Volume 9, Issue 1
Editorial
Editorial
Research Articles
Research Articles
Assessment Quality of Selected Sperm During Glass Wool and Sephadex Filtration Techniques in Infertile Men
Assessment Quality of Selected Sperm During Glass Wool and Sephadex Filtration Techniques in Infertile Men
Abstract
Abstract
Infertility has been defined as the disability to fulfill pregnancy after twelve months of regular sex coition, with no contraceptive taken. Male factor infertility was explained in terms of low spermatozoa concentration (oligozoospermia), or morphology (teratozoospermia), impaired motility (asthenozoospermia), or in some cases, total lack of spermatozoa in the ejaculate (azoospermia). In several cases, a collection of one, or more of these sperm variables defects may be noticed, evaluation these factors by the initial and most important step is seminal analysis. Our study aims to study some sperm characteristics in asthenozoospermia men in comparison with normozoospermia men before and after glass wool and Sephadex activation. This study involved 60 semen samples collected from male patients that came to male infertility clinic at Al-Nahrain University; the recruited semen samples were divided into 2 groups, (40 asthenozoospermic and 20 normozoospermic subjects). After collected semen samples, and assessed analysis of seminal fluid. Each semen samples were divided into 3 aliquots. The first aliquot prepared was In-Vitro to assessed sperm characterization before activation, the second part using glass wool filtration (GWF) technique, while the last part was prepared using Sephadex. Both techniques resulted equally in reducing sperm concentration, were equally effective in upgrading sperm motility and in minimizing round cell count; however, Sephadex was superior to glass wool method in upgrading the percentage of morphologically normal sperm. Both Sephadex and glass wool techniques has been proved effective to improve semen quality.
Infertility has been defined as the disability to fulfill pregnancy after twelve months of regular sex coition, with no contraceptive taken. Male factor infertility was explained in terms of low spermatozoa concentration (oligozoospermia), or morphology (teratozoospermia), impaired motility (asthenozoospermia), or in some cases, total lack of spermatozoa in the ejaculate (azoospermia). In several cases, a collection of one, or more of these sperm variables defects may be noticed, evaluation these factors by the initial and most important step is seminal analysis. Our study aims to study some sperm characteristics in asthenozoospermia men in comparison with normozoospermia men before and after glass wool and Sephadex activation. This study involved 60 semen samples collected from male patients that came to male infertility clinic at Al-Nahrain University; the recruited semen samples were divided into 2 groups, (40 asthenozoospermic and 20 normozoospermic subjects). After collected semen samples, and assessed analysis of seminal fluid. Each semen samples were divided into 3 aliquots. The first aliquot prepared was In-Vitro to assessed sperm characterization before activation, the second part using glass wool filtration (GWF) technique, while the last part was prepared using Sephadex. Both techniques resulted equally in reducing sperm concentration, were equally effective in upgrading sperm motility and in minimizing round cell count; however, Sephadex was superior to glass wool method in upgrading the percentage of morphologically normal sperm. Both Sephadex and glass wool techniques has been proved effective to improve semen quality.
The New Approach of Hyaluronic Binding Assay in Relevance to Sperm Activation by Direct Swim-up Technique in Iraqi Infertile Men
The New Approach of Hyaluronic Binding Assay in Relevance to Sperm Activation by Direct Swim-up Technique in Iraqi Infertile Men
Abstract
Abstract
Hyaluronic acid (HA) is a polysaccharide, that composed in the extracellular matrix of the cumulus cells, and considered to take function in choosing mature spermatozoa. The Sperm- hyaluronic binding assay (HBA) is significant diagnostic instrument for suspected male infertility when examining the semen. The HBA slide supplies the ratio of mature binding sperm in the specimen. To evaluate sperm parameters, and to evaluate the (HBA Score percentage (%) before and after activation. Twenty-five infertile couples a sharer in this current study through their attendance to the Al Nahrain University. Males undergoing seminal fluid analysis were done according to (WHO 2010, and WHO 1999). Sperm parameters assessed and calculate the HBA Score% pre-and-post- direct swim-up technique, the results were statistically tested. In Post- activation there was considerable increment noticed in the progressive motility and morphology of spermatozoa, likewise significant improvement in the (HBA score %). Furthermore, considerable reduction in the concentration, agglutination of spermatozoa and round cells count, when compared to pre-activation. The mean of binding of spermatozoa to hyaluronan pre-activation (direct swim-up technique) was less than normal limit for normozoospermic males. However, it significantly improves post-activation.
Hyaluronic acid (HA) is a polysaccharide, that composed in the extracellular matrix of the cumulus cells, and considered to take function in choosing mature spermatozoa. The Sperm- hyaluronic binding assay (HBA) is significant diagnostic instrument for suspected male infertility when examining the semen. The HBA slide supplies the ratio of mature binding sperm in the specimen. To evaluate sperm parameters, and to evaluate the (HBA Score percentage (%) before and after activation. Twenty-five infertile couples a sharer in this current study through their attendance to the Al Nahrain University. Males undergoing seminal fluid analysis were done according to (WHO 2010, and WHO 1999). Sperm parameters assessed and calculate the HBA Score% pre-and-post- direct swim-up technique, the results were statistically tested. In Post- activation there was considerable increment noticed in the progressive motility and morphology of spermatozoa, likewise significant improvement in the (HBA score %). Furthermore, considerable reduction in the concentration, agglutination of spermatozoa and round cells count, when compared to pre-activation. The mean of binding of spermatozoa to hyaluronan pre-activation (direct swim-up technique) was less than normal limit for normozoospermic males. However, it significantly improves post-activation.
Clinical Role of Follicle Stimulating Hormone, Luteinizing Hormone and Testosterone as Predictive Markers of Sperm Yield by Testicular Biopsy in Azoospermic Patients
Clinical Role of Follicle Stimulating Hormone, Luteinizing Hormone and Testosterone as Predictive Markers of Sperm Yield by Testicular Biopsy in Azoospermic Patients
The study aim is to evaluate the predictive rate of positive sperm retrieval of serum concentration of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (TT) in azoospermic patients presenting to High Institute of infertility diagnosis and assisted reproductive technologies. The study records of 65 azoospermic men with who underwent open testicular sperm extraction between February 2017 to April 2019 were studied. The patient’s age, hormonal profile for FSH, LH and TT and testicular histopathology were recorded. The sperm retrieval rate according to histological findings normspermatogenesis (NS), hypo-spermatogenesis (HS), maturation arrest (MA) and Sertoli cell-only syndrome (SCOS) were recorded as follows: 100%, 75%, 44.4%, and 28.6% respectively. The cutoff value of FSH was (≤ 14.56 mIU/L) with an accuracy level of 73.0%, a sensitivity (66.7 %) and a specificity (79.3 %). The cutoff value of the serum level of LH was (≤ 9.37 mIU/L) with an accuracy level of 78.4%, a sensitivity level of 77.7 % and a specificity level of 72.4 %.
The study aim is to evaluate the predictive rate of positive sperm retrieval of serum concentration of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (TT) in azoospermic patients presenting to High Institute of infertility diagnosis and assisted reproductive technologies. The study records of 65 azoospermic men with who underwent open testicular sperm extraction between February 2017 to April 2019 were studied. The patient’s age, hormonal profile for FSH, LH and TT and testicular histopathology were recorded. The sperm retrieval rate according to histological findings normspermatogenesis (NS), hypo-spermatogenesis (HS), maturation arrest (MA) and Sertoli cell-only syndrome (SCOS) were recorded as follows: 100%, 75%, 44.4%, and 28.6% respectively. The cutoff value of FSH was (≤ 14.56 mIU/L) with an accuracy level of 73.0%, a sensitivity (66.7 %) and a specificity (79.3 %). The cutoff value of the serum level of LH was (≤ 9.37 mIU/L) with an accuracy level of 78.4%, a sensitivity level of 77.7 % and a specificity level of 72.4 %.
Comparative Study Between the Explained and Unexplained Patient Women with Recurrent Miscarriage
Comparative Study Between the Explained and Unexplained Patient Women with Recurrent Miscarriage
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.
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.
Early and Short Follicular GnRH Antagonist (Sandwich) Protocol Versus Conventional GnRH Antagonist Protocol in Normal Responders
Early and Short Follicular GnRH Antagonist (Sandwich) Protocol Versus Conventional GnRH Antagonist Protocol in Normal Responders
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 E2 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.
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 E2 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.
Predictors for Response to Letrozole as an Ovulation Induction in Anovulatory Infertile Polycystic Ovarian Syndrome Women
Predictors for Response to Letrozole as an Ovulation Induction in Anovulatory Infertile Polycystic Ovarian Syndrome Women
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 (E2, 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.
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 (E2, 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.
Comparing the Activation Role of Centrifugation Swim-up and the Density Gradient Combined with ALLGrad Sperm Preparation Techniques
Comparing the Activation Role of Centrifugation Swim-up and the Density Gradient Combined with ALLGrad Sperm Preparation Techniques
In about 40% of infertile couples, the husband was found to be either the single or a contributing cause of infertility and the systemic management ready for those couples with male infertility are restricted. 135 couples with infertility shared herein; the husbands required in vitro activation for their sperm samples, their wives however; had no fertility problem and were submitted ovarian induction protocol. However; Sperm preparation was done using both, the centrifugation indirect swim-up technique with Global medium and density gradient with ALLGrad solution. While ALLGrad 45% is a ready-to-be-used upper layer. There was an acceleration in seminal parameters after preparation using both various techniques. So, a highly significant increment (P≤0.001) in the percentages of progressive forward motility was in grades (A and B) and grade (A) progressive sperm motility, also a significant enhancement (P≤0.05) in percentage of morphologically normal sperms when applying density gradient mechanism in relation to centrifugation swim-up technique. This study concludes that the use of density gradient mechanism with ALLGrad solution and Global culture medium are more efficient in achieving better percentages of progressive forward motility grades (A and B), grade (A) progressive motility and morphologically normal values of spermatozoa than centrifugation indirect swim-up technique by using Global culture medium. However, it was found there was a non-significant difference when we use both techniques concerning other sperm parameters.
In about 40% of infertile couples, the husband was found to be either the single or a contributing cause of infertility and the systemic management ready for those couples with male infertility are restricted. 135 couples with infertility shared herein; the husbands required in vitro activation for their sperm samples, their wives however; had no fertility problem and were submitted ovarian induction protocol. However; Sperm preparation was done using both, the centrifugation indirect swim-up technique with Global medium and density gradient with ALLGrad solution. While ALLGrad 45% is a ready-to-be-used upper layer. There was an acceleration in seminal parameters after preparation using both various techniques. So, a highly significant increment (P≤0.001) in the percentages of progressive forward motility was in grades (A and B) and grade (A) progressive sperm motility, also a significant enhancement (P≤0.05) in percentage of morphologically normal sperms when applying density gradient mechanism in relation to centrifugation swim-up technique. This study concludes that the use of density gradient mechanism with ALLGrad solution and Global culture medium are more efficient in achieving better percentages of progressive forward motility grades (A and B), grade (A) progressive motility and morphologically normal values of spermatozoa than centrifugation indirect swim-up technique by using Global culture medium. However, it was found there was a non-significant difference when we use both techniques concerning other sperm parameters.
Evaluation of Serum Progesterone Level on the Day of hCG Injection on Clinical Outcome of Antagonist Protocol in ICSI Cycles
Evaluation of Serum Progesterone Level on the Day of hCG Injection on Clinical Outcome of Antagonist Protocol in ICSI Cycles
Progesterone's premature rise during late follicular phase will negatively affect
Progesterone's premature rise during late follicular phase will negatively affect
the outcome of antagonist protocol in the Intracytoplasmic sperm injection (ICSI) cycles, on trigger day progesterone level above 1.5 ng/ml create different endometrial gene expression profiles, lead to asynchrony between the endometrium and the fresh embryo transfer. Enhanced FSH-stimulation only without LH support considers as the main cause for premature progesterone rise. To analyze the influence of progesterone rise on trigger day by hCG on clinical outcomes and pregnancy rates of fresh embryo transfer in the ICSI by the use of antagonist protocol. 60 Iraqi infertile women were enrolled in this interventional study stimulated by antagonist protocol, they were subdivided according to the level of serum progesterone on day of trigger by hCG into 30 infertile women with serum progesterone ≤1.5 ng/ml and thirty infertile women with serum progesterone >1.5 ng/ml. The maturation, fertilization, cleavage, implantation, biochemical and clinical pregnancy rates were all measured in both groups. women with serum progesterone level >1.5 ng/ml on hCG trigger day, showed longer stimulation days with significant difference (P < 0.02) and highly significant increment in the mean level of serum progesterone and mean P4/E2 ratio (P <0.001) and of serum LH (P <0.010). While there was significant decrease in implantation percentage (P =0.012) and in biochemical and clinical pregnancy rate (P =0.010) in comparison to women with serum progesterone level ≤ 1.5 ng/ml on day of hCG trigger. Measurement of serum progesterone and P4/E2 ratio on trigger day by hCG are considering as an important predictor factor for the clinical outcome (implantation rate; biochemical and clinical pregnancy).
the outcome of antagonist protocol in the Intracytoplasmic sperm injection (ICSI) cycles, on trigger day progesterone level above 1.5 ng/ml create different endometrial gene expression profiles, lead to asynchrony between the endometrium and the fresh embryo transfer. Enhanced FSH-stimulation only without LH support considers as the main cause for premature progesterone rise. To analyze the influence of progesterone rise on trigger day by hCG on clinical outcomes and pregnancy rates of fresh embryo transfer in the ICSI by the use of antagonist protocol. 60 Iraqi infertile women were enrolled in this interventional study stimulated by antagonist protocol, they were subdivided according to the level of serum progesterone on day of trigger by hCG into 30 infertile women with serum progesterone ≤1.5 ng/ml and thirty infertile women with serum progesterone >1.5 ng/ml. The maturation, fertilization, cleavage, implantation, biochemical and clinical pregnancy rates were all measured in both groups. women with serum progesterone level >1.5 ng/ml on hCG trigger day, showed longer stimulation days with significant difference (P < 0.02) and highly significant increment in the mean level of serum progesterone and mean P4/E2 ratio (P <0.001) and of serum LH (P <0.010). While there was significant decrease in implantation percentage (P =0.012) and in biochemical and clinical pregnancy rate (P =0.010) in comparison to women with serum progesterone level ≤ 1.5 ng/ml on day of hCG trigger. Measurement of serum progesterone and P4/E2 ratio on trigger day by hCG are considering as an important predictor factor for the clinical outcome (implantation rate; biochemical and clinical pregnancy).
All Issue 1 Completed
All Issue 1 Completed
