Relationship Among Traditional Semen Parameters, Sperm DNA Fragmentation, and Unexplained Recurrent Miscarriage: A Systematic Review and Meta-Analysis

Several studies have explored the relationship among traditional semen parameters, sperm DNA fragmentation (SDF), and unexplained recurrent miscarriage (RM); however, the findings remain controversial. Hence, we conducted a meta-analysis to explore the relationship among traditional semen parameters, SDF, and unexplained RM. Multiple databases, including PubMed, Google Scholar, MEDLINE, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI), were searched to identify relevant publications. From the eligible publications, data were extracted independently by two researchers. A total of 280 publications were identified using the search strategy. According to the inclusion/exclusion criteria, 19 publications were eligible. A total of 1182 couples with unexplained RM and 1231 couples without RM were included in this meta-analysis to assess the relationship among traditional semen parameters, SDF, and unexplained RM. Our results showed that couples with unexplained RM had significantly increased levels of SDF and significantly decreased levels of total motility and progressive motility compared with couples without RM, although significant differences were not observed in the semen volume, sperm concentration, and total sperm count between couples with and without RM. The SDF assay may be considered for inclusion in evaluations of couples with unexplained RM.

Effect of Prepregnancy Lymphocyte Active Immunotherapy on Unexplained Recurrent Miscarriage, Pregnancy Success Rate, and Maternal-Infant Outcome

Objective. To evaluate the effect of prepregnancy lymphocyte active immunotherapy on unexplained recurrent miscarriage, pregnancy success rate, and maternal-infant outcome. Methods. A total of 124 patients with recurrent miscarriage admitted to our hospital from January 2018 to December 2020 were selected as the research objects and divided into the experimental group and the control group according to the random number table method, with 62 patients in each group. The experimental group was treated with lymphocyte active immunotherapy, and the control group was given conventional treatment. The pregnancy success rate, estrogen indexes, hemorheology indexes, and psychological state of the two groups were compared. Results. The experimental group garnered a notably higher pregnancy success rate and a prominently lower miscarriage rate than the control group ( P < 0.05 ). Better results of self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were observed in the experimental group, as compared to the control group ( P < 0.05 ). The experimental group yielded more desirable results in terms of treatment satisfaction, estrogen indexes, and hemorheology indexes in comparison with the control group ( P < 0.05 ). Conclusion. The use of lymphocyte active immunotherapy for patients with unexplained recurrent miscarriage can significantly increase the pregnancy success rate, optimize the maternal-infant outcome, drive down the miscarriage rate, and ameliorate the patient’s estrogen levels and hemorheology indicators, which is worthy of promotion and application in clinical practice.

Association of serum progesterone level and endometrial estradiol & progesterone receptors in women with unexplained recurrent miscarriage

This study investigated the endometrial tissue to study the fluctuation of estrogen receptors (ERs) and progesterone receptors (PRs) in women with recurrent miscarriage compared with normal endometrium of fertile women. Forty women were divided into two groups: 20 non-pregnant women with history of recurrent miscarriage (who had three or more first- trimester miscarriages) and 20 controls. Both groups had regular ovulatory menses and proven fertility. Endometrial biopsy was taken in the two groups during the luteal phase of the menstrual cycle, between the 8th and the 10th postovulatory days using an endometrial biopsy curette for determination of estrogen (E2) and progesterone (P4) hormones levels and their receptors. On the same day as the biopsy, a blood sample was taken for determination of estradiol (E2) and progesterone (P4) levels. The obtained results showed no significant differences between both groups regarding age, BMI, menarche, menstrual cycle & menstruation, significant decrease in E2 and P4 levels in the serum and endometrial biopsy of recurrent miscarriage women versus control. In control and recurrent miscarriage; ER levels in cytoplasm and salt extracted nucleus were higher than PR levels. ER and PR values were higher in the nuclear compartment than in the cytoplasmic compartment. The women with early recurrent miscarriage showed lower levels of both ER and PR significantly. All types of endometrial receptors (ER &PR) and hormones (E2 &P4) in serum and endometrium showed correlation relating to number of previous miscarriages.

Relation between Traditional Semen Parameters, Sperm DNA Fragmentation, and Unexplained Recurrent Miscarriage: A Systematic Review and Meta-analysis

Background: Several studies have explored the relation between traditional semen parameters, sperm DNA fragmentation (SDF), and unexplained recurrent miscarriage (RM), but these findings remain controversial. Hence, we conducted this meta-analysis to explore the relation between traditional semen parameters, SDF, and unexplained RM. Methods: Multiple databases including PubMed, Google Scholar, MEDLINE, EMBASE, Cochrane Library, Web of Science databases, and China National Knowledge Infrastructure (CNKI) were searched to identify relevant publications. From the eligible publications, data were extracted independently by two researchers. The heterogeneity between publications was calculated using the I2 statistics and Cochran’s Q test. Statistical analyses were conducted using Stata/SE 12.0 (StataCorp, College Station, Texas, USA). Based on heterogeneity assessment, random- or fixed-effects models were selected to calculate the weighted mean differences (WMDs) and their corresponding 95% confidence intervals (CIs). To estimate the stability of the pooled results, a sensitivity analysis was conducted by excluding each study. To estimate the possible publication bias, Egger’s regression test and Begg’s funnel plot were used. Results: A total of 280 publications were produced using the search strategy. According to the inclusion/exclusion criteria, 19 publications were eligible. A total of 1182 couples with unexplained RM and 1231 couples without RM were included in this meta-analysis to assess the relation between traditional semen parameters, SDF, and unexplained RM. Our results showed that couples with unexplained RM had significantly increased levels of SDF (WMD=8.77, 95% CI=4.03 to 13.51, P<0.001) and significantly decreased levels of progressive motility (WMD=-4.75, 95% CI=-8.35 to -1.15, P<0.05) and total motility (WMD=-10.30, 95% CI=-15.03 to -5.57, P<0.05) than those of couples without RM, but not significantly different in volume (WMD=-0.12, 95% CI=-0.32 to 0.08, P>0.05), sperm concentration (WMD=-2.28, 95% CI=-4.58 to 0.02, P>0.05) and total sperm count (WMD=-10.73, 95% CI=-22.11 to 0.66, P>0.05) between couples with and without RM.Conclusion: Couples with unexplained RM had significantly increased levels of SDF and significantly decreased levels of progressive motility and total motility than those of couples without RM. SDF assay may be considered as part of the evaluation of couples with unexplained RM.