Evaluation of methylenetetrahydrofolate reductase and s-adenosyl-methionine level in male infertility: A case-control study

Background

Methylenetetrahydrofolate reductase enzyme (MTHFR) plays a key role in regulating folate balance, converting homocysteine to methionine, and producing s-adenosylmethionine (SAM) that plays a role in the methylation process.

Objective

This study aimed to determine MTHFR activity and SAM level in men with normozoospermia and oligozoospermia.

Materials and Methods

30 oligozoospermic and 30 normozoospermic men as controls were enrolled in this case-control study. Semen analysis was conducted according to the world health organization criteria. All semen samples were collected after 3-5 days of sexual abstinence. The sperms were evaluated by sperm test video software. All subjects SAM level was measured by enzyme-linked immunosorbent assay kit, and MTHFR were measured manually.

Results

2 groups had a significant difference in sperm morphology (p = 0.02), concentration (p = 0.02) and motility (p = 0.03). The MTHFR activity in normozoospermic and oligozoospermic groups had significantly differences (p = 0.01). The level of SAM in the semen of oligozoospermic men was statistically lower than normozoospermic men (p = 0.03). Also, there was a positive association between MTHFR enzyme activity and SAM level in the normozoospermia group (p = 0.02, β = 0.67) and oligozoospermia group (p = 0.03, β = 0.54).

Conclusion

MTHFR activity and SAM concentration were statistically lower in oligozoospermia men. It seems they can affect sperm concentration, morphology, and motility.

Knowledge and Attitude of Infertile People toward Assisted Reproductive Techniques in Hamadan, Iran

Background: People's knowledge and attitude play a role in deciding whether or not to use assisted reproductive procedures (ART). There is no information about people's attitudes and awareness about ART in western Iran. Thus, this study was performed to determine the knowledge and attitude of infertile people toward ART.

Methods: This cross-sectional study was performed on 124 infertile participants who referred to the in vitro fertilization section of Fatemieh hospital, Hamadan, Iran. To measure the knowledge and attitude of the participants, 2 researcher-made questionnaires were used. Their validity and reliability were confirmed by content validity (eg, content validity index [CVI]; content validity ratio [CVR] ) and the Cronbach alpha, respectively.

Results: The study involved 124 participants, more than half of whom were women (54.8%). The mean of the CVI and the CVR for the attitude questionnaire was 0.76 and 0.79, respectively, and for the knowledge, questionnaire was 0.72 and 0.71, respectively. The Cronbach alpha coefficient obtained for the attitude and knowledge questionnaires was 0.761 and 0.745, respectively. The mean (SD) of the attitude and knowledge of infertile people toward the use of ART was 15.33 ± 2.91 and 9.04 ± 2.92, respectively. The study reported that participants’ age, inhabitation, and job status had a significant effect on their attitude score. Also, the study found that the knowledge score was inversely related to age. The knowledge in those who were unemployed and living in the rural and less than those employed and living in urban areas, respectively.

Conclusion: The 2 questionnaires designed in this study (knowledge and attitude) have the required validity and reliability. As a result, it appears that increasing people's knowledge and improving their attitude, particularly among the elderly, is necessary.

ADAMTS proteoglycanases downregulation with impaired oocyte quality in PCOS

OBJECTIVE

A disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4) and ADAMTS-5 normal expression levels are essential for ovulation and subsequent fertilization. The objective of the present study was to assess expression pattern of these genes in cumulus cells (CCs) taken from patients with polycystic ovary syndrome (PCOS) and to investigate any possible relationship with the oocyte quality.

METHODS

ADAMTS-4 and -5 expression levels within CCs containing oocytes at the metaphase II (MII) and germinal vesicle (GV) stages, taken from 35 patients with PCOS and 35 women with normal ovarian function, were investigated using RT-qPCR. Moreover, possible correlations between ADAMTS-4, ADAMTS-5, and progesterone receptors (PRs) expression as well as oocyte quality were evaluated.

RESULTS

ADAMTS-4 and -5 expression levels were dramatically diminished in the CCs of the PCOS patients when compared to the controls. ADAMTS-4 and -5 expression levels were correlated with each other and with the oocyte quality. Furthermore, lower expression levels of ADAMTS-4 and -5 in the PCOS patients were strongly correlated with the diminished PRs expression levels.

CONCLUSION

Downregulation of ADAMTS-4 and -5 in the human CCs of the PCOS patients correlated with the decline in the PRs expression, and impaired oocyte quality may cause lower oocyte recovery, maturation, and fertilization rate.

Comparison of pregnancy outcome in intrauterine insemination-candidate women with and without endometrial scratch injury: An RCT

Background

Endometrial scratch injury is considered controversial in increasing the success rate of assisted reproductive technology.

Objective

To compare the pregnancy outcomes in women undergoing intrauterine insemination with and without an endometrial scratch.

Materials and Methods

In this randomized clinical trial, 150 women referred to the Fatemieh Hospital, Hamadan, Iran who were candidates for IUI between December 2017 and December 2018 were randomly assigned into two groups (n = 75/each) with or without an endometrial scratch (as case and control groups, respectively). Women in both groups were in proper and identical protocol for IUI. Chemical and clinical pregnancies, abortion, and live birth rate, also pregnancy complications were compared between the groups.

Results

Chemical and clinical pregnancy rates were higher in the case than the control group (p = 0.25, p = 0.54, respectively). In the case group, the abortion and multiple gestation rates were 14.3% and 4.3%, respectively, while it was 5% in the control group (p = 0.60, p = 0.54 respectively). The endometrium thickness on day 21 was higher in the case group than the control (p = 0.01).

Conclusion

Endometrial scratching in intrauterine insemination women is not associated with an increase in both clinical and clinical pregnancy rates, however, studies with a larger sample size are recommended to evaluate this intervention.

Effects of adipose- derived stromal vascular fraction on asherman syndrome model

Asherman's syndrome (AS) is an endometrial damage that results in infertility in women. Although stem cell therapy has been introduced as a potential treatment for this syndrome, its use in clinical settings remains challenging because of the likelihood of contamination and cell differentiation. Herein, we investigated the effects of adipose-derived stromal vascular fraction (SVF) transplantation on proliferation and angiogenesis in the endometrium in an AS model. The AS model was induced using scratch method in adult male Wistar rats, and SVF (5 × 10 (Simsir et al., 2019) cells) was locally administered into the damaged horns. Two weeks after cell transplantation, endometrial thickness, fibrosis, and expression of vascular endothelial growth factor (VEGF) were assessed by Hematoxylin & Eosin, Masson's trichrome, and immunofluorescence staining, respectively. We found thin endometrium, increased fibrosis, and decreased VEGF following AS induction all of which were reversed after SVF transplantation. We concluded that the local injection of SVF may serve as an effective alternative therapy for AS.

Effect of Mindfulness-Based Group Counseling on Depression in Infertile Women: Randomized Clinical Trial Study

BACKGROUND

Assisted reproductive technologies (ARTs) such as in vitro fertilization (IVF) can lead to depressive symptoms in infertile women due to their low success and high costs. Mindfulness-based group counseling can decrease depressive symptoms by increasing mental concentration. The aim of the present study was to evaluate the effect of mindfulness-based group counseling on depression in infertile women undergoing IVF.

MATERIALS AND METHODS

The present clinical trial included 90 infertile women undergoing IVF treatment in an infertility center in 2016. Women were divided into two groups, intervention and control. Both groups completed a demographic questionnaire and the Beck depression inventory (BDI). Eight 90-minute sessions (two each week) of mindfulness-based group counseling were held with the intervention group, while the control group received treatment as normal. Following the intervention, the BDI was again completed by both groups. The data were analyzed and independent t tests and, paired t tests conducted at a significance level of P<0.05.

RESULTS

No statistically significant demographic differences were observed between the two groups. Women in the control group had a somewhat lower depressive symptom score than the intervention group before the intervention. However, compared with before, the depressive symptom score among women in the intervention group decreased significantly (48%) (P<0.001) after the intervention. In contrast, the depressive symptom score in control women was higher after the intervention than before.

CONCLUSION

According to the findings of the present research, mindfulness-based group counseling is able to reduce depressive symptoms in infertile women under IVF treatment. Therefore, group counseling sessions are suggested for all depressed women undergoing infertility treatment (Registration number: IRCT2015082013405N14).

A comparison of in vitro fertilization-embryo transfer outcome by two types of soft embryo transfer catheters

Introduction: One of the remaining challenges in assisted reproductive procedures, especially in vitro fertilization (IVF), is proper embryo transfer. The aim of this clinical trial was to compare IVFembryo transfer outcome by two types of soft embryo transfer catheters in Hamadan Endometrics and Endometriosis Research Center (Iran). Methods: In this clinical trial study, 100 patients who were candidates for IVF were evaluated. Patients were randomly assigned into two groups (A=50 and B=50). The IVF was identical for both groups until the embryo transfer stage. For group A, soft catheter CH3 PM TRANS SET MINI was used and in group B, KITAZATO soft catheter was used for embryo transfer. All transfers were performed by one person. Patients were recruited using checklists, demographic information, infertility history, beta-human chorionic gonadotropin (ß-hCG) serum levels at day 14 post-transfer, and pregnancy bag 28 days after transfer. The results were analyzed by SPSS software version 16 and using descriptive statistics, chi-square and t-test. The significance level was < 0.05. Results: The mean age of group A and group B was 30.12 and 29.24 years, respectively (p=0.341). The mean duration of infertility in both groups was not statistically significant, and in groups A and B were 4.89 and 4 years, respectively. Ninety % of group A experienced their first IVF experience, while in group B it was slightly lower than 86%, which was not statistically significant. The mean number of eggs obtained in group A was 9.84 and in the group B was 9.88 (p=0.962). The mean number of embryos formed in group A was 6.24 and in group B was 5.72 (p=0.405). There was no statistically significant difference between the two groups in using of Tenaculum, the quality of transmission, and the contamination of the catheter head into the blood or mucus. Conclusion: According to the findings of the present study, the use of KITAZATO catheter compared to PM TRANS SET MINI CH3 catheter for fetal transfer in IVF patients showed no significant difference in pregnancy success rate. However, patients who received the KITAZATO catheter had a slightly higher chance of pregnancy that could be clinically valuable.  

Success Rates of Vaginal Sonography and Hysteroscopy for Diagnosis of Intrauterine Pathologies in Female Infertility

Background and Aim: Uterine anatomical pathologies play important roles in causing female infertility. This study was conducted to survey the efficiency of hysteroscopy and vaginal sonography in detecting the intrauterine pathologies in infertile women. Methods: This cross-sectional study was conducted on all the infertile women referring to the Endometriosis Research Center between December 22, 2013 and August 22, 2015. Forty five women were recruited and the data on the examinations of uterine lesions were analyzed by transvaginal sonography (TVS), hysteroscopy, and pathology as the standard test. Data analysis was conducted by SPSSv16 using t-test and Mann-Whitney test, and the sensitivity and specificity were measured with reference to the standard test. Findings: For diagnosing polyp, endometrial hyperplasia, and myoma, TVS showed the 75%, 25%, and 85.71% sensitivity, respectively, and specificity of 92.30%, 92.30%, and 56.97% respectively. For them, hysteroscopy showed the 60%, 75%, and 75.71% sensitivity respectively, and specificity of 71.65%, 30.92%, and 56.97% respectively. Conclusion: According to the findings of this study, the sensitivity of TVS and hysteroscopic findings in diagnosing uterine pathologies is relatively high, but the sensitivity of TVS was low to diagnosis of endometrial hyperplasia.

Abnormal expressions of ADAMTS-1, ADAMTS-9 and progesterone receptors are associated with lower oocyte maturation in women with polycystic ovary syndrome

PURPOSE

ADAMTS-1 and 9 play a crucial role in the ovulation and their altered levels may play a role in the pathogenesis of polycystic ovary syndrome (PCOS). The aim of this study was to assess ADAMTS-1 and 9 expression and their correlation with the oocyte quality and maturity in the cumulus cells (CCs) of PCOS patients and normovulatory women during an IVF procedure.

METHODS

Expression of ADAMTS-1 and 9 and progesterone receptors (PRs) in the CCs containing MII and germinal vesicle (GV) oocytes of 37 PCOS patients and 37 women with normal ovulatory function who underwent IVF treatment was evaluated using qRT-PCR. Moreover, correlation between ADAMTS-1 and 9 expression and oocyte quality were also investigated.

RESULTS

mRNA expression levels of ADAMTS-1 and ADAMTS-9 were significantly reduced in the women with PCOS compared to the normovulatory women. ADAMTS-1 and ADAMTS-9 mRNA expression levels in the CCs showed a considerable correlation. Lower expression levels of ADAMTS-1 and ADAMTS-9 in PCOS patients were strongly correlated with diminished oocyte maturation. There was a remarkable association between ADAMTS-1 and ADAMTS-9 mRNA expression levels and oocyte quality. PRs (PRA and PRB) were dramatically decreased in PCOS patients when compared with the control group.

CONCLUSIONS

The results of the present study indicated that ADAMTS-1 and ADAMTS-9 as well as PRs are downregulated in the human CCs in PCOS patients, which could be associated with impaired oocyte maturation and may result in a lower oocyte recovery and oocyte maturity rates, as well as lower fertilization rate.

Evaluation of pro-oxidant-antioxidant balance (PAB) and its association with inflammatory cytokines in polycystic ovary syndrome (PCOS)

Chronic low-grade inflammation has been suggested as a key contributor of the pathogenesis and development of polycystic ovary syndrome (PCOS). To investigate the association between oxidative stress status and inflammatory cytokines in follicular fluid of 21 PCOS women compared to 21 women with normal ovarian function who underwent intra-cytoplasmic sperm injection. Concentration of IL-6, IL-8, IL-10, and TNF-α was measured using sandwich ELISA. Oxidative stress was examined by measuring total oxidant status (TOS), malondialdehyde (MDA), total antioxidant capacity (TAC), and thiol groups. PCOS women had an elevated concentration of MDA and TOS compared to controls. Levels of TAC and thiol groups were lower in PCOS compared to controls. PCOS patients had a higher concentration of IL-6, IL-8, and TNF-α compared to controls. Concentration of IL-10 was lower in PCOS compared to controls. Significant correlations were found between MDA and TOS concentration with TNF-α and between IL-6 and MDA, IL-8 and TAC, IL-10 and TOS levels and also between IL-10 and TAC levels. TAC and thiol groups were negatively correlated with TNF-α. Increased oxidative stress in PCOS is associated with inflammation which is closely linked. Inflammation can induce production of inflammatory cytokines in this syndrome and directly stimulates excess ovarian androgen production.

A two-component Bayesian mixture model to identify implausible gestational age

Background: Birth weight and gestational age are two important variables in obstetric research. The primary measure of gestational age is based on a mother's recall of her last menstrual period. This recall may cause random or systematic errors. Therefore, the objective of this study is to utilize Bayesian mixture model in order to identify implausible gestational age. Methods: In this cross-sectional study, medical documents of 502 preterm infants born and hospitalized in Hamadan Fatemieh Hospital from 2009 to 2013 were gathered. Preterm infants were classified to less than 28 weeks and 28 to 31 weeks. A two-component Bayesian mixture model was utilized to identify implausible gestational age; the first component shows the probability of correct and the second one shows the probability of incorrect classification of gestational ages. The data were analyzed through OpenBUGS 3.2.2 and 'coda' package of R 3.1.1. Results: The mean (SD) of the second component of less than 28 weeks and 28 to 31 weeks were 1179 (0.0123) and 1620 (0.0074), respectively. These values were larger than the mean of the first component for both groups which were 815.9 (0.0123) and 1061 (0.0074), respectively. Conclusion: Errors occurred in recording the gestational ages of these two groups of preterm infants included recording the gestational age less than the actual value at birth. Therefore, developing scientific methods to correct these errors is essential to providing desirable health services and adjusting accurate health indicators.

Evidence for decreased expression of APPL1 associated with reduced insulin and adiponectin receptors expression in PCOS patients

PURPOSE

To investigate the expression of Adaptor protein containing a PH domain, PTB domain and leucine zipper motif 1 (APPL1), insulin receptor (INSR), adiponectin and adiponectin receptors (adipoR1 and R2) and their possible associations in granulosa cells (GCs) of 22 polycystic ovary syndrome (PCOS) women compared to the 22 non-PCOS controls with normal ovulatory function matched for BMI (body mass index).

METHODS

In this study, 44 infertile women aged 18-40 years undergoing in vitro fertilization (IVF) protocol were recruited. After follicular fluid collection, GCs were isolated and then purified with MACS (Micro Beads conjugated to monoclonal anti-human CD45 antibodies). RNA was extracted from GCs and quantitative real-time PCR (qRT-PCR) was performed to assess APPL1 gene expression.

RESULTS

Expression of APPL1, insulin receptor and adiponectin system genes was significantly decreased in PCOS group compared to the controls.

CONCLUSIONS

Reduction of APPL1, insulin receptor and adiponectin system genes in GCs could be involved in the development of PCOS.

Downregulation of adiponectin system in granulosa cells and low levels of HMW adiponectin in PCOS

PURPOSE

The purpose of the study was to investigate changes in adiponectin system expression in granulosa cells (GCs) and high molecular weight adiponectin levels in serum and follicular fluid (FF) of 40 women with polycystic ovary syndrome (PCOS) compared to those in 40 women with normal ovary function.

METHODS

Adiponectin (Adipo), adiponectin receptor 1 (AdipoR1), and adiponectin receptor 2 (AdipoR2) messenger RNA (mRNA) expression levels were measured using quantitative real-time polymerase chain reaction (qRT-PCR). High molecular weight (HMW) adiponectin protein concentration was evaluated by ELISA method. Data were analyzed using Student's t test and one-way ANOVA in SPSS 21 software. At oocyte retrieval, FF was aspirated and GCs were obtained from a pooled collection of FF per each patient.

RESULTS

PCR results showed expression of adiponectin, AdipoR1, AdipoR2, follicle-stimulating hormone receptor (FSHR), and luteinizing hormone receptor (LHR) in GCs. After controlling body mass index (BMI) values, qRT-PCR demonstrated a decreased expression of adiponectin system in GCs of PCOS patients compared to those in controls (p = 0.001). There was a strong positive correlation among AdipoR1 and AdipoR2 expression and also among FSH and LH receptor expression. (Both r = 0.8, p = 0.001). There were low levels of high molecular weight adiponectin in the serum of PCOS patients with controlled ovarian hyperstimulation (30.19 ± 4.3 ng/ml) compared to the controls (48.47 ± 5.9 ng/ml) and in the FF of PCOS patients with controlled ovarian hyperstimulation (7.86 ± 1.44 ng/ml) compared to the controls (14.22 ± 2.01 ng/ml; p = 0.02).

CONCLUSIONS

Lower expression of adiponectin and its receptors in GCs might be an important manifestation in gonadotropin-stimulated PCOS patients which could influence the physiologic adiponectin roles such as interaction with insulin and LH in induction of GC gene expression.

An epidemiologic survey on the causes of infertility in patients referred to infertility center in Fatemieh Hospital in Hamadan

BACKGROUND

Infertility is considered as a major health care problem of different communities. The high prevalence of this issue doubled its importance. A significant proportion of infertility have been related to environmental conditions and also acquired risk factors. Different environmental conditions emphasized the need to study the different causes of infertility in each area.

OBJECTIVE

The aim of this study was to determine the frequency causes of infertility in infertile couples.

MATERIALS AND METHODS

In this cross sectional descriptive study 1200 infertile men and women that were referred to infertility clinic of Fatemieh Hospital during 2010 to 2011, were examined. This center is the only governmental center for infertility in Hamadan. Sampling was based on census method. Information about the patients was obtained from medical examinations and laboratory findings. To analyze the data, descriptive statistics such as frequencies and the mean were used.

RESULTS

The prevalence of primary and secondary infertility was 69.5% and 30.5% respectively. Among the various causes of infertility women factors (88.6%) had the highest regard. In the causes of female infertility, menstrual disorders, diseases (obesity, thyroid diseases, and diabetes), ovulation dysfunction, uterine factor, fallopian tubes and cervical factor had the highest prevalence respectively. The causes of male infertility based on their frequency included semen fluid abnormalities, genetic factors, vascular abnormalities, and anti-spermatogenesis factors, respectively.

CONCLUSION

Etiology pattern of infertility in our study is similar with the many other patterns that have been reported by the World Health Organization. However, frequency of menstrual disorders is much higher than other studies that require further consideration.

Out of pocket payment for obstetrical complications: a cost analysis study in iran

BACKGROUND

This study was conducted to determine the total expenditure and out of pocket payment on pregnancy complications in Tehran, the capital of Iran.

METHODS

A cross-sectional study conducted on 1172 patients who admitted in two general teaching referral Hospitals in Tehran. In this study, we calculated total and out of pocket inpatient costs for seven pregnancy complications including preeclampsia, intrauterine growth restriction (IUGR), abortion, ante-partum hemorrhage, preterm delivery, premature rupture of membranes and post-dated pregnancy. We used descriptive analysis and analysis of variance test to compare these pregnancy complications.

RESULTS

The average duration of hospitalization was 3.28 days and the number of visits by physicians for a patient was 9.79 on average. The average total cost for these pregnancy complications was 735.22 Unites States Dollars (USD) (standard deviation [SD] = 650.53). The average out of packet share was 277.08 USD (SD = 350.74), which was 37.69% of total expenditure. IUGR with payment of 398.76 USD (SD = 418.54) (52.06% of total expenditure) had the greatest amount of out of pocket expenditure in all complications. While, abortion had the minimum out of pocket amount that was 148.77 USD (SD = 244.05).

CONCLUSIONS

Obstetrics complications had no catastrophic effect on families, but IUGR cost was about 30% of monthly household non-food costs in Tehran so more financial protection plans and insurances are recommended for these patients.

Effect of Iranian Ministry of Health protocols on cesarean section rate: a quasi-experimental study

BACKGROUND

High Cesarean section rate is a major health problem in developing countries. This study was established to evaluate the effectiveness of Iranian Ministry of Health and Medical Education protocols on Cesarean section rate trend.

METHODS

Through a non-concurrent controlled quasi-experimental study, Cesarean section rate in Shohada-e-Tajrish and Taleghani hospitals in Tehran was compared during 2008-2009. Intervention group included 578 participants hospitalized because of premature rupture of membranes, prolonged pregnancy, pre-eclampsia, intra-uterine growth retardation, vaginal bleeding and premature labor in first and second trimester underwent interventions based on MOHME new protocol. On the other hand 594 cases as control group were selected during the same time before the intervention and underwent routine treatments. Descriptive statics, t-test, chi square and univariate analysis were used when appropriate.

RESULTS

Basic characteristics in two groups had no statistically significant difference. Cesarean section applied for 360 (67.8%) women in case group and on the other hand, 270 (48.8%) Cesarean sections were done for control group (P<0.001). There was 19 % difference between intervention and control groups. Complication of pregnancies had increased by 6% in intervention group (P<0.001). Mortality rate in the study was zero in both groups.

CONCLUSION

Applying clinical practice guidelines does not guarantee decreasing Cesarean section rate. Providing appropriate service may increase the ability of service providers to find more indications for Cesarean section.

Does Ramadan fasting has any effects on menstrual cycles?

 

BACKGROUND

During the month of Ramadan, millions of Muslims abstain from food and drink daily from dawn to sunset and people actually experience repeated cycles of fasting and refeeding. Menstruation is a normal physiological process that its regularity is controlled by hypothalamic-pituitary-ovarian axis. Etiology of menstrual dysfunction includes weight loss, hypoleptinemia, abnormal eating behaviors, exercise, and psychological stressors.

OBJECTIVE

To investigate the effects of Ramadan fasting on menstrual cycles.

MATERIALS AND METHODS

This analytic cross-sectional study was performed on 80 female college students resident in a dormitory of Hamedan University of Medical Sciences. A questionnaire including demographic characteristics and menstrual calendar was filled by all participants. All analyses were performed using the statistical software SPSS for Windows version 11.5.

RESULTS

We found 11.3%, 30%, and 16.3% of participates had abnormal menstrual pattern three months before, during and three months after Ramadan, respectively. In participates who fast more than 15 days, menstrual period had significantly more abnormality than participants who fast less than 15 days. Considering our results we demonstrated that menstrual abnormalities during Ramadan month reach to their peak and three months after Ramadan reduce but do not return to previous condition.

CONCLUSION

This study confirms that menstrual abnormalities including oligomenorrhea, polymenorrhea and hypermenorrhea increased during Ramadan especially in participates with more than 15 days of fasting.

Comparison of recombinant human follicle stimulating hormone (rhFSH), human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG) on semen parameters after varicocelectomy: a randomized clinical trial

BACKGROUND

The most frequent physical finding in infertile men is varicocele, in which one of the mechanisms that can affect seminal parameters is oxidative stress.

OBJECTIVE

Our study aimed, for the first time, to compare the efficacy of recombinant human follicle-stimulating hormone (rhFSH), human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG) on sperm parameters and fertility after varicocelectomy.

MATERIALS AND METHODS

113 infertile men with varicocele were divided into four groups. Group A received HCG 5000 IU weekly, group B received HMG 75 IU three times a week, group C received rhFSH 75 IU three times a week and group D received no medical treatment after varicocelectomy.

RESULTS

After three months, in group A sperm morphology improved (p=0.007), causing a 32% pregnancy rate. In group B, sperm motility (p=0.023) and morphology (p=0.014) improved, causing a 57% pregnancy rate. In group C, all of the investigated semen parameters increased (p<0.05), causing a 62.5% pregnancy rate. Only rhFSH improved sperm concentrations to >20×10(6) mL (p=0.027). In group D, sperm morphology increased (p=0.038), but other parameters remained unchanged and no pregnancies occurred.

CONCLUSION

It can be concluded that drugs can reduce induction time for spermatogenesis and fertility in comparison with varicocelectomy alone. For these purposes, rhFSH is more effective than other drugs.

Chronic mustard toxicity on the testis: a historical cohort study two decades after exposure

We aimed to assess the long-term toxic effects of sulphur mustard (SM) on the testis and male fertility two decades after exposure. A historical cohort study was conducted in 2005. Sixty-four SM-exposed and 64 matched SM-unexposed casualties of the Iraq-Iran conflict were enrolled. Fecundity status, semen indices, hormonal assay results and testis histopathology were evaluated. Male factor infertility was diagnosed in 23 and 5% of married exposed and unexposed casualties, respectively (p < 0.01). All semen indices declined over the 15 years since 1990 among the exposed group. Furthermore, all indices with the exception of sperm motility were significantly lower in the exposed than in unexposed men. The follicle-stimulating hormone level was higher in the infertile than in fertile exposed men (p < 0.001). Testis histopathology of the azoospermic men showed complete absence of spermatogenesis with only Sertoli cells in the seminiferous tubules. SM can be gonadotoxic and its chronic toxicity may be permanent. Germ cells are probably the most susceptible gonadal cells to SM.

Non-Hodgkin's lymphoma in autosomal dominant polycystic kidney disease, 12 years after renal transplantation

Autosomal dominant polycystic kidney disease (ADPKD) is a systematic disease which accounts for 10-15% of patients receiving dialysis or renal transplantation. It has a statistically significant association with malignancy in renal transplant recipients. We report a 47-year-old ADPKD female who developed a large renal tumor in the right kidney 12 years after kidney transplantation. During the follow-up, her ultrasound and laboratory tests were within normal limits. Bilateral nephrectomy of the native kidneys was performed, and followed by radiotherapy on the right side because pathology of the tumor suggested non-Hodgkin's lymphoma (NHL).

Genetic Association of Interleukin-4, Interleukin-10, and Transforming Growth Factor-β Gene Polymorphism With Allograft Function in Renal Transplant Patients

Despite advances in immunosuppressive therapy in the past decade, allograft rejection remains the primary cause for kidney graft failure. Cytokines are known to be important mediators in renal allograft outcome. The aim of the present study was to ascertain whether interleukin (IL)-4, IL-10, and transforming growth factor (TGF)-beta cytokine gene polymorphisms contributed to kidney graft outcome. We evaluated single nucleotide polymorphism in IL-4 (-1098G/T, -590C/T, -33C/T), IL-10 (-1082A/G, -819C/T, -592A/C), and TGF-beta (codon 10 and 25) in 100 renal transplant recipients and 139 normal healthy control using polymerase chain reactions based on sequence-specific primers. Recipients were clinically characterized as rejection episode (RE) versus stable graft function (SGF). The results showed the frequencies of IL-4 -33 T allele in the RE, SGF, and control group to be 7%, 73%, and 28%, respectively. IL-10 -592 A allele frequency was 39% in RE, 26% in SGF, and 28% in the control group. TGF-beta codon 10 T allele was 39% in RE, 35% in SGF, and 53% in control group. In conclusion, this study suggested that some cytokine gene alleles reflected SGF among kidney transplant recipients.

Reconstruction of bladder and urethra using ileocecal segment and appendix in patients with exstrophy-epispadias complex: the first report of a new surgical approach

OBJECTIVE

We aimed to describe our experience in administering an innovative surgical technique to treat pediatric cases of exstrophy-epispadias complex.

MATERIAL AND METHODS

Between 1995 and 2004, seven consecutive patients (six males) with exstrophy-epispadias complex were treated using ileocecal segment for bladder augmentation and appendix for urethral reconstruction. In a single-stage operation, the exstrophied bladder was dissected- and a segment of cecum, ascending colon, terminal ileum, and the corresponding appendix were isolated. Using the opened colon to augment the bladder, the ileal segment was fashioned to skin as temporary stoma, and the appendix was laid in the urethral lumen as the neourethra following urethral demucosation. This technique was used as a secondary surgery in one case and as a primary surgery in six neonates. Evaluation of the urinary tract status was performed by cystograms and ultrasonograms.

RESULTS

Renal function was saved in all cases and continence was achieved by clean intermittent catheterization every two hours either via the neourethra (n = 6) or through the temporary stoma (n = 1). The patients did not experience any metabolic complications in their follow-ups. Moreover, no one had vesicourethral reflux, dehiscence, or fistula.

CONCLUSIONS

The technique was deemed safe with acceptable outcomes even when secondary repair of previously failed operation was intended. Experiencing the technique in larger cohorts as well as longer follow-ups might be necessary to assess probable long-term complications.

Primary tuberculosis of the glans penis in male kidney transplant recipients: a report on two cases

An extremely rare form of genitourinary tract tuberculosis (TB) is TB of the glans penis. Here, we report on two men with TB of the glans, both occurring secondary to their wives having genital TB. To the best of our knowledge, this is the first report of this nature from Iran. One case is a 48 year-old blind male with an asymptomatic papulo-pustular eruption over the glans and, the other is a 51 year-old male who had kidney transplantation in March 2004, and was referred to our transplantation clinic nine months later with papulonecrotic ulcer on the glans which did not respond to antibiotic therapy. Both patients responded well to anti-TB treatment. Our cases suggest that every papulonecrotic lesion on the glans must raise the suspicion of TB, and an underlying active or healed focus of TB should be thoroughly searched. Also, it is very important, particularly in endemic areas, that prior to transplanting a male patient, his female partner must be examined for TB of the genitalia.

Nephron sparing surgery in a transplanted kidney renal cell carcinoma

Renal cell carcinoma (RCC) of the transplanted kidney is rare. In Iran, until 2004, 15000 kidney transplantations were performed, mostly from living donors. We report the first case of renal cell carcinoma in transplanted kidney, four years after transplantation, which was treated with nephron sparing or partial nephrectomy.