimizing the fertility work-up by incorporating screening tests for persistent C. trachomatis infections. The aim is to accurately estimate the risk of persistence and identify those women who are at highest risk of tubal pathology. Aim: To compare the frequency of chlamydial infection in infertile women compared to normal women. Study Design: Case control study. Settings: Department of Obstetrics & Gynecology, Hospital, Bahawalpur. Study duration: 1st October 2019 to 31st March 2020. Methods: A total of 88 women (44 infertile and 44 normal), having normal semen analysis report, of age ranging from 18 to 40 years were included. Patients with polycystic ovarian disease, hyperprolactinemia, & hypothyroidism were excluded. Blood sample of all women in both groups was sent to the institutional pathology laboratory for presence or absence of chlamydial infection. Results: The mean age of women in case group was 27.80 ± 3.60 years and in control group was 28.05 ± 3.69 years. The mean duration of marriage in case group was 4.93 ± 1.66 years and in control group was 4.95 ± 1.68 years. The mean BMI in case group was 29.36 ± 2.52 kg/m2 and in control group was 29.50 ± 2.51 kg/m2. My study reveals the frequency of chlamydial infection in infertile women was seen in 15 (34.09%) women as compared to 05 (9.09%) in normal women which has shown p-value of 0.007 and odds ratio of 5.17 which is significant. Conclusion: This study concluded that frequency of chlamydial infection in infertile women is higher compared to normal women. Keywords: Infertility, chlamydial infection, tubal factor, sexually transmitted diseases

Azole Antifungal Resistance in Candida albicans and Candida glabrata Isolated from Vulvovaginal Candidiasis Patients

Background: Vulvovaginal candidiasis (VVC) is the most frequent fungal disorder in healthy and normal women. Objectives: The aim of this study was to evaluate the in vitro antifungal susceptibility of clinical isolates Candida albicans and Candida glabrata, the two most common candida species in Iranian patients with VVC. Methods: One hundred and eight clinical isolates of candida, including; C. albicans (n = 77) and C. glabrata: (n = 31) were isolated from the 108 patients with VVC. The in vitro activity of caspofungin (CAS), amphotericin B (AMB), voriconazole (VRC), itraconazole (ITC), fluconazole (FLC), and nystatin (NYS) were determined according to the CLSI M27-A3 and CLSI M27-S4. Results: Our results were shown 8 (25.8 %) and 6 (7.8 %) C. glabrata and C. albicans isolates resistance to FLU, respectively. Furthermore, resistance to VRC and ITC were observed in 8.4%, and 3.7% of all isolates, and six isolates (5.6%) had intermediate MIC to CAS. Conclusions: We reported 8 (25.8 %) and 6 (7.8 %) C. glabrata and C. albicans isolates resistance to FLU, respectively. Furthermore, resistance to VRC and ITC were observed in 8.4% and 3.7% of all isolates, respectively.