Middle East Fertility Society Journal

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ISSN / EISSN : 1110-5690 / 2090-3251
Total articles ≅ 646
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, Maged M. Yassin
Middle East Fertility Society Journal, Volume 26, pp 1-10; doi:10.1186/s43043-021-00066-3

Background Epigenetics refers to an alteration in gene expression without alteration in the sequence of DNA and this process may be affected by environmental factors and lifestyle like cigarette smoking. This study was designed to evaluate the potential effect of cigarette smoking on the global DNA methylation status and the transcription level of protamine 1 and protamine 2 in human spermatozoa. A total of 188 semen samples were collected from men with a mean age of 34.9 ± 5.8 years old (98 heavy smokers and 90 non-smokers). The DNA and RNA were isolated from purified spermatozoa, then the status of global DNA methylation and the transcription level of protamine 1 and protamine 2 were evaluated using ELISA and qPCR, respectively. The chromatin non-condensation and DNA fragmentation in human spermatozoa were evaluated using chromomycin A3 staining and TUNEL assay, respectively. Results A significant increase has been found in the status of global DNA methylation in spermatozoa of heavy smokers compared to non-smokers (7.69 ± 0.69 ng/μl vs. 4.90 ± 0.40 ng/μl, P < 0.001). Additionally, a significant reduction has been found in transcription level of protamine 1 (25.49 ± 0.31 vs. 23.94 ± 0.40, P < 0.001) and protamine 2 (28.27 ± 0.39 vs. 23.45 ± 0.30, P < 0.001) in heavy smokers. A downregulation has been found in the transcription level of protamine 1 and protamine 2 with a fold change of 0.497 and 0.047, respectively. A significant increase has been shown in the level of DNA fragmentation and chromatin non-condensation in heavy smokers compared to non-smokers (P < 0.001). On the other hand, a significant positive correlation has been found between sperm chromatin non-condensation, sperm DNA fragmentation, transcription level of protamine 1, transcription level of protamine 2, and global DNA methylation status (r = 0.304, P < 0.001; r = 0.399, P < 0.001; r = 0.216, P = 0.003; r = 0.494, P < 0.001, respectively). Conclusion Tobacco cigarette smoking has a potential influence on the global DNA methylation and the transcription level of protamine genes in human spermatozoa, and consequently, affect negatively on the semen parameters.
Mustafa Ali, Aruna Kumari Hira, Haris Jawaid, Faiza Zakaria, Zehra Somjee
Middle East Fertility Society Journal, Volume 26; doi:10.1186/s43043-021-00064-5

Background Heavy menstrual bleeding (HMB) is a common clinical finding in patients with uterine leiomyomas that can negatively impact their quality of life. Recently, a novel oral GnRH-antagonist (elagolix) has emerged as a possible therapeutic agent for this ailment. Herein data was pooled from clinical trials assessing the safety and efficacy of elagolix with and without add-back therapy. Main text PubMed and Cochrane library were systematically searched for RCTs that measured the efficacy and safety of elagolix for the treatment of uterine fibroid-associated HMB. All safety and efficacy endpoints were compared between elagolix-alone, elagolix w/add-back therapy, and placebo. The primary efficacy endpoint was defined as the number of women who achieved menstrual blood loss (MBL) < 80 ml and a reduction in MBL from baseline of > 50% at the end of treatment. Secondary outcomes assessed included change in hemoglobin levels, incidence suppression of bleeding and amenorrhea, and the incidence of adverse events. The random effects model was used to pool data, and heterogeneity was assessed using I2. Our search identified 4 clinical trials meeting our PICO criteria, with a total of 916 patients. Analysis of the primary outcome revealed that elagolix-alone was the most effective treatment compared to both placebo (LOR = 3.47, CI = 3.03–3.91, p = 0.000, I2 = 0.0%) and add-back therapy (LOR = 0.64, CI = 0.12–1.16, p = 0.016, I2 = 43.1%). Furthermore, both elagolix groups (irrespective of add-back therapy) observed a significant improvement in post-treatment hemoglobin levels as compared to the placebo group (elagolix-alone vs PBO: LOR = 1.44, CI = 0.66–2.22, I2 = 66.0%, p = 0.000; elagolix-w/add-back therapy vs PBO: LOR = 1.22, CI = 0.78–1.66, I2 = 0.0%, p = 0.000). Concerning safety, while elagolix without add-back therapy had the highest overall incidence of adverse effects (elagolix-alone vs placebo LOR = 0.84, CI = 0.48–1.20, I2 = 7.8%, p = 0.000; elagolix-alone vs elagolix-w/add-back LOR = 0.68, CI = 0.09–1.26, p = 0.024, I2 = 64.6%), the incidence of serious (life threatening) adverse events between all 3 treatment groups was not statistically different. The inclusion of add-back therapy with elagolix made the treatment noticeably safer (elagolix-w/add-back vs placebo: LOR = 0.19, CI = − 0.10 to 0.48, I2 = 0.0%, p = 0.194) without seriously compromising its efficacy. Conclusion High-quality evidence from 4 trials suggests that elagolix is an effective treatment for leiomyoma-associated HMB, with a marked improvement in all efficacy endpoints. Furthermore, the inclusion of add-back therapy in the treatment regimen should be considered as it mitigates the hypoestrogenic effects of elagolix.
Jansirani Natarajan,
Middle East Fertility Society Journal, Volume 26, pp 1-7; doi:10.1186/s43043-021-00065-4

Background Genetic blood disorders are prevalent in the Middle Eastern countries causing physical, mental, and economic handicap. Premarital screening (PMS) is actively implemented to reduce the burgeoning load of these disorders. Literature shows a low response rate for PMS in this region. This integrated review aims to identify the knowledge and attitude of university students on PMS, as they are at the verge of entering into marriage relationships. Main body of the abstract We systematically reviewed the electronic databases like MEDLINE, PubMed, CINAHL, and Scopus. Studies reporting about the knowledge and attitudes of Middle Eastern university students between 2010 and 2020 are included in the review. Twelve cross-sectional descriptive studies conducted in six countries met the inclusion criteria. Majority of the studies reported good level of knowledge on PMS among the university students, whereas not all of them agreed to undergo PMS due to various religious and cultural beliefs. Short conclusion We recommend massive health education programs at the higher secondary and university levels to create better awareness on PMS. To improve the attitude towards PMS, life cycle approach and support of the religious leaders could be sought.
Koushik Bhattacharya, , Ratnadeep Goswami, Sulagna Dutta, Pallav Sengupta, Tulay Irez, Habibah Abdul Hamid, Alak Kumar Syamal
Middle East Fertility Society Journal, Volume 26, pp 1-7; doi:10.1186/s43043-021-00063-6

Background Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has turned into a global pandemic with multitudinous health impacts. Main body In light of the higher vulnerability of men to COVID-19 than women, there is rising concerns on the impact of SARS-CoV-2 infection on male fertility and possibilities of seminal contamination and transmission. The pandemic has attributed to the brief suspension of many fertility clinics and pathology laboratories, though many remained functional. Few reports reflect that SARS-CoV-2 can contaminate the semen of COVID-19 patients as well as that of recovering patients. The viral invasion into the testis may be due to the disrupted anatomical barriers of the testis by the inflammatory responses, and the persistence of the virus in the semen may be facilitated by the testicular immune privilege. Since SARS-CoV-2 is an enveloped RNA virus, it is also theoretically possible that this virus can remain viable in the semen samples even after cryopreservation with liquid nitrogen. Conclusion The present review emphasizes the possibilities of seminal dissemination of SARS-CoV-2 and thereby the chances of its sexual transmission. These perceptions and predictions are to facilitate immediate necessary actions to improvise the standard precautionary procedures for laboratory practices, including semen analysis or processing the semen sample for fertility treatments.
Seyed-Abdolvahab Taghavi, Solmaz Heidari, , Shakiba Amirjani, Amireh Aji-Ramkani, ,
Middle East Fertility Society Journal, Volume 26, pp 1-8; doi:10.1186/s43043-021-00059-2

Background The purpose of the present study was to evaluate obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran. Results A case-control study was conducted on 55 COVID-19 as the case and 55 matched control pregnant women in Hormozgan, Iran. Patients were considered to be cases if they had a positive COVID-19 test plus a positive chest X-ray result. Our measures were COVID-19 symptoms, including laboratory evaluations, clinical symptoms, and maternal and neonatal outcomes. The most prevalent symptoms related to COVID-19 were fever (69.09%) and cough (58.18%). Less common symptoms included fatigue, diarrhea, shortness of breath, sore throat, and myalgia. Hydroxychloroquine/chloroquine (58.18%) and antibiotic therapy (45.45%) were the most prevalent management in COVID-19 patients. Based on our findings, maternal and obstetric outcomes—neonatal in case groups—such as mode of delivery, premature rupture of membrane, postpartum hemorrhage, perineal resection rate, neonates’ birth weight, Apgar score, and neonatal asphyxia rate were similar to pregnant women without COVID-19. We observed a higher incidence rate of premature delivery in COVID-19 cases (25 vs. 10%) (p < 0.05). In the present study, we found that women with COVID-19 had a more than twofold increased odds of preterm labor. History of preterm delivery was also associated with high twofold odds of preterm labor. Conclusion We observed a higher incidence rate of premature delivery in COVID-19 cases. Women with COVID-19 had a more than twofold increased odds of preterm labor. Considering prematurity has high morbidity and is regarded as the primary cause of mortality in children under 5 years old, more case-control studies are needed to ascertain the results.
, Maged M. Yassin
Middle East Fertility Society Journal, Volume 26, pp 1-11; doi:10.1186/s43043-021-00062-7

Background Prediction of ovarian response prior to the ovarian stimulation cycle is useful in determining the optimal starting dose of recombinant follicle-stimulating hormone (r-FSH). This study was designed to (I) evaluate which of the following parameters (age, AMH, and FSH) can be used as a predictor of ovarian response to GnRH antagonist stimulation protocol, (II) determine the cutoff value of AMH and age for predicting poor and high ovarian response, and (III) investigate the relationship between age, AMH level, and other clinical parameters. It is a retrospective study. A total of 318 women with a mean age of 28.2 ± 5.9 years old were included in this study. Hormone levels (FSH, LH, PRL, E2, and AMH) and the number of collected oocytes were determined. Based on the number of retrieved oocytes, the participants were divided into three groups: poor response (oocytes < 4, n= 51), normal response (oocytes 4–14, n= 192), and high response (oocytes > 14, n= 75). Results A significant increase has been found in AMH level and number of retrieved oocytes and mature oocytes from low to normal and high ovarian response group (P < 0.001). Also, the age in the poor ovarian response group was significantly greater than normal and high ovarian response groups (P < 0.001). A significant positive correlation has been found between the number of retrieved oocytes and mature oocytes and level of AMH (P < 0.001). The receiver operating characteristic (ROC) curves showed that both AMH and age had the highest accuracy in the prediction of poor ovarian response with a cutoff value < 1.45 and > 31.5 years, respectively. Additionally, the ROC analysis has shown that the AMH had the highest accuracy, followed by age in the prediction of high ovarian response with a cutoff value > 3.55 and < 27.5 years, respectively. Conclusions This study demonstrates that AMH level and women’s age may be used as potential predictors of ovarian response to GnRH antagonist stimulation protocol.
Fadi Choucair, Nagham Younis, Alia Hourani
Middle East Fertility Society Journal, Volume 26, pp 1-6; doi:10.1186/s43043-021-00061-8

Background The embryology laboratory remains one of the primary factors influencing the overall performance of the IVF clinic. Clinical embryology, however, has undergone remarkable advancements over the last decade. These developments in both practice and education have been driven together by science and technology. Main body The changes in clinical embryology practice have created a significant challenge for both the profession and the embryologist. New competencies for embryologists have subsequently emerged to provide and manage high-quality services for their patients and clinics. Embryologists’ efficacy behind the scenes reflects positively on the success of the fertility clinic. This framework will serve as the flagship document to shed light on the often-overlooked value of the embryologist as an intellectual and intangible asset for the clinic. Conclusion To fully leverage a modern embryologist’s skill set, significant investment is required from the IVF clinics’ leadership, which is associated with a substantial return on the IVF clinic’s success. From their side, embryologists should be up to date on further developments and innovations. On the other hand, mentors need to mend the curriculum to allow for better training of high-caliber embryologists.
Sana El Adlani, Abdelhafid Benksim, Yassir Ait Ben Kaddour, Abderraouf Soummani, Mohamed Cherkaoui
Middle East Fertility Society Journal, Volume 26, pp 1-5; doi:10.1186/s43043-021-00060-9

Background The knowledge and the beliefs of people could affect the fertility of women and men all over the society. According to gender, the aim of this study was to describe knowledge level and attitude of Moroccan young people about infertility in Marrakesh-Safi region in Morocco. Results We selected 355 Moroccan young people by a simple random sampling method, during 2019 and using a previously validate questionnaire. Both of female and male had a low level knowledge about the meaning, causes, and treatment of infertility (only 20, 8% of female and 25, 6% of male were aware). Almost, half of them (41, 6% of female versus 51, 9% of male) had reported that it is easier to conceive if the couples had already their first baby. However, 92% of female and 86% of male had confirmed that the lifestyle is a factor that may affect the infertility. The results showed that there was a difference between male and female attitude if the fertility treatment fails, the percentage of male who had proposed the polygamy as solution was higher than female (22.5% versus 6.6%). Besides, the minority had accepted divorce as alternative. The adoption was another solution proposed and accepted by both male and female. Conclusion The result of our study reflects the fact that it is important to investigate on education and a public awareness about fertility in order to upgrade the level of knowledge and attitudes of Moroccan young people.
Milad Pournasir, Saied Ghorbian, Tohid Ghasemnejad, ,
Middle East Fertility Society Journal, Volume 26, pp 1-8; doi:10.1186/s43043-021-00057-4

Background Oxidative stress has an undeniable role in the impairment of sperm function and idiopathic male infertility. On the other hand, the local antioxidant system particularly glutathione peroxidase 3 (GPX3) as an extracellular enzyme protects male fertility from oxidative damages. Therefore, in the current study, we evaluated the association between two functional polymorphisms of the GPX3 gene with its levels in seminal fluid and subsequently with the risk of male infertility. Result We recruited 100 fertile and 100 infertile men for the study. Our results showed that the concentration of GPX3 was higher in the fertile group than infertile patients (p= <0.01), and there were positive correlations between GPX3 concentration in seminal fluid with sperm motility and morphology. The frequency of rs8177404 and rs3828599 genotypes and alleles was significantly different between the groups and we found that having the rs8177404 polymorphism (TC and CC genotypes) could increase the risk of idiopathic infertility more than 2-fold. On the other hand, the GG genotype (rs3828599) showed a protective effect against infertility. Our results demonstrated that men carrying CC genotype of rs8177404 polymorphism had significantly lower progressively motile sperm and higher immotile sperm compared with subjects carrying TT and TC genotypes. In the rs3828599 polymorphism, the GG carriers had significantly higher progressively motile and lower immotile sperm than AA carriers. Furthermore, men with genotypes of CC (rs8177404) and GG (rs3828599) had significantly lower and higher levels of GPX3 in the seminal fluid, respectively. Conclusion In conclusion, our results showed associations between sperm parameters with GPX3 levels and the gene polymorphisms. It seems rs8177404 and rs3828599 polymorphisms can affect GPX3 levels in seminal fluid and subsequently sperm parameters.
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