In human-assisted reproduction both partners need to be evaluated during counseling because causes of infertility are due to male factors and female factors. some body hormones play important role in fertile women and cortisol one of these hormones which is essential for normal ovulation, cortisol usually increases during the follicular phase of the menstrual cycle, play a role in the early stages of follicular development by their interaction with aromatase activity and granulose cell functions. To investigate the correlation of cortisol hormonal level in serum and in follicular fluid that relationship with age in women under Intracytoplasmic sperm injection outcome. Its randomized prospective clinical trial study performance conducting in the Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies / Al-Nahrain University, Baghdad-Iraq, during the period from November2021to June 2022. a total of Sixty-three Infertile Iraqi women, who planned to inter intrasytoplasmic sperm injection program. The blood sample and follicular fluid sample obtained from all infertile women inter intracytoplasmic sperm injection program to measure cortisol hormonal level at specific days of this study. There was increase in cortisol level in women aged between (30-40) years, So there was significant finding between cortisol level and this age group and there was increase in cortisol level in women aged < 30 years at the same day and no significant difference in cortisol level in women age more than 40. Significant differences in cortisol level appear in group of women age between (30-40) years, also the same result appears in group of women age more than > 40 years and no significant differences in cortisol level in women aged < 30. No significant differences in cortisol level in all age women group (30-40) years, <30 years ,and the women age > 40 years.
Oxidative stress in the field of reproduction has been extensively considered in association with sperm properties and male infertility; in any case, the effect of oxidative stress in association with oocyte trademark got less thought than that of sperms. The goal of the study is to understand the possible association among serum and follicular oxidative markers in infertile women and oocyte characteristics and pregnancy result in ICSI cycles. The present case-control study included 57 infertile women undergoing ICSI that was done in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies at Al-Nahrain University. The assessment started in April 2018 and connected with March 2019. Mean metaphase II oocyte count of all women was 5.70±3.87, that of pregnant women was 6.90±3.68 and that of non-pregnant women was 4.46±3.73; there was a basic qualification in mean metaphase II oocyte check among pregnant and non-pregnant women (P = 0.016); being higher in pregnant women. The mean abnormal oocyte count of all women was 0.63±1.26, that of pregnant women was 0.28±0.45 and that of non-pregnant women was 1.00±1.68. Oxidative stress markers inside and out affected clinical pregnancy result (P < 0.05) and appear to impact clinical pregnancy bring about women undergoing ICSI due to its effect of oocyte characteristics.
Placenta growth factor is, VEGF family member, a Pleiotropic Factor affects a variety of cell types and regulates various biological responses. PlGF is similar in structure and function to VEGF, and it amplifies VEGF's angiogenic actions. Ovulation stimulation during cycles of in vitro fertilization (IVF) for the management of infertility results in ovarian hyperstimulation syndrome (OHSS), an iatrogenic side effect. Considering potential roles of PlGF and its receptor (sflt-1) in angiogenesis, the association of these factors with OHSS among study women during controlled ovarian stimulation have evaluated in the present study. Comparative cross-sectional study including of 60 women who go through controlled ovarian stimulation. On oocyte retrieval day, their serum and follicular fluid were taken. The concentrations of PlGF and sFlt-1 were assessed using ELISA .Eighteen patients presented with ovarian hyperstimulation syndrome (OHSS) and 42 patients were no OHSS. There was significantly higher serum PIGF in women with OHSS patients as compared to women with no OHSS, 141.4 ± 11.8 versus 91.9 ± 5.4 respectively (p<0.001). Furthermore, Follicular fluid PlGF there was significantly higher in women with OHSS patients as compared to women with no OHSS, 163.4 ± 7.2 versus 91.1 ± 5.5 respectively (p<0.001). Additionally Follicular fluids PlGF/sFlt ratio significantly higher in women with OHSS patients as compared to women with no OHSS, 0.034 ± 0.01 versus 0.026 ± 0.01 respectively (p<0 . 001). On the contrary there was significantly lower serum and follicular fluid sFlt in ovarian hyper-stimulated patients These statistics show that serum and FF PlGF and PlGF to sFlt ratio higher in women with ovarian hyperstimulation syndrome (OHSS) patients as compared to women with no OHSS. So, the PlGF may be played an important a role in angiogenesis dysregulation.
The effect of maternal body mass index (BMI) on fertility outcomes in women undergoing in vitro fertilization/intracytoplasmic sperm injection cycles has been extensively evaluated and the results of these studies have shown a lot of controversial issues. Folate is a naturally occurring type of vitamin B9 crucial for reproductive health. 65 infertile couples were subjected to intracytoplasmic sperm injection cycles. Both primary and secondary types of infertility were involved, with different causes. The mean plasma folate of all infertile women was 12.71±6.52, with pregnant 11.60±5.57 and non-pregnant 11.74±8.80; with no significant difference in mean plasma folate between them. Moreover, the means of follicular fluid folate of all infertile women, pregnant women, and non-pregnant women were 8.00±5.39, 7.84±4.68, and 8.39±6.19 respectively. There was no significant statistical difference in mean follicular fluid folate between pregnant and non-pregnant women (p=0.719). Also, both plasma folate and follicular fluid folate were not significantly correlated to oocyte and embryo characteristics. Although plasma folate was higher in obese than normal and overweight women, the difference did not reach statistical significance. It appears that the correlation among maternal BMI, folate level and fertility outcomes in women undergoing intracytoplasmic sperm injection cycles are still controversial and much research work is needed to figure out such complex interaction among these variables.
Activin is a member of the transforming growth factor-beta superfamily and is a polypeptide growth factor. Activin regulates follicle growth, gonadotropin responsiveness, steroidogenesis, oocyte maturation, ovulation, and corpus luteum function in the ovary via a local autocrine/paracrine effect. Activin measurement A level in serum and follicular fluid during the preovulatory stage in PCOS women undergoing an IVF/ICSI cycle to predict fertilization capacity earlier Fifty infertile couples, 25 with PCOS and 25 without PCOS, who attended Al Nahrain University in Baghdad, Iraq's High Institute of Infertility Diagnosis and Assisted Reproductive Technologies. The females that participated were between the ages of 18 and 40. On the day of oocyte retrieval, the level of Activin A in serum and follicular fluid was measured. Activin A levels in PCOS women's serum (activin A=1274 77.9) and follicular fluid (activin A =1038 50.3) compared to non-PCOS women's serum (activin A=453 25.74) and follicular fluid (Activin A=450 23.73). The study shows no correlation between activin A hormone with oocytes characteristics and fertilization rate in PCOS women with a significant increase of activin A hormone in the serum and FF of PCOS women compared to non PCOS women. Activin A level can predict a diagnosis of PCOS in addition to positive predictive pregnancy but not indicator of fertilization capacity in PCOS women.
Background: Leptin, a key hormone in energy homeostasis and neuroendocrine function, has a permissive role in the pathogenesis of reproductive dysfunction. Objective: To assess the role of serum leptin in women with PCOS and to evaluate leptin and insulin levels in PCOS women before and after treatment with metformin. Materials and Methods: Sixty women of reproductive age (18- 38years) were allocated to four groups: 15 obese women with PCOS (BMI >30 kg/m2), 15 obese controls, 15 non-obese women with PCOS (BMI 18 -30 kg/m2), and 15 non-obese controls. Serum leptin and insulin levels were measured and compared between case and control subjects also comparison done pretreatment and after treatment with metformin. Results: There was a significant increase in leptin in nonobese PCOS compared to non-obese control (5.64±1.43), (P value=0.0032), insulin level was significantly higher in PCOS group (15.87±6.65) than control (5.47±1.68), (P value<0.001). There was significant decrease in BMI, leptin and insulin levels after 12 month of metformin treatment in obese and non-obese PCOS subjects. Conclusion: Leptin level increased remarkably with increasing body weight and it is higher in non-obese PCOS women in comparison with non-obese healthy women.
Pregnancy-Associated Plasma Protein (PAPP-A) is a zinc metalloproteinase in the insulin growth factor system (IGFs) produced by the syncytiotrophoplast region of the placenta. It plays a critical function in the cleavage of IGFBP4. In the ovary IGFs, it regulates follicular and oocyte maturation, and steroidogenesis. While in polycystic ovarian syndrome (PCOS) Hyperinsulinemia and hyperandrogenemia it causes follicular environment changes and early ovulation resulting in lower oocyte and embryo quality in patients and this will decrease the success of pregnancy in women enrolled in the ICSI cycle. The present study aimed to assess the relationship of PAPP-A levels in serum and follicular fluid in women with PCOS and non-PCOS with oocyte and embryo quality in women undergoing ICSI cycle. 45 infertile Iraqi women were enrolled. Women with PCOS had to meet at least two of the three criteria set by the Rotterdam ESHRE/ASRMS criteria, the age of the included women ranged between 20-45 years. In non-PCOS patients, PAPP-A has higher level in serum and follicular fluid but without a statistically significant difference matching with PCOS group. In addition, there was no significant correlation between PAPP-A levels in serum and follicular fluid with oocytes and embryo characteristics. However, PAPP-A levels are higher in serum and follicular fluid in women with positive pregnancy but without significant differences. PAPP-A had no correlation with oocyte and embryo quality.
Implantation failure and disorders of endometrial receptivity represent an essential cause of infertility; multiple parameters were needed to predict the uterine receptivity understanding that no sole parameter could predict the same. A score was termed as (Uterine Biophysical Profile) could be utilized as a predictor of endometrial receptivity. To evaluate the predictive potential of Uterine biophysical profile of both endometrial receptivity and pregnancy outcome in infertile women undergoing Intrauterine Insemination (IUI). The current cross-sectional study was conducted in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in Al Nahrain University, Baghdad, Iraq from the 1 st of Oct. 2018 till 1 st of May 2019 involving seventy women of infertile couples with the same inclusion and exclusion criteria. Uterine biophysical profile was evaluated using a doppler ultrasound examination and then a score was calculated and correlated to pregnancy outcome. The mean Uterine Artery Pulsatility Index (UAPI) was significantly lower in women with positive pregnancy in comparison to women with negative pregnancy, 2.10±0.19 versus 2.47±0.65, respectively (P=0.032). Moreover, no women with Pulsatility Index (PI) score (0) succeeded to get pregnant and the higher the score, the higher the rate of pregnancy (P=0.006). Furthermore, Spearman correlation showed significant positive correlation between positive pregnancy outcome and UAPI (r=0.365; P= 0.002). The mean total score was significantly higher for pregnant women than in women with negative pregnancy, 18.27±1.33 versus 16.35±2.47, respectively (P= 0.005). The cutoff value was >17 with an acceptable accuracy level of 74.2. The sensitivity of that cutoff vale was 80 % and the specificity was 65.5%. Uterine artery pulsatility index and total uterine biophysical score are the principal predictors of positive pregnancy outcomes in infertile women undergoing IUI.
Background: Elevated serum concentrations of testosterone is common in women with polycystic ovary syndrome (PCOS)but it'srelationto body mass in dex(BMI), isstillunknown. Objective: The present study was conducted to investigate the relationship between testosterone level and body massindexin womenwith polycysticovary syndrome. Methods: A total of eighty PCOS women with average age 27.6±0.7 and BMI 31.9±0.5 were compared with twenty-two healthy women considered as a control group (age 28.2±1.1, BMI 28.8±1.0). Patients and controls were grouped according to (BMI: Lean, overweight and obese. Allwomen in both groups were subjected to the following investigations: evaluation of luteinizing hormone (LH), follicle stimulating hormone (FSH.), prolactin (PRL), testosterone levels and ultrasonography. Results: The serum levels of LH, LH/FSH and testosterone were significantly higher (P< 0.05) in PCOS compared to control women,while in FSH and PRL the difference was non significant. Obese women with PCOS also had a significantly higher (P<0.05) mean level of testosterone (1.33±0.28ng/ml) compared to lean and overweight patients (0.53±0.17, 0.61±0.08 ng/ml respectively). Uitrasound examination was performed in the ovulatory phase during (12-14) days of the cycle in both PCOS patients and controls, and all women with PCOS with evidence of polycystic ovaries on ultrasonography. Conclusion: Testosterone levelwas significantly elevated in obesecompared to overweightand lean women with PCOS.The role of weight reduction is more beneficial in the management of PCOS and improvementoftestosteronelevel.
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Polycystic ovary syndrome signs and symptoms often begin soon after menarche. In some cases, PCOS develops later during the reproductive years, for instance, in response to substantial weight gain. The PCOS produces symptoms in about 5-10% of women of reproductive age(12-45 years) and it is one of the leading causes of female subfertility.Women with PCOS suffer not only from subfertility, but also from a high rate of early pregnancy loss. About 30-50% of clinically confirmed early pregnancy loss are associated with PCOS.In addition to early pregnancy loss, women with PCOS have increased risk of recurrent miscarriage ,which defined as 3 or more consecutive pregnancy loss before 20 week. Metformin hydrochloride, an insulin sensitizing agent, has been shown to have encouraging effects on several aspect of PCOS like insulin sensitivity, plasma glucose concentration & lipid profile.It is found that using Metformin during pregnancy in women with PCOS may reduce the pregnancy loss and also reduce the risk of gestational diabetes,intrauterine growth retardation(IUGR) & preterm labor. Aim of study: To evaluate the role of Metformin in women with recurrent miscarriage & its effect on other pregnancy complications in women with PCOS. Patients, Materials & Methods: A prospective study done at gynecology outpatient clinic of AL-Batool Teaching Hospital in Baquba-Diyala -Iraq, from September 2012 to September 2016. A total of 100 cases were studied, all have aconfirmed diagnosis of PCOS depending on the following criteria:1)Oligo or amenorrhea (8 or fewer cycles per a year) , 2) signs of hyperandrogenism 3)ultrasound features of PCOS.All should have history of 3 or more recurrent first trimester miscarriage & they were invistigated for other causes of recurrent miscarriage. All cases were followed before getting pregnant and received Metformin for enhancing fertility & when they become pregnant, they were divided into two groups: the 1st group stopped using Metformin once they get pregnant while the 2nd group continued to use Metformin in a dose of 500-1000mg per day throughout pregnancy .Both groups are followed to determine pregnancy outcome. Results: Patients who continued to receive Metformin during pregnancy had better pregnancy outcome regarding early pregnancy loss and recurrent miscarriage, gestational diabetes development, IUGR & preterm labor. Conclusions: Metformin use during pregnancy improve pregnancy outcome in patients with polycystic ovary syndrome.
Background: Polycystic ovary syndrome is the most common, yet complex, endocrine disorder with principal features of anovulation, amenorrhea, ovulation-related infertility, polycystic ovaries, and obesity. Number of metabolic aberrations is now well recognized as a growing public health problem in PCOS as glucose intolerance, hyperinsulinemia and dyslipidemia. Objective: To investigate and analyze the anthropometric, hormonal profile and metabolic abnormalities of obese and non-obese women with this disorder. Materials and Methods: Sixty-five healthy Iraqi women serves as the control group and eighty-four infertile women divided into two subgroups depending on the BMI (< and ≥30 kg/m2) were studied. BMI, waist to hip ratio and waist to thigh ratio were measured. Serum levels of luteinizing hormone, follicle stimulating hormone, estradiol, testosterone, fasting blood glucose, and oral glucose tolerance test, and total lipid profile were measured. Results: BMI, waist/hip, waist/thigh ratio were significantly higher in PCOS than control women. Lower FSH level, higher LH and E2 levels, LH/FSH ratio, and lower E2/testosterone ratio was found in obese and non-obese PCOS. Higher blood sugar level, high cholesterol, triglyceride, LDL, VLDL and lower HDL levels in PCOS compared to control women. Conclusion: Obesity is a common finding of women with PCOS, but it is not part of the diagnostic criteria. Women with PCOS usually have the so-called centralobesity (Visceral adiposity), and therefore tend to have an increased waist-hip ratio (WHR) and waist to thigh ratio, regardless of the weight factor (i.e., in obese and non-obese). PCOS patients exhibited abnormal hormonal status and biochemical indices also regardless of obesity.
In a perfect world, the peak of receptivity of the endometrial lining would occur simultaneously with the entry into the uterine cavity of a healthy blastocyst, which would then be able to adhere, attach, invade, and develop protected until the time of delivery. This would be the ideal scenario. The study was carried out on 200 infertile women who have thin , poorly vascularized endometrium, those patients were divided into five groups ; 40 patients in each group, group A received esterofem oral, group B received vagifem vaginal tablets, group C received sildenafil citrate gel, group D received pentoxifylline oral and group E received 4 grams of pentoxifylline vaginal gel. The endometrial thickness, vascularity zones, sub endometrial flow, and both uterine arteries resistance and pulsatility indices were assessed at the middle of the menstrual cycle (day 11–14) on a monthly basis for six cycles or until a positive pregnancy test was obtained. Pentoxifylline vaginal gel, pentoxifylline+ vitamin E capsule, and sildenafil vaginal gel have improved the vascularity indeces of endometrium and uterine arteries, while the vagifem and esterofem were less effective in terms of improving the vascularity indeces of endometrium and uterine arteries. The study also showed that 57.5% of women succeed to get pregnant after six months of receiving pentoxifylline vaginal gel, 35% of women succeed to get pregnant after six months of Pentoxifylline+vit E, while 22.5% of women succeed to get pregnant after six months of sildenafil, about 10% of women got pregnant after six months of vagifem, and finally 2.5% of women got pregnant after six months of receiving estrofem tablets. It was discovered that pentoxifylline vaginal gel, pentoxifylline tablet plus vitamin E capsule, and sildenafil vaginal gel were able to improve the vascularity index of the endometrium, the uterine arteries and endometrial thickness, and enhance the pregnancy rates in patients with thin poorly vascularized endometrium.
Recurrent miscarriage can be defined as two or more consequence unsuccessful clinical pregnancies and confirmed by ultrasonography or histopathological examination and consider the most common clinical complications reproduction, and it affects (2%–5%) of reproduction couple. The present study included 140 women who were already diagnosed with recurrent miscarriage. Following complete clinical workup, including history, examination and investigations, enrolled women were classified into two main subgroups, explained group ( n = 85) and unexplained group ( n = 55). In this study, the result showed no significant difference found between the two subgroups explained and unexplained regarding age and the body mass index. In the obstetric history characteristics of women enrolled in the current study, there is no significant difference between the explained and unexplained group according to gravity, parity, and the number of abortions. Additionally, no significant difference according to gestational age and types of abortion but found significant in the type of complete abortion between the explained and unexplained group. Results showed that recurrent miscarriage rates increased in women with positive anti-phospholipids, in addition, a significant difference in the type of complete abortion between the explained and unexplained group of recurrent miscarriage women.
Background: Fibrillin- 3 is a recently discovered hormone.However, there are no studies till now regarding the role of fibrillin-3 hormone on fertilization capacity in infertile pregnant and non-pregnant women. Objectives: The goals of this study are concentrated on the fertilization capacity parameters by examining the effect of in vivo concentration of fibrillin-3 hormone on the ovarians status at different menstrual cycle phases and to elucidate the correlation between the levels of this hormone with pregnant and non -pregnant women following Intrauterine insemination (IUI) outcome or through natural pregnancy. Methods: Sixty infertile couples were involved in this prospective study. The couples were divided according to the type of insemination and ovulation induction program into two groups Group(1): Thirty spouses were subjected to induced ovulation stimulation by using clomiphene citrate(CC) and recommended for natural coitus. Group(2): Thirty couples, the females were induced ovulation stimulation by CC, Gonal F-751U /ml and Fostimon 50IU/ml with IUI. Measurements of Fibrillin-3 with other reproductive hormones were done at different phases of menstrual cycle and for pregnant and non-pregnant women following natural coitus and IUI. Results: The mean of fibrillin-3 hormone level at day 2 of menstrual cycle was 3.7ng/ml (ranged from 3.50 to3.91) in the two groups. The mean of fibrillin-3 hormone at cycle day 13 was 6.6ng/ml( ranged from 5.83to 7.0). Whereas, The basal level of Fibrillin-3 at 14 days post insemination was 3.3ng/ml. The range is from 2.76,395 to 3.29 ng/ml. There was no significant difference in the mean of Fibrillin -3hormone between pregnant and non-pregnant women through the phases of menstrual cycle or between the two groups, but there is a significant value between fibrillin-3 post insemination and E2 day 2 and day 13 P<0.05. Conclusion: The present study concluded that Fibrillin -3 hormone has no role in pregnancy, but it may have a main relationship with estrogens reaction in folliculogenesis, oocyte maturation and follicular contents. Therefore, this hormone may be one of the new hormones that interfere with fertilization capacity.
The vaginal microbial makeup has a substantial impact on women's health. The typical vaginal microbial profile in healthy women of reproductive age comprises aerobic, facultatively anaerobic, as well as obligately anaerobic organisms. However, the optimal vaginal microbiota is dominated by lactobacilli and is thought to defend against pathogenic microbial colonization and infection by producing lactic acid, antimicrobial metabolites, and lowering immune system activation. Recent research has come up with the term "molecular bacterial vaginosis (BV)" to describe non-optimal vaginal microbiota that is low in Lactobacillus species (spp.) and has a lot of facultative and absolute anaerobic bacteria specifically Gardnerella vaginalis. In the context of IVF, BV has been linked to infertility. The study comprised forty-six women to explore the vaginal and follicular microbiota of asymptomatic infertile Iraqi women starting an ICSI trial. At the time of ova pick-up, a high vaginal swab and follicular fluid were acquired from each instance for DNA extraction to test for the presence of microorganisms by the use of a real-time PCR special commercial kit. In conclusion, molecular technologies have offered a more thorough view into the vaginal microbiota, which may explain why vaginal dysbiosis shifts during the ICSI-ET treatment. Even though the majority of women have no clinically visible infection, the fact is that they have an aberrant vaginal micro-ecology profile. Nevertheless, isolating microorganisms from follicular fluid did not reduce the likelihood of fertilization or the pregnancy rate during ICSI cycles.
Resistin and follistatin levels have been found to be high in polycystic ovarian syndrome (PCOS) patients, that play role in pathophysiology of PCOS and pregnancy status of women having ICSI cycle. This study aimed to determine the relationship between the hormone levels and pregnancy outcome in PCOS and non-PCOS women undergoing intracytoplasmic sperm injection (ICSI) program. The study was done at Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies from 2022 to 2023. Eighty infertile women participating in the IVF/ICSI treatment. They were split to control (40 non-polycystic ovarian syndrome-PCOS women) and 40 women for PCOS group. They were subdividing to subgroups’ according to body max index (BMI; normal and overweight / obese). ELISA method was used to measure hormone level at day 2 and follicular fluid and serum at day of ova pick up. About 38.8% of study participants were got pregnant. Means of serum resistin and follistatin in day 2 and OPU were significantly higher in patients with PCOS and normal BMI level while follistatin at day 2 and in follicular fluid (FF) were significantly higher in participants who got pregnant. Follistatin level at day 2 > 9.89 ng/ml and in FF > 15.06 ng/ml and might be as a predictor for occurrence of pregnancy after ICSI. The cutoff point of follistatin level in the serum at day two and in FF at the day OPU was found to be a predictor of pregnancy following ICSI, while no correlation was found between resistin and pregnancy outcome.
Polycystic ovarian syndrome (PCOS) is a group of clinically distinct endocrine conditions. Insulin resistance-related proteins are involved in PCOS pathogenesis. Irisin is a new myokine that functions similarly to adipokines. Irisin has been linked to insulin resistance and metabolic syndrome. There have been conflicting findings regarding irisin levels and their connection to hormonal and metabolic alterations in PCOS .This study aimed to compare the levels of irisin in follicular fluid and serum between women with PCOS and healthy women and correlate them with oocyte and embryo quality in women undergoing the ICSI cycle .Ninety infertile Iraqi women were enrolled, 46 women with PCOS and 44 weight-matched non-PCOS controls, in whom ICSI was done for them and evaluated the level of follicular fluid, serum Irisin, and insulin level with measure of Homeostasis Model of Assessment-Insulin Resistance (HOMA-IR) and correlate them to with oocyte and embryo quality. HOMA-IR, FF, and serum irisin levels in PCOS considerably increased. (P ≤ 0.01). In addition, there was a significant negative correlation between Irisin levels in follicular fluid and serum with MII oocyte, oocyte maturity rate, and grade 1 embryo. The serum, follicular fluid Irisin, and HOMA-IR were significantly higher in PCOS than in control cases, which may cause a reduction in oocyte maturation, embryo quality, and pregnancy outcome.
Endometriosis is a chronic inflammatory gynecological disease and a leading cause of female infertility, characterized by Th1/Th2 cytokine imbalance. Interleukin-13 (IL-13) and Interferon-gamma (IFN-gamma) are cytokines mediating anti-inflammatory and pro- inflammatory pathways, respectively, and were investigated in this study in infertile women with endometriosis undergoing Intracytoplasmic Sperm Injection (ICSI).To explore the potential impact and prognostic value of Interleukin-13 (IL-13) and Interferon- gamma (IFN-gamma) on ICSI outcome and to confirm their role in endometriosis-related infertility .A prospective case-control study was conducted involving 80 infertile women aged 18-40 years, including (n=40) women laparoscopically confirmed with endometriosis and (n=40) infertile women without endometriosis serving as controls. Both groups enrolled in ICSI cycles, and on the day of oocyte retrieval, serum and follicular fluid were collected; then concentrations of IFN-γ and IL-13 were quantified using enzyme-linked immunosorbent assay (ELISA). Ovarian stimulation characteristics, oocyte maturity, embryo quality, maturation rate, fertilization rate, and pregnancy rate were compared between groups using appropriate statistical analyses to investigate their association with endometriosis and their impact on ICSI outcomes. Elevated IFN-γ and IL-13 levels in both serum and follicular fluid are strongly associated with impaired ovarian response and poor ICSI outcomes in women with endometriosis. These findings suggest that inflammatory cytokine imbalance contributes to reduced oocyte developmental competence and embryo quality. Assessment of IFN-γ and IL-13 may provide clinically valuable biomarkers for predicting ART outcomes and could facilitate individualized therapeutic strategies targeting immune-mediated reproductive dysfunction.
Background : Bacterial vaginosis (BV)is a polymicrobial clinical syndrome re sulting from replacement of the normal hydrogen peroxide producing Lactoba cillus sp. BV is the most common lower genital tract disorder among women of reproductive age (pregnant and non-pregnant) and the most prevalent cause of vaginal discharge and malodor. Objectives: To study the role of asymptomatic bacterial vaginosis on outcome in patients undergoing ICSI. Patients and Methods: This prospective study was undertaken in the High Insti tute of Infertility Diagnosis and Assisted Reproductive Techniques / Al-Nahrain University. During the period from September 2017 – April 2018. A total of 100 infertile women .All of them were underwent controlled ovarian hyper stimula tion for intra cytoplasmic sperm injection cycle. Antagonist oocyte maturation used as ovulation induction protocol in all the cases. Assessment of oocyte mat uration and embryo quality is done to the all the cases, bacterial vaginosis smear was collected on the day of oocyte retrieval. B.V. smear diagnosis by Amsel’s Criteria and Nugent’s Scoring. Results: TThere was no significant difference in mean age of pregnant and non-pregnant ladies, 29.40 ±6.47 years versus 30.78±6.84 years, respectively (P= 0.333).In addition the frequency of women under 35 years age was compara ble in the two groups with no statistical significant difference, 34 (79.1%) versus 33 (73.3%), respectively (P = 0.528). Wide variation and non-normal distribu tion was the role followed by the duration of infertility concerning sub-fertile women participating in this study. However, no significant difference was ob served in the duration of infertility between pregnant and non-pregnant ladies, 6.00 (5.00) years versus 6.00 (5.00) years (P = 0.289). Comparison of basal hor monal levels between pregnant and non-pregnant groups revealed no significant difference despite the presence of some minor differences in mean hormonal levels between the two groups (P> 0.05). Comparison of oocytes characteristics between pregnant and non-pregnant ladies was conducted and revealed no signif icant difference in mean total number retrieved oocyte (TNO), ruptured oocytes (RO), abnormal oocyte (AO), germinal vesicle oocyte (GV), metaphase I oocyte and metaphase II oocytes (P > 0.05), table Mean total number retrieved oocyte (TNO), ruptured oocytes (RO), abnormal oocyte (AO), germinal vesicle oocyte (GV), metaphase I oocyte and metaphase II oocytes was 10.81 ±4.95 versus
Spontaneous miscarriage is the spontaneous ending from a pregnancy at a phase where the embryo is incapable of remaining independently, generally defined in humans at prior to 20 weeks from gestation. Overall, reported spontaneous miscarriage rates in recognized pregnancies are 10% to 20%. Pregnant women are exposed to many infectious agents that are potentially harmful to the fetus and an increased risk of miscarriage. The aims of the study were to evaluate the role of many pathogens (Parvovirus B19, Cytomegalovirus, Rubella, and Toxoplasma gondii), and urinary tract infections (UTI) as causes of spontaneous miscarriage. A case-control study conducted in Baghdad Teaching hospital during a period of ten months. A total of 120 women aged between (20 to 25) years were enrolled within the study, 80 with spontaneous miscarriage as a study group and 40 with normal delivery as a control group. A full history was taken, clinical examination was done and various laboratory investigations were carried out for all women in both groups. The study showed a statistically significant correlation between viral infection, Parvovirus (IgM, IgG), Toxoplasmosis (IgM), Rubella (IgM) and Cytomegalovirus (IgM, IgG), with spontaneous miscarriage (P-value 0.001, 0.005, 0.008, 0.014, 0.002). Bacterial, viral and protozoal infection may increase the risk of spontaneous miscarriage in comparison to healthy normal delivery ladies.
Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder with symptoms and diverse clinical manifestations. Obesity, a common comorbidity in PCOS, may exacerbate and lead to varied hormonal and inflammatory profiles. This study aimed to compare serum DHEAS, TNF-α, and IL-10 levels between obese and non-obese women with PCOS, providing insights into the intricate interplay between obesity, hormonal imbalances, and inflammation in this condition and offering potential pathways for enhancing fertility treatment outcomes in this challenging patient population. In this cross-sectional study, the data was analyzed from sixty -five women diagnosed with PCOS, categorized into two groups based on their Body Mass Index (BMI): Thirty-eight were non-obese (BMI < 30) and twenty-seven obese women (BMI ≥ 30). Serum samples were collected to measure DHEAS, TNF-α, and IL-10 levels using the ELIZA kit. These measures were then compared between the two groups to ascertain any significant differences. The study found significantly higher serum DHEAS levels in non-obese PCOS patients compared to their obese counterparts (p = 0.01). However, no significant difference was observed in serum TNF-α and IL-10 levels between the two groups (TNF-α p = 0.58; IL-10 p = 0.13). Serum DHEAS were significantly higher in non-obese compared to their obese counterparts’ women with PCOS. In contrast, no significant variance was found regarding S.TNF-α and S.IL-10 between the two groups
The association between the two hormones (progesterone and Activin A) in infertile women on the day of ova pick up and their relationship with pregnancy status in assisted reproductive programs are both poorly understood. To determine the correlation of progesterone and activin A on the day of ova pick up with pregnancy status of women undergoing IVF/ICSI cycle. The study was conducted on 80 infertile couples. The serum at day of ova pick up was collected. Serum progesterone and activin A analysis were done for all samples for activin A. Out of eighty infertile females twenty-five became pregnant (Pregnancy rate = 31%). Serum progesterone levels at days of oocytes pick up was significantly higher in pregnant females than non-pregnant (9.22 ± 0.54 vs. 4.47 ± 0.44; p < 0.001). There was a significantly higher serum activin levels at day of oocytes pick up in pregnant women compared to non-pregnant (2.19 ± 0.04 vs. 1.52 ± 0.04; p < 0.001). The cut-off value of serum progesterone at day of oocytes picks up was > 7.5 ng/ml and the cut-off value of serum activin A at day of oocytes pick up was > 1.85 ng/ml. Pregnant women had higher levels of the hormone progesterone and Activin A than non-pregnant women, which is significantly correlated. This result can be utilized to predicate the pregnancy status early in IVF Centers.
In recent years increasing evidence proposed that local immune cells at implantation site have largely contributed to embryo implantation. The intrauterine infusion of activated peripheral blood mononuclear cells culture 2 days before embryo transfer can enhance the implantation. One of the methods used to evaluate the endometrial receptivity is by assessing the sub endometrial blood flow. A total of 67 infertile women (30) women receives intrauterine non-invasive insemination of peripheral blood mononuclear cells (PBMC) culture 2 days before embryo transfer representing the PBMC test group, and (37) women without receiving any cell as Non-PBMC group. The cultured PBMC are administered into the uterine cavity of the patients. 2 days later, embryos are transferred into the uterine cavity. Endometrial thickness and sub-endometrial blood flow measurements are taken for all cases on trigger and embryo transfer days. On embryo transfer day there was no significant difference (p = 0.770) in mean endometrial thickness between the PBMC group and Non-PBMC group. There was a significant difference (p< 0.001) in the mean resistive index; the level being lower in the PBMC group. Moreover, there was a significant difference (p< 0.001) in the mean pulsatility index. Regarding all enrolled women, the pregnancy rate of 25.4 %, the rate was higher in the PBMC group in comparison with the Non-PBMC group, 43.3 % versus 10.8 %, respectively and the difference was significant (p = 0.002). The use of PBMC culture can improve sub-endometrial. Endometrial Receptivity, ICSI, Fresh Embryo Transfer, Peripheral
To assess the predictive value of different clinical, laboratory, and ultrasound parameters in Letrozole when used as an ovulation induction in anovulatory infertile PCOS women. The current study was done in the secondary-referral infertility clinic in AL-Yarmouk teaching hospital, and Al-Mustansiriyah medical college. Sixty-seven anovulatory infertile women with the polycystic ovarian syndrome. Letrozole was given orally on day 2 or 3 of the menstrual cycle for five days and repeated for three consecutive cycles. The primary outcome measures were to evaluate the response rate in the form of successful ovulation and clinical pregnancy. The ovulation rate was (64.2%), with clomiphene naïve vs. previous clomiphene use; it was 87.5%, 51.2% respectively, while pregnancy rate was (32.8%), 41.6% with clomiphene naïve vs. 27.9% with previous clomiphene use. Clinical (age, BMI, Waist circumference, cycle length and days between cycle, infertility period and type, previous reproductive outcome, androgen symptom and m-FG score), laboratory (E 2 , FSH, LH, testosterone, FAI, FBS, fasting insulin, HOMA – IR, and AMH) and ultrasound (mean ovarian volume, mean AFC and antral follicular diameter) parameters were founded to affect ovulation and pregnancy in different extent. After putting all variables in a scoring system, it was found that if the patients had > 26 points for the score, it's more likely that the woman becomes pregnant. A predictive pregnancy score was developed from basic clinical, laboratory, and ultrasound parameters. It may help the clinician to individualized ovulation induction protocol in PCOS women; however, external validation of this system is recommended in a more extensive prospective study.
During the process of embryo development, endometrial receptivity is very important for the successful implantation of blastocysts. This research investigated the influence of endometrial thickness on the day of oocyte retrieval and fresh embryo transfer on pregnancy outcomes in Iraqi women who are undergoing intracytoplasmic sperm injection (ICSI). Women from Iraq are taking part in this investigation. Participating in in vitro fertilization (IVF) cycles with the use of ICSI was a group of 44 women who were diagnosed with polycystic ovarian syndrome (PCOS) and had unexplained infertility. During the phases of oocyte retrieval and embryo transfer, there were significant differences seen between the two groups (p-values of 0.003 and 0.049), respectively. There was a total of 44 individuals, and 31 of them had negative pregnancy test results. The remaining 13 persons had positive findings. These results illustrate the importance of endometrial thickness in influencing the effectiveness of assisted reproductive technologies in achieving pregnancies.
Failure to conceive may be deeply upsetting and stressful, eventually leading to social, physical, and psychological implications. This study aimed to evaluate the impact of dual trigger on endometrial receptivity and the role of uterine biophysical profile in estimating the conception rate in women with primary or secondary infertility. A comparative prospective randomized clinical study was conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/ Al-Nahrain University, from October 2019 to April 2020. 90 infertile women who were attending the infertility diagnosis clinic of the institute was included in the study, receiving stimulated intrauterine insemination. Vaginal ultrasound was done for all women at the early and mid-follicular phase. The uterine scoring system for reproduction was assessed and total score of 20 was calculated and subsequently correlated to conception rate. A uterine scoring system for reproduction cut-off of 16 showed a sensitivity of 86.4% and a specificity of 75%. Patients with total score of 18, pulsatility index of lower than 1.79, and three or more endometrial contractions had the highest prevalence of successful pregnancy. Individual variables of endometrium (thickness, pattern, blood flow in zone 3, and myometrium features) had no statistical significance Applebaum's uterine score system for reproduction is a simple and non-invasive ultrasonic assessment. Low pulsatility index, endometrial contraction ≥3, and total score of 18 can point to the appropriate endometrial environment for implantation as well as the rate of conception.
Human chorionic gonadotropin is a glycoprotein hormone produced by the placenta. It exists in several isoforms with long half-lives (hours) and angiogenic potential; it maintains the corpus luteum to produce progesterone. This study aimed to evaluate Human chorionic gonadotropin concentration in follicular fluid and its effect on oocyte maturity and pregnancy rate, and whether it can be used as a noninvasive biomarker for predicting oocyte competence and pregnancy rate during intracytoplasmic sperm injection cycles. Infertile women undergoing ICSI treatment were included in the study. An antagonist protocol was used for ovulation induction. Patients were divided into two groups: pregnant women (n=18) and non-pregnant women (n=22). Samples of follicular fluid were collected on the day of oocyte pick-up. Chemiluminescent Immunoassay (CLIA) equipment was used for the quantitative determination of total β-human chorionic gonadotropin in follicular fluid. The mean beta-human chorionic gonadotropin level showed a highly significant increase relative to the mean level of non-pregnant women (110.24 ±20.50) versus (56.195 ±29.45). Moreover, there was no significant relationship between the levels of beta-human chorionic gonadotropin follicular fluid and the total number of oocytes and oocyte quality in the two groups. The Beta Human chorionic gonadotropin concentration in the follicular fluid plays an important and influential role in the prediction of pregnancy rates. Despite this, follicular fluid hCG level showed no relationship with the total number and quality of oocytes in the pregnant and non-pregnant groups.
Women who have transvaginal oocyte retrieval feel nervous and have mild to moderate pain because a needle is used to poke holes in the vaginal skin and ovarian capsule to get the oocytes. The aim of this study is compare between general and spinal anesthesia effect on ICSI outcome . A cross-sectional study was conducted in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/ Al-Nahrain University, from first April 2021 to the first of February 2022. Patients were randomized blindly at time of oocyte retrieval for types of anesthesia given: (50 women subjected to spinal anesthesia and 50 women subjected to general anesthesia). All females were subjected to flexible antagonist protocol. Also, all of them had the same surgical procedure by the same physicians. ICSI outcome was compared between the groups. The study showed there was non-significant difference (p>0.05) between the two groups regarding pregnancy rate with higher oocyte number in women subjected to spinal anesthesia than those who were under the general anesthesia although the difference was not statistically significant. The fertilized oocyte number was non significantly higher in spinal anesthesia group than the general anesthesia. So; spinal anesthesia and general anesthesia have comparable ICSI outcome.
Human chorionic gonadotropin is a glycoprotein hormone produced by the placenta. It exists in several isoforms with long half-lives (hours) and angiogenic potential; it maintains the corpus luteum to produce progesterone. This study aimed to evaluate Human chorionic gonadotropin concentration in follicular fluid and its effect on oocyte maturity and pregnancy rate, and whether it can be used as a noninvasive biomarker for predicting oocyte competence and pregnancy rate during intracytoplasmic sperm injection cycles. Infertile women undergoing ICSI treatment were included in the study. An antagonist protocol was used for ovulation induction. Patients were divided into two groups: pregnant women (n=18) and non-pregnant women (n=22). Samples of follicular fluid were collected on the day of oocyte pick-up. Chemiluminescent Immunoassay (CLIA) equipment was used for the quantitative determination of total β-human chorionic gonadotropin in follicular fluid. The mean beta-human chorionic gonadotropin level showed a highly significant increase relative to the mean level of non-pregnant women (110.24 ±20.50) versus (56.195 ±29.45). Moreover, there was no significant relationship between the levels of beta-human chorionic gonadotropin follicular fluid and the total number of oocytes and oocyte quality in the two groups. The Beta Human chorionic gonadotropin concentration in the follicular fluid plays an important and influential role in the prediction of pregnancy rates. Despite this, follicular fluid hCG level showed no relationship with the total number and quality of oocytes in the pregnant and non-pregnant groups.
Gestational diabetes mellitus (GDM) is a serious pregnancy complication in which a woman who has never had diabetes develops chronic hyperglycemia during her pregnancy. Normal placental function is essential for optimal fetal growth. The transport of glucose from the mother to the fetus is critical for fetal nutrient demands and can be stored as glycogen in the placenta. However, the function of this glycogen deposition is unknown: It may well be a source of fuel for a placenta itself or the storage reservoir for the later use by the fetus in times of need. While the significance of the placental glycogen remains unknown, the mounting evidence indicates that the altered glycogen metabolism and/or deposition is associated with many pregnancy complications, such as gestational diabetes, that adversely affect fetal development. The aim of this study is to assess glycogen deposition using Histochemical staining of Periodic Acid Schiff (PAS) stain. The placenta tissue collected from 50 women were enrolled in this study (25 women with no complications) and (25 women with gestational diabetes). The placentas of the two groups were compared in this study based on glycogen deposition with periodic acid-Schiff stain. The results of a histochemical investigation using PAS stain revealed a significant increase in the glycogen deposition (p≤0.001) in diabetic women's placentas within the intervillous core, around fetal vessels, and the basement membranes.
EMMPRIN (Basigin) is a potent inducer of matrix metalloproteinases (MMPs). Expression of EMMPRIN in the uterus has a very important role in implantation of embryo, this study was conducted to evaluate the relationship of pregnancy rates with EMMPRIN levels in follicular fluid and serum of intracytoplasmic sperm injection patients. The study was cross sectional study analyzed the serum and follicular fluid samples of 58 patients undergo ICSI procedure. The serum and follicular fluid samples were collected from infertile women aged 20 to 42 years. However, the levels of EMMPRIN were measured in the serum and follicular fluid samples and these samples were obtained during oocytes retrieval and another serum samples were collected at the day of embryo transfer. All women have ovarian stimulation with recombinant follicle stimulating hormone (FSH) at the second or third day of the cycle. Result: The pregnancy rate was 27.6 %. The present study showed that EMMPRIN in serum and follicular fluid at day of ova pickup and its level at embryo transfer day, are significantly low in pregnant women (p < 0.05) compared to non-pregnant women. The statistical analysis showed no significant correlation between serum and follicular fluid EMMPRIN with endometrial thickness (p > 0.05). EMMPRIN level can be used as a promising parameter for the prediction of pregnancy rate in ICSI cycles.
The 5,10-methylenetetrahydrofolate reductase (MTHFR) enzyme is a key methionine and folate metabolism enzyme that is found in oocytes and embryos in preimplantation stages and plays a vital role in female reproduction.To assess the impact of MTHFR genetic polymorphisms (C677T and A1298C) on follicular stimulating hormone (FSH), luteinizing hormone(LH), Estradiol (E2), progesterone and antimullerian hormone (AMH) in female receiving intracytoplasmic sperm injection (ICSI), 85 infertile women undergoing ICSI treatment at the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies in Baghdad, Iraq, were recruited. These patients had their MTHFR polymorphism genotypes examined, FSH, LH, E2, progesterone, and AMH levels were compared between groups. Furthermore, all demographic characteristics as well as ICSI outcomes were compared between pregnant and non-pregnant women. The research revealed no discernible variation between the means of FSH, LH, E2 and AMH with respect to the 219A>C(rs1801131) (A1298C) genotypes (p > 0.05). Progesterone level was significantly differed with high level found in CC followed by AA and AC. There was no statistically significant variation in hormonal features between CC, CT, and TT for A1298C, 219A>C(rs1801133). The demographic features (age, duration, type of infertility, cause of infertility and previous trial) were not notably different between women who were pregnant and those who were not. In women undergoing ICSI, the maternal MTHFR polymorphisms is not related to FSH, LH, E2 and AMH. MTHFR polymorphisms therefore don't offer useful information regarding the hormonal levels in our groups.
Stem cell factor (SCF) is one of the first growth factors derived from granulosa cells in the ovarian follicle plays a critical role in hematopoiesis and the generation of melanocytes and germ cells. SCF also serves an important role in the development of the interstitial cells of Cajal in the intestine and the learning functions in the hippocampal region of the brain. This study aimed to investigate the levels of SCF in follicular fluid (FF) and if it can be used as a potential marker for predicting oocyte, embryo quality, and pregnancy rate. A total of 44 infertile couples involved in the study. All of them underwent controlled ovarian hyperstimulation for the ICSI cycle. Antagonist protocol was used as an ovulation induction protocol. Patients were divided into two groups according to ICSI outcomes as pregnant (23 women) and non-pregnant (21 women) groups. A comparison was done in both groups based on the oocyte, embryo quality, and other ICSI cycle characteristics, and follicular fluid stem cell factor level. SCF level was measured by using an enzyme-linked immunosorbent assay. Our study showed lack of association between patients' characteristics which included (age, BMI, infertility duration, type of infertility, and causes of infertility, basal hormonal, stimulation characteristics levels), FF SCF level and the oocyte characteristics comparison (total number retrieved oocyte, germinal vesicle oocyte (GV), MI oocyte and MII oocytes, and the number of injected oocytes, fertilization rate, and embryo characteristics) between pregnant and non-pregnant groups. The present study showed that Mean follicular fluid SCF was significantly lower in pregnant women in comparison with that of non-pregnant women, 135.92±38.96 pg/ml versus 185.15±63.58 pg/ml, respectively (P=0.003). Raised SCF level in FF harms ICSI outcome.
Plasminogen Activator Inhibitor-1 expression in serum and follicular fluid plays a crucial role in regulating fibrinolysis during the pregnancy period by blocking the action of other proteins called plasminogen activators. The aim is to assess the Plasminogen Activator Inhibitor-1 level in blood serum and follicular fluid as a predictive marker of pregnancy. This study included Sixty-nine infertile females undergone ovarian stimulation with antagonist protocol and received recombinant follicle-stimulating hormone, at the cycle day two. The serum and follicular fluid were collected from each female on the day of oocyte retrieval, for PAI estimation using the Elisa kit. The data were analyzed using version 23.0 SPSS and Microsoft Office 2010. The serum PAI-1 levels at the day of oocyte retrievals were significantly lower in positive pregnancy women in comparison with non-pregnant women (p < 0.05), Yet no significant follicular fluid PAI-1 levels were noted in comparison with non-pregnant women. There was a negative significant correlation (p > 0.05) between serum and follicular fluid PAI-1 levels on the day of oocyte retrieval according to oocyte ICSI outcome. The evaluation of serum PAI-1 levels can be used as a promising parameter for the prediction of pregnancy outcomes of ICSI patients. It is assumed that the pregnancy rate was affected by PAI-1 level during ICSI cycles. The concentration of PAI-1 in serum and follicular fluid at the retrieval day is not correlated with the oocyte's maturity.
Hyaluronic acid (HA) is an anionic, non-sulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. The study included 40 infertile females. A full history taking, complete general examination, complete gynecological examination, and infertility workup including basal hormonal analysis, and uterine cavity assessment by ultrasound and tubal patency evaluation by hysterosalpingogram was done in addition to husband’s seminal fluid analysis. The control group did not receive any ovarian stimulation drugs, while the 2 nd group was treated with letrozole + gonadotropin. The ovarian stimulation protocol was chosen for each patient according to her age, history, and hormonal assay. Evaluation of thickness and pattern of the endometrium, size, and the number of mature follicles was performed by transvaginal ultrasonography on the 2 nd day of the menstrual cycle and cycle day 11-14 before hCG injection. The study showed no correlation between HA and LH at triggering day in women who received letrozole plus Gonadotropin but a positive correlation was documented between HA concentration and E 2 in addition to a positive correlation with progesterone, the number of follicles, and endometrial thickness at the day of triggering of ovulation. The study revealed that mean hyaluronic acid concentration was elevated significantly (P<0.05) in pregnant women after stimulation protocol compared with nonpregnant (164.2 vs. 152.1 pg/ml). HA was significantly higher in women who undergo ovarian stimulation with letrozole which was a good protocol in the treatment of women with ovulatory problems.
The selection of protocols in controlled ovarian stimulation during intracytoplasmic sperm injection affect the treatment outcomes. Both GnRH agonist and GnRH antagonist protocols are clinically utilized, therefore comparision of these protocols is important for the evaluation of their laboratory and clinical outcomes.To compares the short GnRH agonist and GnRH antagonist protocols effectiveness in expected normal responder females undergoing intracytoplasmic sperm injection (ICSI). Methods: A retrospective study was involved 60 women aged less than 35 with antimullerian hormone (AMH) more than 2.5 ng/ml. Participants women were assigned to either group1 short GnRH agonist protocol and group2 GnRH antagonist protocol. The outcomes measured including total oocyte, mature and immature oocytes, number and quality of embryo and pregnancy rate.The short GnRH agonist protocol group showed statistical significant benefit in oocyte yield (p- value 0.04), metaphase I (p- value 0.09), metaphase II (p- value 0.03), embryo number (p- value 0.04), embryo quality (p-value 0.01) and pregnancy rate in expected normal responder women compared to GnRHantagonist protocol. The short GnRHagonist protocol reveals favorable ICSI outcomes than antagonist protocol and may be better choice in expected normal responder women.
To explore whether dual triggering for final oocyte maturation using a low dose of recombinant human chorionic gonadotropin (hCG) plus gonadotropin-releasing hormone agonist (GnRH-a) is as effective as the standard dose of recombinant hCG triggering alone in term of a total number of retrieved oocytes, fertilization and pregnancy rate in fresh autologous antagonist intracytoplasmic sperm injection (ICSI) cycles. 80 infertile women undergoing ICSI, aged ˂ 40 years, 18˂ Body mass index ˂30 Kg/m2 included in fresh autologous antagonist ICSI cycles. 40 women received a Standard dose of recombinant hCG (500 µg) alone and 40 women received GnRH-a (0.2 mg triptorelin plus 250 µg recombinant hCG) were used for final oocytes maturation. This study was conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Techniques, Al Nahrain University. The mean total number of retrieved oocytes, fertilization, and pregnancy rate were measured. The mean total oocyte number being statistically higher in the dual trigger group. The mean number of fertilized oocytes and clinical pregnancy rates was higher in the dual trigger group than in the control group, but the difference showed borderline statistical significance. Furthermore, fertilization rates show no statistical difference between the control group and the dual trigger group. Results of the study confirm that dual triggers show favorable improvement in fresh autologous antagonist ICSI cycles with the use of GnRH agonists plus hCG compared with hCG alone for triggering of final oocyte maturation.
Despite many improvements in Assisted reproductive techniques during the last three decades, clinical pregnancy and live-birth rates still nearly 30–40% and 20–30%, respectively. To enhance endometrial receptivity many attempts done one of the endometrial scratching could provoke delay in endometrial maturation reforms asynchrony between endometrium and the concepts and indeed induce wound healing by producing a considerable raise in the local secretion of pro-inflammatory cytokines and growth factors like Heparin Binding Epidermal Growth Factor (HBEGF) and its receptors has role in mediate the receptivity, maturation, and decidualization of endometrium and facilitates the implantation and development of both placenta and embryo. All women were undergone IUI procedure. They divided into two groups. Intervention group who did endometrial scratching by using pipelle catheter in luteal phase of preceding cycle and another blood sample aspirated before scratch. Control group include women without intervention of endometrial scratch. Both groups underwent controlled ovarian stimulation, triggering of ovulation and another blood sample was aspirated at day of IUI to measure level of HBEGF. 14 days later with luteal support, BHCG test underwent in blood to check pregnancy. Higher pregnancy rate among patients with scratch group (5/20) 25% than non-interventional group (3/25)12%. These result showed that HBEGF level in scratch group (386.1±124.7) is significantly higher than control group (279±189.3) as P-value was (0.035). Moreover, the HBEGF level at day of IUI (455.67±157.34) and in pregnant (563.9±163.66) is significantly higher than before scratch in scratch group (279.0±124.67), (406.26±138.89), as P-values were (0.00007, 0.049) respectively. Intentional local damage to the endometrium is a cost–effective procedure can be used to enhance the uterine receptivity that may help to overcome implantation failure problem.
Background: it is important to study a history of the science to appreciate the past as a motive for hard work in the present for better future. In the other hand, the factors affecting pregnancy rate of frozen embryos are yet to be clarified at different embryonic developmental stages. Objectives: to record a brief history of embryo cryopreservation in Iraq and to study many clinical and embryological factors that might affect the pregnancy rate. Subjects, materials and Method: a cross-sectional study of many clinical and em-bryological variable, where120 frozen-thawed embryo transfer cycles enrolled in the study at the period from January 2017 till July 2018. The variables were sta-tistically analyzed first by one factor analysis comparing between pregnant and non-pregnant cases; then by multivariate logistic regression analysis to illustrate main factors without a possible confounder effect. Results: In one factor analysis, the following variables showed a significantly high effect on pregnancy rate (P value <0.001) which are women’s age, women’s weight, number of retrieved oocytes, mature oocytes and good quality embryos, developmental stage, E2 level, and endometrial thickness. While in multivariate logistic regression analysis the women’s weight, the number of retrieved oocytes and good quality embryos were the main factors. Conclusions: it is judiciously to consider these factors while managing infertile couples with embryo cryopreservation programs especially the modifiable fac-tors.
Granulosa cells produce most ovarian function indicators in infertile women like estradiol, AMH, and inhibin B. Female peptide hormone insulin-like factor 3 is produced by theca cell. Signaling of insulin-like factor 3 from theca cell stimulates antral follicle development and theca androgen production. To investigate how INSL3 levels may be a theca cell marker of ovarian reserve and the association with current markers of ovarian reserve, including AFC, FSH, E2, and AMH, in infertile women undertaking assisted reproduction. In this cross-sectional study, 75 Iraqi infertile couples were chosen at Al-Nahrain University's High Institute for Infertility Diagnosis and Assisted Reproductive Technologies from October 2022 to April 2023 for the ICSI cycle. Based on the levels of INSL3 in the serum on the day 2 of the menstrual cycle and on the day of retrieving oocyte in the follicular fluid. A comparison was made with current ovarian reserve markers (AFC, FSH, E2, and AMH) .From 75 infertile women undergoing intracytoplasmic sperm injection (ICSI), 21 of them achieved pregnancy. Positive Significant relations were found between serum INSL3 levels and anti-mullerian hormone (AMH and antral follicle count. there were no significant relationships between follicular fluids INSL3 with serum LH, FSH and E2 . The study provides compelling evidence for the significant role of INSL3 in female fertility and its association with the success of intracytoplasmic sperm injection (ICSI). Positive correlations between serum INSL3 levels and anti-mullerian hormone (AMH) and Antral follicle count AFC indicate its potential involvement in ovarian reserve and hormonal regulation.
Background: Polycystic ovarian syndrome (PCOS) constitutes the most common endocrinopathy of women of reproductive age. Women with PCOS manifest hyperandrogenemia, hyperinsulinemia, and hypothalamic-pituitary-ovarian axis aberrations. Objective: The objective of the present study was to find the prevalence and the presenting features of PCO patients and associated manifestations in relation to biochemical and anthropometric parameters in adult obese women attending obesity research and therapy unit. Methods: Patients diagnosed as PCOS according to Androgen Excess and PCOS Society/2009 criteria were grouped into two groups: those with BMI less than 30kg/m2 and those with BMI 30kg/m2 and more. Blood was drawn for biochemical and hormonal assay. Information tabulated, means and percentages used, and the results were analyzed. Results: The number of adult females 20-40 years of age attending Obesity research and therapy unit (ORTU) during February 2013 to February 2014 was 756, (14.3%) of them had PCOS, (65%) were diagnosed during examination. (94.4%) had menstrual disturbances, (63.8%) had hirsutism and (91.7%) had PCOS ultrasound findings. Mean BMI of the patients with PCOS was 33.62 (SD 4.21). Mean LH exceeded mean FSH in patients with PCOS and it was more evident with increasing BMI where it was doubled in those with BMI more than 30 kg/m2. LH/FSH ratio for BMI above 30 was 2.1, and although testosterone level was elevated showed no statistical relation to BMI. The fasting glucose level, cholesterol and triglycerides levels showed the same pattern of elevation that with increasing BMI. Conclusions: The prevalence of PCOS in females (20-40y) attending ORTU was 14%, of them 65% were undiagnosed before, 63% had hirsutism, 94% had menstrual disturbances and 90% had ultrasonic features of polycystic ovary. These findings suggest the need to stress on diagnosing PCOS in adult female during management of obesity.
Granulocyte colony-stimulating factor (G-CSF), traditionally utilized in hematopoietic disorders, has garnered attention in reproductive medicine for its potential to enhance endometrial receptivity and improve pregnancy outcomes in assisted reproductive technology (ART). This study aimed to compare the effect of G-CSF administration via intrauterine infusion versus subcutaneous injection on pregnancy outcomes in infertile women undergoing IUI, 75 infertile women aged 18–40 years were enrolled and randomly assigned into three groups (n=25 each): Group 1 received 300 µg G-CSF via intrauterine infusion, Group 2 received 300 µg G-CSF via subcutaneous injection, and Group 3 served as the control with no G-CSF treatment. All participants underwent controlled ovarian stimulation followed by IUI. Endometrial thickness and sub-endometrial blood flow indices (PI, RI, V1/V2) were evaluated using Doppler ultrasound. Serum levels of TNF-α, IL-10, and VEGF were measured before and after G-CSF administration. Clinical pregnancy was confirmed by β-hCG testing two weeks after IUI and confirmation by transvaginal ultrasound. Both G-CSF intervention groups demonstrated significant improvements in sub-endometrial blood flow parameters compared to controls, with intrauterine infusion showing the most favorable Doppler indices (p<0.05). Additionally, intrauterine G-CSF administration resulted in upregulation of VEGF and IL-10 and a reduction in TNF-α levels, though differences did not reach statistical significance. Clinical pregnancy rates were higher in the intrauterine group compared to the subcutaneous and control groups, though differences did not reach statistical significance. Intrauterine infusion of G-CSF appears to offer superior benefits in enhancing endometrial receptivity, modulating inflammatory and angiogenic biomarkers, and improving pregnancy outcomes in IUI cycles compared to subcutaneous injection or no treatment. Further large-scale studies are warranted to validate these findings.
Background: Unlike sperm production in men which is continuous, women are born with all their eggs and they do not produce any more. Technique to bank eggs would allow girls and women to have the same reproductive options as men when faced with a serious disease and the long term complications of chemotherapies that threatens to destroy their eggs. Objective: The aim of this study is to improve the efficiency of existing ovarian cryopreservation, by following the most recent method named needle immersed vitrification (NIV) beside the slow freezing method. In this review we discussed also the historical description of the methods used, freezing and vitrification of mature and immature oocytes, this include comparison of principles, procedures and results as reported in the literature. Materials and Methods: A total of 285 fragments of human ovarian tissues were isolated and cryopreserved from 36 women aging 26 - 55 years old in the Reproductive Unit, Lubeck-Germany. Ovarian tissue strips of 1-3 mm thick of ovarian cortical biopsies obtained from patients. The collected human ovarian cortex fragments were assigned to two different cryopreservation procedures, slow-freezing and NIV. On the other hand, a total of 80 patients (100 cycles) with polycystic ovaries (PCO) were underwent in vitro maturation (IVM) treatment. The number of inspirated immature oocytes was 536. Vitrification of immature oocytes were carried out. Results: Successful freezing and storing were performed on 285 fragments of ovarian cortex tissue from 36 patients by two cryopreservation protocols as mentioned before but these tissues do not thaw and use yet. Concerning the IVM, the percentage of maturation, fertilization, survival, embryo transfer, and pregnancy rates were 55.2%, 44.5%, 96.2%, 88.1%, and 10.6%, respectively. Conclusion: Recent advances in freezing technology, modifications of conventional protocols used and continuing optimization of vitrification have efficiently improved the method. These results may lead to increase the possibility of preserving fertility by cryopreservation of ovarian tissue. Ovarian tissue banking can offer hope for cancer patients who want to safe guard their fertility against sterilizing chemotherapy and radiotherapy. Immature oocytes can be successfully isolated from the oophorectomy specimen regardless of the day of menstrual cycle, and undergo IVM and cryopreservation.
Infertility is the disability of a couple to obtain pregnancy after one year of sexual intercourse that is unprotected and regular. Bisphenol A is an industrial chemical spread worldwide, that is a raw material utilized in multiple industries. Bisphenol A is assorted as an endocrine-disrupting chemical, which can interfere with hormone activity. This study aimed to assess the effect of BPA levels in serum on ICSI outcomes. The study was conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies / Al-Nahrain University during the period from October 2021 to April 2022. sixty infertile women enrolled in this study. BPA levels were analyzed through an enzyme-linked immunosorbent assay (ELISA) technique. Mean serum BPA was not significantly higher in non-pregnant women in comparison with that of pregnant women. Serum BPA was positively correlated to immature oocytes (MI) and abnormal oocytes. Also, BPA inversely correlated to Grade1 embryos and positively correlated to Grade 3 embryos. Bisphenol A can be detected in sera of infertile female undergoing ICSI. High BPA level in serum may impact oocyte quality and embryo grading
Background: Polycystic ovary syndrome (PCOS) is the most common and prevalent endocrinopathy in women, and the most common cause of anovulatory infertility. An altered lipid profile is common in polycystic ovary syndrome (PCOS) and is usually characterized by increased total cholesterol, triglycerides, low-density lipoproteins and very low density lipoprotein levels with low high-density lipoprotein. PCOS is associated with a higher frequency of cardiovascular disease because of dyslipidemia. Which are potent markers for cardiovascular risk factors. Metformin, is a widely used antihyperglycemic agent. It decreases insulin resistance and reduces hyperglycemia through a reduction of the hepatic glucose production. Objectives: Determine the beneficial effect of metformin in PCOS patients in reducing lipid profile and subsequently reduction in cardiovascular disease. Method: Measurements and analysis levels of total cholesterol, triglycerides, low-density lipoproteins, very low density lipoprotein and high-density lipoprotein were samples collected at the Institute of embryo research and infertility treatment, Al-Nahrain University. PCOS patients were recruited at the consultant clinic Patients: forty three women with PCOS were studied. Anthropometric data, lipid profile, were evaluated, before oral metformin (500mg/twice daily) treatment and after three months of use. Results: Patients with PCOS after oral metformin treatment, revealed a significant lowering serum concentrations of total cholesterol, triglyceride, low-density lipoproteins and very low density lipoprotein and elevated high-density lipoprotein compared to before treatment. Conclusions: dyslipidemia is common finding in PCOS women, in this study we found that the use of oral metformin tablets 500mg/twice daily for three months will correct lipid profile level (cholesterol, triglyceride, LDL, VLDL and HDL) which is considered as cardiovascular risk factors and this lead to reduce risk of cardiovascular diseases.
Inhibition of luteinizing hormone (LH) by gonadotropin releasing hormone (GnRH) antagonist may lead to suboptimal response during ovarian stimulation. In addition, several studies suggest that low level of LH is associated with lowered fertilization and implantation rate and increased early pregnancy loss rate. The aim of this study is to study the effect of adding low dose human chorionic gonadotropin (hCG - 200 IU), as an LH supplement, to recombinant follicle stimulating hormone (rFSH) in a GnRH antagonist cycles in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Sixty-three infertile women undergoing IVF were randomly divided into two groups. One group was stimulated with the conventional stimulation protocol (rFSH alone), while the second group received 200 IU hCG in addition to rFSH in the late follicular phase (hCG + rFSH). Both groups' results including pregnancy rate, total dose of rFSH required, duration of stimulation, endometrial thickness, oocytes and embryos characteristic, serum hormone levels (Testosterone, Estradiol, Progesterone, and LH) and level of epidermal growth factor (EGF) were compared. The results show that pregnancy rate among the group of women who received the low dose hCG was higher than those who did not receive hCG. However, this difference did not reach statistical significance. Furthermore, other cycle outcomes and hormonal values were comparable between the two stimulation protocols.
It is well known that oocyte quality is essential in the determination of the developmental potential of the fertilized oocytes. The oocyte developmental potential decreases in all species with increasing age. Use of serum and follicular fluid concentration of GDF9 as biomarkers of oocyte and embryo quality and their relation to pregnancy rate. Eighty-eight women were included in this study are selected from those undergoing intra-cytoplasmic sperm injection. Positive pregnancy was achieved by 14 women. The difference in mean serum and follicular GDF9 between pregnant and non-pregnant women was not significant. MI oocyte count was not significantly correlated to serum and follicular GDF9 (p > 0.05). MII oocyte count showed a non-significant correlation to serum and follicular GDF9 (p > 0.05). Grade 1 embryo count showed a non-significant correlation to serum and follicular GDF9. Grade 2 embryo count showed a non-significant correlation to serum and follicular GDF9. Also, grade 3 embryo count showed a non-significant correlation to serum and follicular GDF9. The current study revealed that serum and follicular GDF9 could not be used as indicators for oocyte maturity, embryo quality, or pregnancy rate.
Due to malfunction of the hypothalamus-pituitary-ovary axis and probable dysregulation of ovarian activities, ovary has a large number of small follicles but no developed follicles. L-Carnitine is a tiny, water-soluble chemical that plays a critical role in fat metabolism. It is required for appropriate mitochondrial fatty acid oxidation and acyl-CoA ester excretion, as well as affecting ATP levels. The current study was aiming at evaluating the protective effect of L-Carnitine (LC) against deleterious substances present in serum of patients with PCOS, which may affect the oocyte maturation. 60 infertile women diagnosed with polycystic ovarian syndrome have been enrolled in this study and enter their Intracytoplasmic Sperm Injection (ICSI) cycle; they were informed about the study and signed a written informed consent. They were grouped into treatment group (n=30) who were treated with L-Carnitine® tablet for two months and placebo group (n=30). All enrolled women underwent flexible antagonist protocol for ICSI. Significant increase in mean mature metaphase II (MII) oocyte count in study group than placebo group, oocyte maturity rate was significantly higher in study group in comparison with placebo group. In addition, mean fertilized (2PN) oocyte count was increased significantly in study group in comparison with placebo group. Mean fertilization rate was significantly higher in study group in comparison with placebo group. Treatment with of patients with polycystic ovary syndrome of L-Carnitine resulted better oocyte quality and the improvement in oocyte quality is reflected by mature MII oocytes, maturity rate and fertilized rate with eventual improvement in embryo quality.
Preeclampsia-eclampsia still continues to be one of the major causes of maternal and fetal mortality and morbidity. Recent evidence suggests that there may be several underlying causes or predispositions leading to develop this syndrome, which not only affects the mother but significantly affects the fetal growth and development.The objective of the study was to assess the difference in birth weight in pregnancy with and without preeclampsia . A case – control study at Al-kadhmya teaching hospital The study included 200 pregnant women with singleton viable gestation presented in labor who were admitted to hospital.A comparison of 100 women in the preeclamptic group and 100 women in the non-preeclamptic group in terms of maternal age, parity, gestational age at delivery, placental weight, and fetal birth weight and sex. Detailed obstetric and general medical history was taken and general and obstetric examination performed. The newborn infants were carefully examined and weighed, and the APGAR score was assessed after delivery. The fresh placenta was examined and then weighed with the membranes and cord attached.At low placental weight, preeclampsia had significant association with low birth weight (35%). However, at high placental weight, preeclampsia had non-significant association with high birth weight (4%). Birth weight of neonatal case group was close to birth weight of control group especially at late onset of preeclampsia but this was not significant statistically .Preeclampsia is multisystemic disorder and it is (the disease of theories) these result suggest that preeclampsia may represent different entities with different degree of placental involvement and different degree of fetal growth and development.
Successful implantation needs a receptive endometrium, a functional and normal embryo at the stage of blastocyst developmental and a synchronized dialogue between embryonic tissues and maternal tissues. The current study was planned and conducted to investigate the potential role of vaginal pessary of hyaluronic acid on intracytoplasmic sperm injection (ICSI) outcome. This study included 63 infertile women (32 women as study group receiving hyaluronic acid and 31 control group) who were subjected to ovulation induction programs with gonadotropin releasing hormone (GnRH) antagonist protocols for in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) procedures. Blood samples were taken by Vacutainer tubes and centrifuged according to the manufacturer’s instructions for the preparation of serum samples. Serum samples for Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) were obtained from each patient when the basal hormonal status was determined. The second time point is when the samples were obtained on the day of ova pickup, after that the G1 embryos will be transferred inside the uterine cavity. Then performance of endometrial receptivity parameters or patterns evaluation and patients were followed up to do pregnancy test after14 days after embryo transfer. On the day of human chorionic gonadotropin (hCG), there was no significant difference in mean serum Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) between hyaluronic acid group and reference group, respectively (p = 0.824). There was no significant difference in mean follicular fluid Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) between the hyaluronic acid group and reference group, 0.92 ±0.36 pg/ml versus 0.82 ±0.22 pg/ml, respectively (p = 0.223). Treatment with the hyaluronic acid resulted in non-significant increase in serum and follicular fluid Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1), and this increment is not related to Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) improvement in local blood endometrial blood flow as reflected by reduction in resistive index and pulsatility index with eventual improvement in pregnancy outcome.
Bisphenol A (BPA) is one of the world's greatest produced chemicals. BPA is present in various consumer goods that are commonly used in daily life. It was considered an endocrine disruptor and effects on spermatogenesis and male fertility. To assessment the impact of BPA on male reproductive via evaluation the correlation the concentrations of BPA in blood serum with male reproductive hormone. The study was conducted on 28 men recorded at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies /Al-Nahrain University, private clinic (AL-Zahawi) and Babel Teaching Hospital for Women and Children from January 2022 to April 2022. The blood serum was collected from men. The blood serum samples were assayed the FSH, LH, testosterone and prolactin hormones by mini VIDAS. The residual samples of blood serum were examined BPA concentrations. The measuring of BPA concentration in blood serum by using ELASA Kits. The result of hormones revealed that the correlation between concentrations of BPA and prolactin hormone was slightly positive in blood serum (r = 0.225). There is not detected relationship between BPA and FSH. The BPA concentrations were correlated a negative with testosterone in blood serum (r = - 0.599). Whereas, the LH was correlated slightly positive with blood serum BPA. This study indicated that the BPA in blood serum were highly concentration and there was proof that BPA could effect on male reproductive hormone.
Background:Ovulation disorders, usually presents as menstrual disturbance, are the cause of infertility in around 25% of couples who have difficulty to conceive. The drug most commonly prescribed for the induction of ovulation is clomiphene citrate (CC). If the patient does not ovulate after the use of CC, the choice was to add gonadotropins. Gonadotropin therapy is very expensive with significant risks of high order multiple gestations and ovarian hyperstimulation syndrome. Human chorionic gonadotropin hCG can function as a surrogate for LH and oc-cupies LH receptors for more than 24 hours allowing prolonged stimulation also it has longer half-life and greater affinity for the LH receptor. Objective: The purpose of this study was to compare the effectiveness of low-dose human chorionic gonadotropin (hCG) in the late follicular phase to induce ovulation in clomifene citrate resistant patients who had previously failed to ovulate on clomiphene citrate (CC) alone. Subjects,Materials and Methods: A total of 71 patients who attend infertility clinic in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, where prospectively randomly assigned into two groups. hCG Group received 100 mg dose of CC from day 5 of men-strual cycle for 5 days, then each patient received 200 IU hCG (DICLAIR®) subcutaneous injection daily when the largest follicle mean diameter was 12 mm or larger starting on day twelve of menstrual cycle. Non-hCG group received 150 mg dose of CC from day 5 of menstrual cycle for 5 days, and both groups were monitored with transvaginal ultrasound. Ultrasound measurements of follicle number and growth, ovulation, endometrial thickness and pattern were recorded and compared between the two groups. Student t test and fisher exact test were used for statistical comparison between the two groups. Results: The low-dose hCG group had significantly higher percentage of ovula-tory cycles (80% vs 44.4% P value 0.006). There was no significant difference in the endometrial thickness between the groups but it appears higher in hCG group (10.55±1.82 vs. 9.62 ± 1.87 in non-hCG group, p value 0.056). Non significant but higher incidence of echogenic (luteinized) endometrium 48 hour post ovula-tion in hCG group (36/40 (90%) vs. 20/25 (80%) for non-hCG group p-value = 0.288). Conclusions: The use of low-dose hCG after CC in the late follicular phase re-sults in continued follicle growth, higher ovulation rate. This treatment offers an efficient and cost-effective alternative before gonadotropin therapy for this type of patients.
Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders among females in reproductive age. Women with PCOS have several cardiovascular disease risk factors. Hyperinsulinemia and insulin resistance (IR) which is a known key factor in the development of type 2 diabetes (T2DM) may associate PCOS. Homocysteine, a sulfur-containing amino acid, is toxic to vascular endothelium, leads to early atherosclerosis. PCOS said to be associated with high plasma homocysteine. Objective: To determine the correlation between insulin resistance and homocysteine in PCOS patients. Methods: Patients diagnosed as PCO according to Androgen Excess and PCOS Society/2009 criteria were grouped into two groups: those with BMI less than 30kg/m2 and those with BMI 30kg/m2 and more. Blood was drawn for biochemical and hormonal assay. Information tabulated, means and percentages used, and the results were analyzed. Results: Homocysteine levels were significantly higher (P value < 0.05) in PCOS group (12.28±1.89 µmol/l) as compared to control (9.51±1.92 µmol/l).HOMA-IR was significantly higher (P value < 0.05) in PCOS (4.15±2.54) as compared to control (1.69±0.54) .There was no correlation between IR and homocysteine within PCOS group. Conclusions: Polycystic ovarian patients have higher levels of homocysteine and IR compared to control but there is no correlation between IR and homocysteine within PCOS group.
CA125 is a glycoprotein mucins (MUC16) tumor marker, used in screening, ovarian and endometrial malignancies and in monitoring therapy, early recurrences, and prognosis of these cancers. Hormonal induction for ovulation can elevate the risk of ovarian cancers so CA125 may be used for screening in PCOS as an unsafe group and the way of treatment may need to be changed in these patients. Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal disturbed diseases that can affect females in reproductive life. It has both metabolic and fertility impacts that can be seen in the reproductive period and post-menopausal life. To study the correlation between PCOS and CA125 level in relation to body weight in non-cancerous patients. 60 women were selected with age 18-42-year-old forty of them were diagnosed with PCOS according to Rotterdam criteria. They were divided into two groups according to BMI G1 was more than 25 kg/m 2 (overweight and obese) G2 was less than 25 kg/m 2 (normal) and the G3 was 20 healthy non-PCOS BMI less than 25 kg/m 2 . Blood samples were taken in the early follicular phase for assessing luteinizing hormone (LH), follicular stimulating hormone (FSH) and, free testosterone (FT) hormone. Other blood samples were taken at the late follicular phase to measure CA125 levels using Enzyme-Linked Immune Sorbent Assay (ELISA). PCOS G2 were significantly higher in the concentration of CA125 than PCOS G1 (p< 0.05), but there was no significant difference in CA125 level in groups when there is no significant difference in body mass index (BMI) between PCOS G1 and G2. P>0.05. The negative relation between CA125 concentration and weight. The tumor marker CA125 efficacy is decreased in obese women. Furthermore, PCOS not causes an increase in CA125 in the non-cancerous patient.
Background: Polycystic ovarian syndrome (PCOS) is the most common cause of hyperandrogenism anovulatory infertility; it affects 5-10% female reproductive age. The present study aims to investigate the total prostate specific antigen levels, total serum testosterone, FSH and LH in women with PCOS and compare the results with control group of normal fertile females of corresponding age group on Iraqis PCOS patients. Materials and Methods: Seventy patients with PCOS diagnosed depending on three criteria: Menstrual history: Oligomenorrhea, Ultrasound reveals polycystic ovaries and Biomedical and/ or clinical hyperandrogenism. Twenty normal fertile females who serve as control group in this study. Blood samples were aspirated from all individuals from 2-4 day of menstrual cycle to measure total prostate specific antigen(PSA), total testosterone and FSH, LH. Results: Patients with PCOS and controls differed significantly in PSA, Total serum testosterone (p<0.05). Patients with PCOS and controls have highly significant difference in LH level, the mean was (7.88±1.83 vs 3.90±0.73) respectively highly significant difference in LH/FSH ratio and BMI parameters (p<0.001). No significant differences were found in FSH (p>0.05). Positive correlation between PSA and testosterone, PSA and BMI. Conclusion: Total serum prostate specific antigen levels are higher in patient with PCOS. Total testosterone levels are higher in patient with PCOS. Serum PSA measurement might be marker of hyperandrogenism in females suffering from PCOS.
Infertile couples undergoing Assisted Reproductive techniques are really receptive to any intervention intended to enhancement their fertility. Successful implantation of an embryo requires a receptive endometrium, a good quality embryo, and embryo endometrial synchronization in all species. Pharmacological agents such as aspirin and sildenafil have been included in previous clinical trials to improve endometrial vascularity and perifollicular blood flow but the results were inconsistent. To evaluate the effect of oral low dose aspirin or vaginal sildenafil citrate on endometrial thickness, retrieved oocyte, degree of maturation, embryo quality and pregnancy test. This comparative prospective study was conducted on the 60 infertile women who participated in intracytoplasmic sperm injection (ICSI) cycles at the infertility clinic associated with the "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University / Baghdad/ Iraq." December 2020 to June 2022. In the present study the count of total oocytes retrieved was significantly higher in aspirin treated group in comparison to sildenafil treated group 12.5 ±5.3 versus 9.37 ±5.5 respectively. No significant variation in mean endometrial thickness among study groups. Regarding biochemical pregnancy test, positive results were obtained in 12 (40.0 %), 10 (33.3 %) in aspirin treated group, sildenafil treated group respectively and the difference was not significant. Aspirin treatment resulted in higher number of total retrieved oocytes, aspirin and sildenafil did not improve endometrial thickness, but they resulted in improvement of sub endometrial vascularity; however, biochemical pregnancy test was not affected by either pharmacological agent.
The estimation of oocyte quality in human in vitro fertilization (IVF) is an important point for the embryologists. Oocyte selection and the identification of the best oocytes may help to limit an overproduction of embryos and to improve the results of oocyte cryopreservation programs. The follicular fluid (FF) can be provided easily during oocyte pick-up and known to represents an optimal source for non-invasive biochemical predictors of oocyte quality. However, till now no substance was found to be used as reliable markers of oocyte competence to fertilization, embryo development and pregnancy. Metabolism and ATP levels within the oocyte and adjacent cumulus cells are associated with quality of oocyte and optimal development of a healthy embryo. Lipid metabolism provides a potent source of energy and its importance during oocyte maturation is being increasingly recognised. Objectives: To determine the effect of lipids (Cholesterol. Triglyceride and HDL) level in serum and follicular fluid in predicting oocyte quality, embryo quality and outcome in patients undergoing intracytoplasmic sperm injection program Patients and Methods: Fifty eight (58) infertile women with an age range 21-41 years old undergoing intracytoplasmic sperm injection cycles were included in this study. Lipids (Cholesterol. TG and HDL.,) levels in serum and follicular fluid were measured by auto analyzer for biochemistry (Flexor El_200) and correlation with oocyte quality, embryo quality and ICSI outcome was done. Results: The results of this study showed no significant (p<0.05) difference in lipid levels in serum and follicular fluid between pregnant and non pregnant females as well as non significant correlation was found between lipid level in serum and follicular fluid in relation to oocyte quality and embryo quality. Conclusions: Serum and follicular fluid lipids are not good predictors of oocyte quality, embryo quality or ICSI outcome in women undergoing IVF/ICSI cycles. Accordingly, these biomarkers would be less reflective of the follicular environment and that the effect of maternal metabolic disorders on oocyte quality and fertility outcome is complex and of a multifactorial kind.
Various types of anesthetic techniques were described for oocyte recovery. Different anesthetic agents have been used with different effects on oocyte quality and embryonic development and studies on the potential toxicity of general anesthesia ended up with conflicting results. Many experiments as well as human studies documented the existence of anesthetic agents in the follicular fluid (FF) with possible adverse effects on the oocyte quality and subsequent embryo development. Ketamine and remifentanil were used for the studied groups to compare oocytes and embryos characteristic of infertile women during oocytes retrieval under general anesthesia: one group receiving ketamine, midazolam, and propofol and the other group receiving remifentanil, midazolam and propofol. 60 infertile females were undergoing intracytoplasmic sperm injection categorized in two groups, group I received midazolam, remifentanil and propofol; whereas, group II received midazolam, ketamine and propofol. There was highly significant difference in mean abnormal oocyte between ketamine and remifentanil groups. Grade III embryos were significantly limited to ketamine group. FF ketamine and remifentanil were not significantly correlated to any of oocyte characteristics or embryo characteristics. Anesthetic agents, ketamine and remifentanil, were detected in the FF of infertile women and within recommended doses. Ketamine resulted in adverse effects on oocyte and embryo quality in comparison with remifentanil represented by greater percentage of abnormal oocytes and that bad quality embryos were limited to ketamine group.
Infertility is prevalent among couples in our community, and a considerable number of cases of infertility are caused by tubal factors. The hysterosalpingography (HSG) technique is one of the most important tools for determining the patency status of the tubes. Nevertheless, this method has certain drawbacks that can be addressed with a less invasive alternative, such as hysterosalpingo-contrast sonography (HyCoSy) and hysterosalpingo- foam sonography (HyFoSy) .By enrolling subfertile patients undergoing hysterosalpingo- foam sonography (HyFoSy) or hysterosalpingo-contrast sonography (HyCoSy) procedures and subsequently undergoing intrauterine insemination (IUI), this study sought to evaluate the pregnancy rate in a large single center prospectively . Between January 2024 and January 2025, 100 women who underwent IUI as a therapy modality for infertility at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in Kadhimiya city, Baghdad, were involved in this randomized controlled research. Those who underwent hysterosalpingo-contrast sonography with foam (HyFoSy) or HSG evaluation of the fallopian tube were included. The main results were a biochemical pregnancy test (blood test) and clinical pregnancy verified by ultrasonography at 6–8 weeks gestation . When comparing the HyFoSy and HyCoSy groups, the mean serum levels of estradiol, FSH, LH, prolactin, TSH, and testosterone did not differ significantly (p > 0.05). Differences in the mean length of infertility, the mean ova size, the mean ova count, the average endometrial width (ET), the average number of antral follicles (AFC), and the forms of infertility (p > 0.05). Sixty-eight percent of the HyFoSy group and forty percent of the HyCoSy group experienced successful pregnancies, with a significant difference (p = 0.005) . These results imply that HyFoSy might be better than HyCoSy when tubal evaluation is required before IUI, assuming they are validated in bigger multi-center trials. Future studies should investigate long-term results, such as live birth rates, and include a control group (IUI without prior tubal evaluation).
Node-like receptor pyrin 3 is a tripartite protein composed of an amino-terminal pyrin domin (PYD), nucleotide binding NACHT domine, and a carboxy-terminal leucine-rich repeat (LRR) domine, and consider an intracellular sensor that detects a broad range signal and resulting in the formation and activation the NLRP3 inflammasome. This complex lead to the release of the inflammatory cytokines IL-1β, IL-18 which is important for host defense against invading pathogen. Modern evidence indicates that the NLRP3 inflammasome is involved in gestational hypertension. This study was conducted on fifty pregnant women and divided into two groups: 25 placentas from normotensive mothers having no hypertension before as the control group and 25 from gestational hypertension women as gestational hypertension group, obtained from the Department of Obstetrics and Gynecology in Almosil El Aam Hospital and Alkhanssa Teaching Hospital, Mosul city, Iraq. The placental tissue samples were collected from the central region and processed for an immunohistochemical technique to t h e expression of NLRP3 in placental tissue. The immunohistochemical study of t h e placenta of the gestational hypertension group showed the localization of NLRP3 protein and staining intensity in trophoblast, stroma, and endothelium villi were high quantification compared with placenta from the control group.
There is a relation between adipose tissue and macrophages. These macrophage cells influence adipose tissue by releasing many bioactive chemicals, including the wingless-type MMTV integration site family 5a (wnt5a) glycopeptides and the more traditional cytokines. Healthy adipocytes can release the wnt5a inhibitor Secreted frizzled-related protein 5(SFRP5). However, this protective effect was found to be reduced in obesity. This study aimed to assess the effect of follicular and serum levels of SFRP5 as well as serum and follicular levels of wnt5a on ICSI outcome and determine the potential roles of SFRP5 as a predictor of positive pregnancy in Iraqi infertile females undergoing ICSI with different body mass index .Ninety infertile females who received intracytoplasmic sperm injection and had various infertility factors between 18 and 45 years participated in this prospective clinical cross-sectional study. Follicular fluid, serum SFRP5, and serum and follicular fluid wnt5a levels were measured for all participants on the day of ovum pickup. In addition, ICSI outcomes were determined. There was a significant difference in the mean total gonadotrophin dose used among the three studied groups (p = 0.023), higher in overweight and obese females than normal-weight females. There was a positive significant correlation between serum plus follicular fluid wnt5a and total gonadotropin dose. Serum and follicular fluid SFRP5 levels were significantly higher in normal-weight females. There were higher serum (p-value=0.002) and follicular fluids (p-value=0.005) SFRP5 levels in pregnant females. Both SFRP5 and wnt5a glycoproteins were detected in infertile women's serum and follicular fluid. Serum and follicular fluid secreted frizzled-related protein 5 level positively associated with ICSI outcome. The cutoff values for serum and follicular fluid SFRP5 were ≥15.86 (ng/ml) and ≥ 11.3(ng/ml), respectively, as predictors of positive pregnancy in women undergoing IVF/ICSI cycles. Obesity, BMI, SFRP5, wnt5a, ICSI Outcome
Female infertility is caused by ovulation issues, tubal disorders, uterine abnormalities, endometriosis, and peritoneal factors. For years, intrauterine insemination has been used to treat infertility alone or with ovarian stimulation. Obtaining adhesion ligands and losing inhibitory components are necessary for pregnancy. LIF promotes and differentiates proliferation and differentiation in embryonic, hematopoietic, and endothelial cells. LIF also controls prostaglandins (PGs), which mediate implantation and decidualization. The measuring hormone profile on cycle day 2 before control ovarian stimulation including FSH, LH, E2, Prolactin, TSH, and AMH. Serum LH, E2. The progesterone level was estimated on the day of triggering. The effect of LIF gene genotypes on hormone level. The hormone levels of 100 intrauterine inseminated women were measured on the second day of the cycle and the day of ovulation. DNA extraction for LIF gene variation detection utilizing sequencing and HRM. The current study found no significant differences between pregnant and non-pregnant groups for hormone levels, genotype, and genetic effect on female hormone levels with (P ≥0.05). The LIF gene did not affect hormone levels in infertile females may be due to the tiny samples or the complex signaling chain that happens during implantation.
Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility and is associated with an increased risk of premature luteinizing hormone (LH) surges during controlled ovarian stimulation. Progestin-primed ovarian stimulation (PPOS) using Medroxyprogesterone Acetate (MPA) has emerged as a convenient alternative to conventional gonadotropin-releasing hormone (GnRH) antagonist protocols. This study aimed to compare the effects of MPA-based PPOS and GnRH antagonist protocols on oocyte yield, maturation, fertilization, and embryo quality in women with PCOS undergoing ICSI . This prospective, randomized, open-label controlled clinical trial included 108 women with PCOS undergoing ICSI at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq, between 2023 and 2024. Participants were allocated to an MPA-based PPOS group (n=49) or a flexible GnRH antagonist group (n=59). Oocyte yield, metaphase II (MII) oocytes, fertilization rate, embryo quality, ovarian sensitivity index (OSI), gonadotropin consumption, stimulation duration, and LH profiles were evaluated.No significant differences were observed in baseline characteristics or hormonal profiles between groups. The MPA group showed a numerically higher number of retrieved oocytes (20.65 ± 7.50 vs. 13.39 ± 4.41; p=0.083) and MII oocytes (15.10 ± 5.20 vs. 11.24 ± 4.12; p=0.09), although these differences were not statistically significant. Fertilization rates were comparable between groups (72.4 ± 10.6% vs. 71.2 ± 11.3%; p=0.68), as were embryo quality, OSI, gonadotropin consumption, and stimulation duration. Both protocols effectively suppressed premature LH surges without premature ovulation or cycle cancellation. MPA-based PPOS appears to be an effective and practical alternative to GnRH antagonist protocols for PCOS patients undergoing ICSI, providing comparable fertilization and embryological outcomes with effective LH suppression. Its oral administration and potential cost advantages may be particularly valuable in resource- limited ART settings.
Reactive oxygen species (ROS) are active chemical compounds created by the body's metabolic process and are crucial in human reproduction. Excessive ROS can contribute to oxidative stress, which has been linked to poor fertility. Embryo culture medium plays an essential role in IVF/ICSI cycles. Eighty participants underwent ovarian stimulation and ICSI cycles; ROS levels were measured in blood samples on the ovum pickup (OPU) day and in each embryo culture dish on ET day using enzyme-linked immunosorbent assay (ELISA). These values were associated with the quality of generated embryos. Women were divided into two groups; the first had day three embryo transfers, whereas the second received blastocyst transfers on day 5. Grades I embryo count was shown to be inversely related to the serum and culture medium ROS levels. Pregnant women had significantly greater levels of GI embryos (p=0.011) and lower levels of GIII embryos (p=0.024). Pregnancy rates for the third-and fifth days of the embryo transfers were 24% and 50%, respectively, with (p=0.045). Pregnancy success rates were increased after ET day five and were strongly influenced by transfer day. Blastocyst-stage embryos with high serum ROS levels were found to be underdeveloped. Culture medium ROS levels can be used as an adjuvant criterion for embryo selection and metabolic marker for developing embryos.
Reactive oxygen species (ROS) are believed to play an important role in the function of the male and female reproductive system, as well as in embryonic development. If the balance between production and elimination of ROS is disturbed, pathogenic consequences would happen. Reactive oxygen species can sometimes exert damaging effects when overabundant, oxidative stress is hypothesized to have a negative impact on, for example, folliculogenesis, embryo development, oocyte maturation, oocyte fertilization, endometriosis, polycystic ovary syndrome and unexplained infertility .8-Hydroxy2-desoxy guanosine (8‐OHdG) is a sensitive indicator of DNA damage as a result of oxidative stress. The study aim was to evaluate follicular fluid levels of 8-Hydroxy2-desoxy guanosine in patients undergoing Intracytoplasmic Sperm Injection (ICSI) and compared the results between both pregnant and non-pregnant patients . One hundred and twenty-seven women included in this study, they underwent controlled ovarian hyper stimulation, program followed by ova pick up, at that time follicular fluid were obtained and freezes till the time of analysis for reactive oxygen species (ROS), patient injected oocyte was cultured in CO2 incubator, then embryo grading, embryo transfer, pregnancy rate and reactive oxygen species level were determined. Follicular fluid 8-OHdG was significantly lower in pregnant females (p < 0.001), 8-OHdG had negative correlations with grade 1 and grade 2 embryos and negative correlation with total blastocyst count. Follicular fluid levels of 8-OHdG provides sensitive tool to predict positive pregnancy outcome in women undergoing ICSI.
Kisspepetin is considered as a key regulator of reproduction, through its direct role in controlling the hypothalamic pituitary gonadal axis necessary for controlling the ovulatory process and indirectly by impacting glucose heamostasis and metabolism. We aimed to examin the correlation between body mass index and level of Kisspeptin in serum and follicular fluid. This study is a cross sectional study done on (80) infertile Iraqi patients aged (18-40 years) scheduled for fresh intracytoplasmic sperm injection cycle. This study is conducted in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies of Al-Naharin University, from September 2020 to May 2021. For each participant, the GnRH antagonist protocol was used to hyperstimulate the ovaries, and samples from serum and follicular fluid were obtained at day of oocytes retrieval for measuring Kisspeptin level using enzyme linked immunosorbent assay (ELIZA) technique. Serum and follicular fluid Kisspeptin were insignificantly increasing with the increase in the BMI (p value =0.406) (p value = 0.352) respectively. Serum and follicular kisspetin were positively and significantly correlated (r = 0.536, p value= 0.000). Serum and follicular fluid kisspeptin were numerically increasing with the body mass index of infertile women, although this increament is statically insignificant, serum kisspeptin can be used as a mirror image to follicular fluid kisspeptin as there was a statistical association between them in this study.
Background: Azoospermia is defined as the lack of sperm in male ejaculate and is suggested to be present in about 1 % of all males and to account for 10-15% of the causes of infertility in men. The development of intracytoplasmic sperm injection (ICSI) as an effective therapy. Embryo grading has gained special attention in published literature regarding its predictive role in pregnancy outcome following ICSI; however, substantial controversy is present that justified the carrying out of the present study. Objective: To study the association between embryo quality and pregnancy rate in women of males with azoospermia. Patients,Materials and Methods: This prospective cohort study included 60 patients with azoospermia, 15 male with obstructive type and 45 males with non-obstructive type.Those patients were randomly selected form the population of infertile couples who regularly visits the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies and from Kamal Al-Samarrai Hospital -Center for Infertility Treatment and IVF. Results Pregnancy was encountered in 7 patients (23.33%). It was not statistically associated with type of azoospermia (P=0.388), also it was not affected by age and serum hormonal level, but highly determined by good quality of embryo. Quality of embryo was graded from 1 to 4. The lower the grade, the better the quality of the embryo was. Quality of embryo was not significantly correlated with type of azoospermia, age and hormonal levels. Conclusions Good quality of embryo is a significant predictor of positive pregnancy outcome in ICSI and the quality of embryo is not affected by age of male patient or type of azoospermia.
Poor ovarian responders (PORs) are characterized by decreased the response of the ovaries to stimulation. Nowadays, using soft protocol of low doses of Gn with/without oral compounds such as letrozole was accepted as a good option. The endometrium receptive parameters include sub endometrial resistance, pulsatility index and endometrial thickness. Eighty infertile POR women divided to two equal groups and undergoing IVF/ICSI antagonist protocols. One group underwent soft protocol using letrozole 2.5mg twice daily for 5 days starting from cycle day 2-3 overlapped low-dose Gn (225 IU) from cycle day 4-5. Other group received high dose Gn only (450 IU) from cycle day 2-3. Both groups continued stimulation cycle until the day of trigger using the flexible antagonist protocol. Estimation of values of sub endometrial RI and PI with endometrial thickness by 2 Color Doppler ultrasound was performed at day of trigger, OCP and ET. There was no significant difference for endometrial thickness at day of trigger, OCP and ET. There was significant difference in means of sub endometrial RI and PI at day of trigger, OCP and ET (P>0.05). This study showed evidence in favor of soft protocol for POR regarding pregnancy rates in spite of the statically difference in means of sub endometrial RI and PI associated with much less cost effectiveness.
Background: The effects of Lead and other essential metal like zinc and copper on the reproductive system have been previously reviewed. Objective: Our goal in this study was to estimate the levels of Lead, Zinc and Copper in patients with polycystic ovary syndrome and to confirm the effect of such metals on the female reproductive system at environmental exposure. Materials and Method: Fifty two women in their reproductive age (20-40) years old, which had been diagnosed as PCOS. Venous blood sample were taken from each patient and control, blood lead, zinc and copper were determined by atomic absorption spectrophotometer. Hormone assay were determined by ELISA (Enzyme Linked Immune Sorbet Assay) technique. Results: This study showed a significant increase of blood lead and serum zinc, copper (p<0.01), in addition to testosterone, lutenizing hormone, LH/FSH ratio and body mass index (BMI) (p<0.05) in patients with polycystic ovary syndrome when compared with control. Conclusions: On the basis of the observations of the present study, it can conclude that the increased levels of Lead as a result of the exposure to this metal may be a risk factor for the development of polycystic ovary syndrome in women and has adverse effects on female endocrine and reproductive function.
The crosstalk between a receptive endometrium and a functional blastocyst during human embryo implantation is crucial for conception. Because platelets rich plasma (PRP) with concentrated platelets 4-5 times higher than normal, when release of granules containing growth factors including VEGF, TGF, PDGF, IGF, and EGF, these factors involved for sub endometrial angiogenesis and endometrial receptivity. 44 women under the age of 40 were given antagonist ovarian stimulation treatments, the oocytes were harvested utilizing 2-D power doppler ultrasound guidance, then ICSI done for them. On the hCG day all had an intrauterine autologous PRP infusion. Power Doppler is utilized to measure endometrial thickness (EnT), pulsatility index (PI), and resistance index (RI) of sub endometrial arteries, as well as serum levels of VEGF and EGF were measured on the hCG day and ovum pickup (OPU). The ultrasound findings, on the hCG day compared to those of OPU in all women with intrauterine infused autologous PRP were highly significant (HS). The mean EnT, RI, PI, VEGF and EGF at OPU day was lower than that on hCG day in a HS manner, with (p < 0.001), (p < 0.001), (p=0.047), (p < 0.001), and (p<0.001) respectively. These characteristics were shown to be significantly and independently associated to intrauterine PRP infusion. After PRP injection, both growth factors serum levels (VEGF and EGF) increased, and ultrasonography sub-endometrial metrics such as EnT, RI, and PI changed as the thickness grew while vascular resistance decreased, and all considered as predictors of endometrial receptivity.
Background : The overall success rate of assisted reproductive techniques is only about 30% due to certain limiting factors. Endometrial scratching could induce inflammatory response which manifested by the up-regulation of different cyto kines and chemokines with subsequent accumulation of immune cells in the in jured site. One of the most important cytokine in this regard is TNF-α which was found to induce tissue remodeling by stimulating the production of many other pro-inflammatory cytokines. Objectives: To investigate the role of endometrial injury during the luteal phase before ICSI cycles in the enhancement of pregnancy outcomes. Materials and Methods: This prospective study was undertaken in the High In stitute of Infertility diagnosis and Assisted Reproductive Techniques / Al-Nahrain University. All women were undergone ICSI cycles. Women in the intervension group underwent endometrial scratching with a Pipelle catheter in luteal phase preceding cycle. Blood sample was taken before scratch. All patients undergo controlled ovarian hyperstimulation, oocyte retrieval and embryo transfer, anoth er blood sample was taken at day of embryo transfer to measure level of TNF-α. Clinical pregnancy rate then evaluation after luteal support of two weeks. Results: The patients in scratch group has higher pregnancy rate (14/23) 60.9% than non intervention group (11/33) 33.3% although not significant (p value 0.057). The results showed that the TNF-α after scratch (54.53±10.2) was significant ly higher than before scratch (39.26±14.74) in the same group, as p value was ( <0.001). In addition the TNF-α was significantly higher in scratch group (54.53±10.2) than control (25.91±9.08) as p value was (< 0.001). Conclusion: Induced endometrial local injury is an easy, simple and cost-effec tive technique that can be used to improve the uterine receptivity and enhance embryo transplantation.
Background: The evaluation of ovarian reserve has been, and still, the focus of substantial clinical research. The assessment of ovarian reserve is valuable for determining stimulation protocols, and because of limited predictive value of age alone, or other passive hormonal analysis in estimating response to the exogenous stimulation, Dynamic research was done on serum inhibin B. Objective: Measurement of serum inhibin B as a predictive evaluation of early ovarian response following ovulation induction program in intrauterine insemination(IUI). Materials and Methods: Thirty couples were involved in IUI program. They divided into two groups: group (1) 15 women were treated by Gonadotropin(Gn) recombinant follicle -stimulating hormone (rFSH). While group (2), 15 women were treated by Clomiphene citrate (CC). Treatment started at day 3 of the menstrual cycle. Serial hormonal profile tests namely; Inhibin B, Estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH) were done at days 3, 7 of the menstrual cycle and the day of human chorionic gonadotropin hormone (hCG) injection with recurrent ultrasonography (US) to confirm the number and development of the follicles. Results: There was a significant difference in the level of inhibin B (P< 0.05) between day 3 and 7 of the cycle with the mean of the follicle number 1.67±0.18 in group(1), while in group (2) there was a non significant difference (P>0.05) in the level of inhibin B between day 3 and 7 of the cycle with the mean of the follicle number 2.14±0.17. Percentage of pregnancy rate in IUI in this study was 19.23%. Percentage of pregnancy rate in group (1) was 25%,while in group (2) was 14.28%,but there is a significant difference (P<0.05) in the pregnancy rate between the two groups. Conclusion: It was concluded that serum inhibin B obtained at day 7(day 5 of (Gn) therapy) offers an early and accurate prediction of ovarian response to (Gn) stimulation while there was no significant change in the level of inhibin B between day 3 and 7 of the cycle in patients treated by CC.
Prelabour rupture of membrane (PROM) is a cause for 85% of the neonatal period morbidities and fatalities. PROM is the main cause of preterm deliveries and accounts for 30-40% of these cases, indeed it complicates three percent of all pregnancies. The fetal and maternal mortality and morbidity risks of PROM, increases when the rupture occurs early in the course of pregnancy. In this study we sought to compare the detection efficiency of the standard diagnostic test of PROM with other new methods such as urea and Creatinine of vaginal fluid and Amnisure tests. The study sample is composed of 90 women divided into three groups; each woman had informed consent, questionnaire with full history, clinical examination (general and abdominal and sterile speculum examination to detect cervical dilatation, amniotic fluid leakage for sample collection to do Fern, Amnisure, Creatinine and urea tests. General investigations and ultrasound were done for each patient. Mean vaginal fluid Creatinine level among the group (1) were 0.44±0.14, versus 0.38±0.12, and 0.24±0.08 among group (2) and (3) respectively. When the results of the tests compared with the standard method of diagnosis, the specificity was 100% for Amnisure, vaginal fluid Creatinine and urea, while it was 80% for fern test. The sensitivity was 97% for Amnisure, 95% for vaginal fluid urea, 91% for vaginal fluid Creatinine and 60% for fern test. Amnisure is superior for other tests followed by vaginal fluid urea level, Creatinine and lastly Fern test.
Background: The brain seems to be inherently feminine. Masculine characteristics of the structure and functions are imposed on developing CNS by the action of testicular hormones during a critical embryonic period. Testosterone is a prohoromone responsible for sexually dimorphic characteristics of the brain. A number of structural sex differences in the human brain have been reported, but their functional significance are less well established. Brain function in men appears to be more lateralized than women and this may be the reason that women are more likely than men to recover speech, after a stroke that damages cortical speech areas. Objective: this study examines the effects of testosterone on sexually dimorphic nucleus of the rat spinal cord i.e. the spinal nucleus of the bulbocavernosus muscle, which innervates two sexually dimorphic, androgen-sensitive perineal muscles that are active during copulation, the bulbocavernosus and levator ani. Methods: the study was performed on litters of albino rats. Their pregnant mothers received on embryonic days (E16-E20) subcutaneous injection of 2mg of testosterone propionate. The spinal nucleus of bulbocavernosus was examined in control group, female litters with and without prenatal testosterone injection. Results: It was demonstrated that perinatal injection of testosterone prevented the involution of spinal nucleus of bulbocavernosus in the female rats. Conclusions: It is concluded that androgens have a sparing effect on the motor neurons of this nucleus that prevent the developmental cell death of neuronal cells. The mechanism of the effects of androgen are discussed, whether it is through direct effect of androgen on motor neurons themselves, or indirect effect as a result of the androgen action on the target androgen-sensitive perineal muscles.
Background: Since 1999 the World Health Organization (WHO) recommended the assessment of sperm morphology by Kruger strict criteria (KSC). The manual of WHO contains the cut off values of sperm morphology measured by KSC for normal subject and patients treated by in vitro fertilization (IVF) and intra- cytoplasmic sperm injection (ICSI) without any information regarding intrauterine insemination (IUI). Objectives: The objective of this study is to achieve two major goals that are:1- Assessment of sperm morphology by applying KSC, using two different biological stains, named commercially Testsimplets (TS)pre-stained slides and Sperm-O-Scan (SOS)stain 2- To have a cut off value for morphologically normal sperm that resulting into a successful IUI outcome. Materials and Methods: Fifty five unselected couples attending the Institute of Embryo Researches and Infertility Treatment were included in this prospective study from December 2007 till August 2008. The mean age of male partner was 31.7±1.87years with an average duration of 6.25±1.65years of infertility. The women were prepared for IUI. All the males were subjected to semen analysis with in vitro sperm activation using layering swim-up technique. Assessments of the morphologically normal sperm (MNS) of the samples were performed by using both, High power field and KSC by using TS and SOS stains before and after the activation. Correlation of the positive IUI results and MNS by KSC waw recorded denoting the cut off value for successful results. Results: The mean of morphologically normal sperm applying KSC with the use of SOS stain before in vitro sperm activation was 16.10% and after activation was 37.85% and by using TS stain before in vitro sperm activation was 15.14% and after activation was 37.09%. No significant (P>0.05) differences was detected between the results of MNS of the two stains. The result of IUI was 11 positive pregnancies out of the 55 cases. The mean of MNS using KSC for these positive cases was 11.58% and 12.84% for SOS and TS stains, respectively. Conclusions: The cut off value of MNS by applying KSC and using two different biological stains for a successful IUI program was 11.58% by SOS stain and 12.84% by TS pre-stained slides. Although the study found no statistical differences between the two stains, TS found to be easier, simpler and less time consuming technically than SOS stain.
The research objective was to evaluate the blood vitamin B12 levels in females before and after two months of vitamin B12 supplementation. Additionally, the study intended to investigate the effects of this supplementation on antral follicle count (AFC), the number of dominant follicles (DF), the outcome of intrauterine insemination (IUI), and the effect of the outcome by age, and BMI, cause of infertility and types of infertility . A randomized controlled trial was undertaken, including 100 couples that have provided comprehensive data. Segregated into two equivalent groups based on their vitamin B12 intake. Groups A and B, group. Group A comprises 50 pairs of individuals using B12 supplements for eight weeks, and Group B contains no additional elements. Collect blood and seminal plasma samples from all couples to assess their vitamin B12 levels. The two groups underwent ovulation induction and intrauterine insemination (IUI) concurrently with the medical evaluation. Group A started after two months of supplement, but Group B began immediately. Vitamin B12 increases female blood levels, antral follicle count, and dominant follicles (DF). The pregnancy rate has little effect. The antral follicle count and numbers of dominant follicles did not differ between pregnant and non-pregnant women after vitamin B12 supplementation.
The compromise of uterine receptivity is one of the main reasons for the failure of assisted reproduction techniques. Leukemia inhibitory factor is one of those molecular parameters that allow us to identify an endometrium as receptive. Platelet rich plasma (PRP) contains a range of cytokines and growth factors including leukemia inhibitory factor that encourage the migration, proliferation, and differentiation of cells. Treatments for antagonist ovarian stimulation were administered to 75 women under the age of 40, and 2-D power doppler ultrasound was used to guide the oocyte harvest. Patients were allocated into three groups according to the time of intrauterine infusion of PRP (no PRP, PRP at triggering day and PRP at ova pickup day). Power Doppler is utilized to measure endometrial thickness (ET), pulsatility index (PI), and resistance index (RI) of sub endometrial arteries, as well as serum levels of leukemia inhibitory factor (LIF). The mean endometrial thickness as well as serum level of LIF in PRP trigger group were higher, resistance index and pulsatility index were lower in a significant manner than control and PRP ova pickup group at all the days of study (triggering, ova pickup and embryo transfer days). These findings revealed that intrauterine PRP infusion on ova pick up day is associated with a significant increase in serum level of LIF that in turn enhances endometrial thickness for patients scheduled for intracytoplasmic sperm injection (ICSI).
Luteinizing hormone (LH) plays vital role for optimal follicular growth, maturation and is responsible for inducing ovulation, various protocols in ICSI cycles used to prevent the premature surge of luteinizing hormone. Currently, flexible GnRH antagonist protocols appears to be mostly used protocols. individualization of controlled ovarian hyper stimulation (COS) needs better timing of antagonist administration, assessing variation in LH levels during COS helps in determining appropriate initiation of inhibition .This prospective comparative observational analysis was made on one hundred twenty females with infertility who were undergoing ICSI flexible antagonist protocol at the “High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/Al-Nahrain University” from October 2020 to April 2022, primary infertility was the with higher percentage (78.3%) than the secondary type. However; the main cause of infertility among the participant was male type (36.7%) fallowed by the combined one (20.8%). A highly significant difference was present in LH levels at all time points, with level decreasing from 4.99 ± 1.90 at baseline to 4.82± 2.15 at antagonist starting day to 1.63± 0.87 at trigger day and p value was > 0.001, no statistical difference in LH levels regarding the three time points between patients who get pregnant and non-pregnant women with pregnant patients having higher baseline lower antagonist starting day, and higher trigger LH levels 5.16 ± 1.87, 4.30 ± 1.72, 4.30 ± 1.72 respectively. Difference in LH level between cycle day 2 and the day of antagonist starting according to starting day of antagonist reveals that the basal LH values declined significantly (p= <0.001) until cycle day 7 of stimulation after which the basal LH start to increase and also with a high significant difference (negative values mean that the level decrease in comparison to the base line level).The comparable LH level in the current study reveals that earlier initiation of antagonist may serve no purpose and it is advisable to include the measurement of LH level to the criteria of antagonist initiation for better individualization and better outcome and to avoid un necessary earlier start of antagonist.
For successful implantation, a high-quality embryo, receptive endometrium, and tight communication between the two are required. The lack of uterine contractions during embryo transfer is one of the characteristics that greatly affects endometrial receptivity. This is because it has been observed that ET may cause uterine contractions, which may be harmful to embryonic apposition and endometrial blood flow .The aim of this study was to assess how magnesium sulfate administration on the day of embryo transfer improve sub endometrial blood flow, endometrial receptivity, and increase implantation rate and clinical pregnancy rate . Eighty infertile women undergoing ART cycles participated in this prospective. Recombinant FSH (Gonal-F) was used in a controlled ovarian hyperstimulation technique. The first group A (n=40) got a 4gm infusion of magnesium sulfate, while the second placebo control group B (n=40) received 200ml of 5% glucose water as a placebo, respectively. While there were no significant changes in body mass index (BMI), endometrial thickness, number of transferred embryos, or embryo transfer day, significant variations were seen in patient mean age (p<0.001) and mean number of grades I embryo (P=0.003). It was significantly different after magnesium sulfate administration with the lowest value in magnesium sulfate group (P=0.024; P <0.001 and P <0.001 respectively). Implantation rate and clinical pregnancy rate both increased after drugs administration although it was non-significant (P= 0.106 and P= 0.348 respectively). It appears that magnesium sulfate injection before to embryo transfer can significantly increase sub endometrial vascularity and endometrial receptivity and improving implantation rate and clinical pregnancy rate non significantly in ICSI cycles by lowering uterine muscular
Pregnancy cannot develop without a coordinated stability between an invading trophoblast and a receptive maternal decidua. Both the maternal decidua and the trophoblast, which is embryonic, must incessantly regulate and change one another during the processes of implantation, trophoblast invasion, and placentation. The goal of this study was to determine whether intrauterine infusion of hCG at various doses on the day of ovum pick-up would affect endometrial receptivity markers, biochemical markers, and ICSI outcome. To this end, measurements of serum levels of TNF and IL-10, endometrial thickness using ultrasound, and sub-endometrial blood flow indices using Doppler ultrasound were used.Ninety infertile women were randomly assigned to one of three groups: the research group (n = 60) was given intrauterine administration of either 700 IU or 500 IU of hCG on the day of ova pickup. The control group (n = 30) without hCG. On cycle days 2- 3, a plasma hormone level assessment was performed on each patient.In the 700 hCG group, the pregnancy rate was statistically higher (53.3% and 40%in the 500IU group respectively) as compared with the control group C (26.7%), no significant difference in ICSI outcome between group A &B. The RI and PI were significantly lower in group A (700IU) compared to group B and C. The biochemical marker TNA and ratio of TNF/IL-10 also lower in group A confirming role of Hcg in enhancement of implantation. Intrauterine injection of hCG at day of ova pickup significantly improved the endometrial receptivity marker and this effect occur in dose dependent manner
Iraq is one of the countries that have suffered from decades of heavy conflict, industrial activity, and little environmental regulation. As a result, notable environmental degradation has occurred. Urban environments, in particular, suffer severely from air pollution, which may be affecting reproductive health outcomes .This study examined the environmental pollution rates and infertility rates in 5 large urban areas in Iraq from 2019- 2023 .A cross-sectional ecological study was conducted across five large Iraqi cities. Air pollution data were obtained from monitoring stations and included PM2.5, PM10, NO2, SO2, and O3 measurements. Infertility rates were obtained from hospital records and fertility clinics. Statistical analysis was conducted employing Pearson correlation coefficients and multiple regression models .Overall, we found strong positive relationships between air pollution and infertility rates in both men (r=0.73, p<0.001) and women (r=0.68, p<0.001) with respect to PM2.5 concentrations. NO2 levels were also associated with decreased sperm quality parameters (r=-0.61, p<0.01). In areas where PM2.5 concentrations were >50 μg/m3, the infertility rates were 34% higher than those in areas with lower PM2.5 concentrations. Higher air pollution levels in urban Iraqi cities show associations with reproductive health outcomes. Meaning, there is an urgent need to address environmental health and policy reform in Iraq.
Gonadotropin-releasing hormone antagonists are one of the GnRH analogs that were used in assisted reproductive technologies to produce prompt downregulation of pituitary gonadotropin secretion. During conventional antagonist protocol (CAP), exposure to high LH and E 2 occur that have the potential to worse clinical reproductive results. So the downregulation of pituitary secretion for short period during early follicular phase will result in synchrony in follicular developments and this will improve mature oocytes and total embryos numbers. 44 women as normal responders undergoing ICSI-ET cycles were randomized into two groups. The conventional group (CG) (n 30), gonadotropin started from menstrual cycle day 2 or 3 and continue until hCG trigger day, flexible protocol in which GnRH antagonists administered with follicular size (13-14 mm). In the sandwich group (SG) (n 14), a GnRH antagonist was administered for three days in which GnRH antagonists administered with follicular size (13-14 mm). Gonadotropin started from menstrual cycle day 3 and continue until hCG trigger day. Retrieved and MII oocyte mean numbers were significantly higher in SG than in CG ( P = 0.006, and 0.025), respectively. Embryos and frozen embryos mean total numbers were significantly higher in SG than in CG ( P = 0.004). SG patients have a higher pregnancy rate of 9/14 (64.3 %) than CG 12/30 (40.0 %) although not significant ( P =0.057). Early and short GnRH antagonists proved improvements in synchronization of follicular development, retrieved mature oocytes numbers, total embryos, frozen embryos, and pregnancy rates.
Receptive endometrium is essential for successful embryo implantation and is created by the synergistic activities of estrogen and progesterone, as well as support from other endocrine, paracrine, and autocrine pathways. Granulocyte Colony Stimulating Factor (G-CSF) may play a crucial role in modulating the immune response to enhance implantation. To estimate the role of granulocyte-colony stimulating factor on the clinical intracytoplasmic sperm injection (ICSI) outcome parameters. A prospective comparative study with random sample selection was carried out from 2021 to 2023 at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University. It included 80 women with infertility, with or without previous failure trials of intracytoplasmic sperm injection, who completed IVF and ICSI protocols and reached the day of embryo transfer. On the day of embryo transfer, patients were divided into two groups: 49 patients received no additional treatment (group 1), and 31 patients received granulocyte-colony stimulating factor subcutaneous injection within one hour of embryo transfer (group 2). The implantation rate was 13.3% in group 2 compared to 7.6% in group 1. The chemical and clinical pregnancy rates were 29.0% and 25.8% in group 2, while group 1 had 18.4% for both chemical and clinical pregnancy rates. The pregnancy and implantation rates were slightly higher in group 2, but the difference was not significant. More research is needed to support the use of G-CSF as a standard treatment in ICSI patients.
Human sperm chromatin and integrity of DNA have multiple endogenous factors, such as sperm compression and nucleoproteins, with various mechanisms all through their own sperm production and transport. The integrity of the paternal genetic material in both regular and assisted pregnancy is essential for initiating and maintaining a viable pregnancy. The study included semen samples from 100 men taken from Al Nahrain University Medical Clinic and Babylon Teaching Hospital for Women and Children. The first sperm test was based on the World Health Organization (1999), followed by a DNA integrity test that uses a DNA fragmentation test, and the third intensification test Chromatin by aniline blue dye. It was correlated negatively with the sperm count in combination with DFI and chromatin sperm with semen characteristics (r = - 0.223, p = 0.026). As well as DFI, sperm chromatin was being clinically significant associated with the rate of round cells (r = 0.39, < 0.001). DFI was positive and significantly associated with sperm chromatin in all infertile men (r = 0.958; p<0.001). DNA isolation in all enrolled men has been adversely linked with sperm/ejaculation, has been associated with the round cell count positive way and is not understanding and resolving with other parameters. The width of abstinence and beneficial cell count in all register men were strongly linked with Sperm chromatin. There was a direct relationship between the fragmentation of DNA and chromatin. This could imply that one exam can be used instead of the other.
Non-steroidal anti-inflammatory medications may interfere with ovulation, implantation, and pregnancy; they are generally avoided during reproductive procedures. The risks of using them during IVF must be carefully weighed against the necessity of pain relief during oocyte retrieval. About 64 women (ages 20–42) undergoing ICSI participated in a single-blind, cross- sectional clinical trial at the High Institute for Infertility at Al-Nahrain University from October 2024 to May 2025. During oocyte retrieval, participants were split into two groups at random and given propofol anesthesia and ketorolac analgesia, respectively. They all adhered to a common protocol for ovarian stimulation. Based on their maturity stage (MII, MI, or GV), oocytes were categorized; those that were aberrant or degenerated were not included in ICSI. ELISA was used to measure the levels of cortisol and serum LH both before and after oocyte retrieval. The mean post -operation LH Marker level were 10.41±8.0, 6.40± 7.48 among GA and analgesia groups respectively, this relation was statistically significant (P value =0.04). The mean Post -operation Cortisol Marker level were 201.13±132.34, 159.13± 78.42 among GA and analgesia groups respectively . The mean number of Oocytes: Similar for both groups (10±5.53 for anesthesia and 10.59±5.44 for analgesia). Abnormalities of Oocytes: slightly lower in the group receiving anesthesia (0.56±1.44 vs. 0.69±1.18). The anesthesia group had fewer ruptured oocytes (0.16±0.45 vs. 0.25±0.57). Fertilized embryos: Grade I: The anesthesia group had slightly fewer (2.75±2.63 vs. 3.13±2.46). Grade II: Groups are comparable (1.41±1.58 vs. 1.31±1.53). Grade III: Lower in the group under anesthesia (0.19±0.54 vs. 0.38±0.83). Similar results were obtained from arrested embryos (anesthesia: 0.63±1.1, analgesia: 0.68±1.64). The analgesia group had a significantly higher number of transferred embryos (anesthesia: 1.84±1.08, analgesia: 2.88±1.62; P = 0.004). The analgesia group showed a significant decrease in post-operation LH marker, Cortisol Marker, and higher mean number of transferred embryos compared to the anesthesia group.
Infertility is described as a couple's failure to conceive for at least a year, using unprotected sex. Even though all anesthetic chemicals have been revealed in the follicular fluids, general anesthesia is still used in many IVF centers for patients who want to get pregnant. This study included 60 infertile women randomly divided into two groups under general anesthesia. 30 patients were given a Ketamine dose of 0.5 mg/Kg and the other 30 patients were received Remifentanil dose of 0.5 µg/Kg for induction of anesthesia. We collected serum for Reactive Oxygen Species (ROS) levels assessment for all patients before and after starting general anesthesia. Routine ICSI procedures was performed on all participants, including clinical evaluation (history, examination, and investigation), controlled ovarian and ovulation stimulation, oocyte retrieval under general anesthesia, follicular fluid collection for postoperative anesthesia medication concentration (Remifentanil and Ketamine), oocyte stripping, oocyte maturity assessment, intra-oocyte sperm injection into mature cells (MII), fertilization and division evaluation and embryo categorization, embryo selection and transfer, luteal phase support, and beta-hCG determination. ROS concentrations were compared between the Remifentanil and Ketamine groups. There was no significant difference in embryo features between Remifentanil and Ketamine, indicating that neither one is superior to the other in this regard. When Remifentanil or Ketamine was taken, there was no significant difference in ROS levels in serum or follicular fluid.
Background: Obesity, defined by the World Health Organization (WHO) as “abnormal or excessive fat accumulation that may impair health .The effects of obesity on male reproduction have been less well studied than those on female reproduction, but there is a growing body of evidence suggesting that obesity has an adverse effect on male reproduction However, a little is known about the effect of obesity on male reproductive system and infertility. Infertility is defined as inability to achieve conception within one year. It has not yet been clearly established how excess adiposity relates to the biological changes that underlie male infertility, although there are several theories worth exploring. The endocrine abnormalities associated with obesity in women are well known with an increase in androgen metabolism and changing in reproductive hormones in over weight and obese men. Objective: The study aim at assessing the role of obesity in infertile males through measurement of BMI, some of sex hormones. Methods: This study was carried out in Tikrit Teaching Hospital, on the adult male population aged 17-45 years, from September 2013 to April 2014. The recruited cases divided into 90 infertile obese male and 30 normal weights infertile as pathological control group and 30 normal weight fertile men as normal control group.The serum samples willed collect of the patients and measure the concentrations of the sex hormones (FSH, LH, INHB) by using ELISA technique. Body Mass Index Calculation Height (m) and weight (kg). Results: There was no significant correlation between BMI (30.1±93.45, 21.40±5.24,23.24±1.42)kg/m2 in patients group, pathological control group and control group and serum LH level (22.35±12.79, 19.31±9.94, 13.90±8.33) ml U/ml in all three group respectively. There was a significant negative correlation (P< 0.03) between BMI (23.24±1.42)kg/m2 and serum FSH level (7.10±3.77) ml U/ml, in control group. While there was no significant correlation between BMI (30.19±3.45,21.40 ±5.24) kg/m2 and serum FSH level (13.59±15.72, 11.58±14.06) ml U/ml in both patients' group and pathological control group respectively.There was no significant correlation between BMI (30.19±3.45, 21.40±5.24,23.2±1.42) kg/m2and serum INHB level in the patients group, pathological control group and control group (88.8±57.96, 108.51±78.39, 141.65±63.95) pg/ml respectively. Conclusions: The BMI did not correlated with some reproductive hormones (LH, FSH,INHB) in obese infertile males, but there was a significant correlation between the FSH and BMI in control group. In infertile obese group found the highest level of LH, FSH, and the lowest level of INHB comparing with other group in this study.
It was observed that embryos from oocytes resulting from well-vascularized follicles had a higher implantation rate than those from oocytes developed in poorly vascularized follicles. Neovascularization was recognized as primary in terms of ovulatory follicles growth and selection. Vascular endothelial growth factor serum level has a positive correlation with perifollicular blood flow. The 2D Color and Pulsed Doppler ultrasounds that allow visual observation of the flux of the blood in a limited part of the wall of the preovulatory follicles can be easily measured. To study the preovulatory follicle's blood flow parameters in infertile women undergoing different ovulation induction protocols. 50 infertile female patients who had undergone Intrauterine Insemination (IUI) procedures were classified into two groups which were letrozole or clomiphene citrate groups as induction protocol. Another ultrasound was performed on cycle day 11, 12, or 13 to evaluate growth follicles, also a Doppler study was done to measure perifollicular blood flow and endometrial thickness at the same time blood sample to measure vascular endothelial growth factor were taken. Human chorionic gonadotropin was injected and then after 36-40 hrs. IUI Procedure is done and follows up with the patient to do a pregnancy test after 14 days. The number of dominant follicles, endometrial thickness at HCG trigger, Perifollicular doppler blood flow vascular endothelial growth factor level, pregnancy rates were all measured in both groups. There were significant differences in Perifollicular RI (p<0.001) but there were no significant differences in Perifollicular PI (p=0.476). Regarding pregnancy rate, the letrozole group has a higher although not significant pregnancy rate (32%), if compared with those using CC (20%).
Serum chemerin levels are associated with body fat percentage and BMI, and elevated chemerin levels are associated with metabolic problems and inflammatory shifts. This study aimed to evaluate the effect of BMI in serum and follicular fluid chemerin and Leptin levels on patients undergoing ICSI . This study was performed by 44 women who underwent ICSI procedures and divided into two groups based on BMI: the non-obese group, with a BMI<30 and the obese group, with a BMI>30. The result in the non-obese group showed a significant positive correlation was found between Serum chemerin levels, indicating a strong effect size (p< .001). This suggests that as Serum chemerin levels rise, so will FF chemerin. A significant positive correlation of r =0.92 was found between the oocytes retrieved and the Number of metaphases II, indicating a strong effect size (p<.001, This shows that the number of metaphase II oocytes increases as the number of retrieved oocytes increases. A significant positive correlation of 0.66 was found between the number of embryos and the G1 embryo, indicating a large effect size. Conclusion: Serum chemerin had a significant correlation with oocyte maturity and embryo grading, and there was no significant difference between obese and non-obese patients regarding serum chemerin pregnancy.
Obesity induces metabolic dysfunctions in bodily systems and is a significant health challenge. Excessive adipose tissue accumulation encompasses dynamic, endocrine, and biologically active processes. The fundamental pathogenic mechanism of obesity is chronic low-grade inflammation exacerbated by pro-inflammatory biomarkers such as free fatty acids, lipopolysaccharides, adipokines, and cytokines. The rising prevalence of obesity over the past forty years has led to an increase in associated comorbidities, including polycystic ovarian syndrome (PCOS). To clarify the impact of increasing body mass index (BMI) in PCOS and non PCOS on the ICSI outcomes of 143 infertile Iraqi females, dividing them into two main groups: PCOS and non PCOS and each group into normal weight and overweight/obese group. Group 1= normal BMI PCOS, group 2= overweight/ obese PCOS, group 3= normal BMI non PCOS, group 4= overweight/obese non PCOS. Significant differences in ICSI outcomes were observed in the PCOS groups compared to the non-PCOS groups concerning the total number of harvested, MI, MII oocytes, GV, abnormal and fertilised oocytes, total and D3 grade I embryos alongside higher number of arrested and transplanted embryos. There are numerically higher number of D3 grade II and III embryos, morula and blastocyst with no significant difference seen. The rates of maturation and fertilisation exhibited no significant disparities. The biochemical pregnancy rate was higher in group 2 compared to group 1, and in group 4 compared to group 3, with a statistically significant difference. A higher BMI among younger PCOS individuals may be associated with better pregnancy outcomes.
Fertility is a fundamental function of reproductive health that is under the control of different hormones, cytokines, and growth factors. Transforming growth factor superfamily is a group of cytokines necessary for blastocyst implantation as they regulate endometrial stromal cell proliferation, and promote embryonic adherence to the receptive endometrium. Hyaluronic acid molecule (HA) is a long, unbranched polysaccharide that plays a delicate function in reproduction. Hyaluronic acid regulates gametogenesis, folliculogenesisi, and implantation, thereby was oroposed to improve the rate of successful pregnancy.This study is a prospective clinical trial that includes 80 infertile Iraqi women aged (18-40 years) scheduled for fresh ICSI program. The study sample had been divided into 2 groups based on the type of intervention performed on the day of oocytes retrieval. The Hyaluronic acid group and the control group. For each participant, twice measurement of the serum level of transforming growth factor were done , the first measure was done on day of oocytes retrieval, while the second measure was performed on day of embryo transfer. A comparative statistic was made to examine the effect of hyaluronic acid intrauterine wash on the serum level of transforming growth factor and pregnancy rate.Hyaluronic acid intrauterine wash exerts a significant reduction in transforming growth factor serum level, and a significant improvement in the pregnancy outcome compared to the control group.
Background : Although progress was made in an in vitro fertilization (IVF) tech niques, the majority of transferred embryos fail to implant. Morphology embryo scoring is the standard procedure for most of IVF centers for choosing the best embryo, but remains limited since even the embryos classified as (top quality) may not implant. Determining molecular mechanisms of human embryo implan tation is an extremely challenging task due to the limitation of materials and significant differences underlying this process among mammalian species. L-Se lectin and its ligand carbohydrate have been proposed as a system that mediates initial adhesion of human blastocysts to the uterine epithelia. Objectives: Quantitative evaluation of soluble L-Selectin molecule in an in-vitro culture media used for in vitro fertilization. Determine cut-off value of soluble L-Selectin quantity to be as qualitative predictor of successful implantation Patients and Methods: This prospective study was undertaken in the High In stitute of Infertility diagnosis and assisted Reproductive Technologies/ Al-Nah rain University/ Baghdad/ Iraq, during the period from September2017 to April 2018.A total of 74 infertile women were underwent controlled ovarian hyper stimulation for intracytoplasmic sperm injection cycle. Flexible antagonist pro tocol was used as ovulation induction protocol in all the cases .culture media L-Selectin level were measured on the day of embryo transfer by using Enzyme linked immune sorbent assay (ELISA) for all cases . Comparison in culture me dia L-Selectin was done to all cases. Results: There was no significant difference between pregnant and non-pregnant groups in age , BMI, and level of basal hormone FSH, LH , AMH and E2 in the day of hCG injection, and significant difference in the level of L-Selectin in pregnant compared to non-pregnant groups. Conclusion: Level of L-Selectin concentration in embryo culture media can be used as predictor of ICSI success
Pro-fusion proteins as mitofusins-1 are required for controlling mitochondrial shape which determined by a dynamic balance between organelle fusion and fission and also supports oocyte development. When compare with somatic cell, mitochondria of oocyte are tiny and circular in presence. The aim is to study the mitofusin-1 in the follicular fluid as a marker for evaluating of oocyte maturation in women undergoing ICSI cycles. Fifty infertile females were included in cross-section study was undergoing ICSI procedure with age 20 to 42 years. After retrieval of oocyte and the number of oocytes was recorded by embryologist and follicular fluid Samples were used for the measurement of Mitofusin 1. Mitofusin 1 levels by ELISA kit (Mybiosource /USA).The results showed considerable higher mitofusin-1levels in patients with good oocytes quality (3.71 ± 1.35 vs. 2.45 ± 1.12 & p=0.001). There were much positive correlations between follicular fluids mitofusin-1 with both total oocytes count (r= 0.374 & p= 0.007) and MII oocytes (r=0.383 & p=0.006); and there was no much correlation between mitofusin-1 levels with MI oocyte (r= - 0.100 & p= 0.490), germinal vesical oocyte (r=0.103 & p= 0.475) and fertilization rate (r= 0.054 & p= 0.711). High follicular fluid levels of Mitofusin 1 may positively impact oocyte development and pregnancy rate.
Background: Polycystic ovary syndrome (PCOS) is the most common cause of hyperandrogenism anovulatory infertility; it affects 510-% of females in the reproductive age. PCOS is a risk disease; it has an association with gynecological malignancy. Objectives: To determine whether Cancer Antigen 125 (CA125) and Cancer Antigen 153-(CA153-) levels are increased in PCOS and possibility of CA125 and CA153- to be used as a diagnostic marker of PCOS. Methods: Seventyfemales with PCOS diagnosed depending on threecriteria: Menstrualhistoryofoligomenorrhea ultrasound examinations revealed polycystic ovaries and biochemical hyperandrogenism. Twenty normal fertile females serve as control group. Blood samples were obtained from all individuals from 2nd-4th day of menstrual cycle to measure levels of FSH, LH and testosterone.Second blood samples were collected from the same patients during late follicular phase to measure CA153- and CA125( by ELISA). Results: Females with PCOS and controls differed significantly(p< 0.05) in total serum testosterone (p). Females with PCOS and controls have highly significant difference (p < 0.001) in LH mean level (7.881.83+ vs 3.900.73+) respectivelyand, highly significant difference (p < 0.001) in LH/FSH ratio and BMI parameters. No significant differences (p > 0.05) were found in FSH, CA125 and CA153- between PCOS patients and the controls.There were positive correlation between testosterone and CA125.Negative correlation between testosterone and CA153- serum values. Conclusion: There were no changes in the serum levels of CA125andCA153- in PCOS patient at the age of reproduction and those cancer antigens could not be used as diagnostic markers for polycystic ovarian syndrome.
Despite developments in assisted reproductive technology, there is immaterial progress in the implantation and pregnancy rates. Intrauterine infusion (IUIF) of autologous platelet-rich plasma (PRP) might renew implantation rates through its paracrine properties by progression cytokines and growth factors which favor implantation. Here we determine whether the IUIF of autologous PRP had a role in pregnancy outcome through its outcome on epidermal growth factor and endometrial thickness. An overall of 43 patients where prospectively randomly dispersed into two groups subjected to a superovulation program using Letrozole® tablet orally 2.5 mg twice daily 12 hours apart from day 2 for 5 days for one cycle. 20 women were considered as control receiving the conventional intrauterine insemination (IUI) management while 23 of them were given PRP by IUIF on the day of human chorionic gonadotrophin injection. The IUI was done for both groups 36-48 hours after confirming ovulation. The blood samples were collected from both groups on the day of IUI for the valuation of epidermal growth factor and an ultrasound was done on the day of human chorionic gonadotrophin injection and day of IUI for assessment of endometrial thickness. The mean endometrial thickness in the PRP group at the day of IUI was significantly thicker than that of the control group and the difference in percentage change of endometrial thickness between PRP group and controls significantly higher in PRP group. The mean epidermal growth factor and the pregnancy rate were significantly superior in the PRP group than that of controls. In conclusion, autologous PRP IUIF was well-tolerated and resulted in a significant expansion in endometrial thickness, epidermal growth factor Level and, subsequent pregnancy rate in an infertile woman undergoing IUI.
Amphiregulin, a growth factor inspired by LH surge, promotes oocyte maturation and follicular rupture. This study investigated whether amphiregulin growth factor levels in follicular fluid and blood serum can predict oocyte maturation and positive pregnancy rates in ICSI patients . Methods: The study included 50 women and they did ICSI from October 2024 to February 2025. Each woman got antagonist ovarian stimulation and recombinant follicle stimulating hormone. Blood samples were taken on cycle day two for infertility hormone assessment and on oocyte retrieval day for Elisa Amphiregulin growth factor estimate . Follicular fluids amphiregulin growth factor levels were significantly higher among pregnant females; however there was no significant difference of serum amphiregulin growth factor between pregnant and non- pregnant females. Out of 50 females, 11 females were had positive pregnancy test (Pregnancy rate = 22.0 %), there was a solitary positive correlation between follicular fluids amphiregulin growth factor with metaphase II oocytes count (r=0.800& p=0.003); however follicular fluids amphiregulin showed no significant correlations with other ICSI parameters. There were also no significant correlations between serum amphiregulin with all ICSI parameters. The current study found that elevated Amphiregulin (AREG) levels are linked to successful pregnancy outcomes in ICSI cycles