Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory fertility problems in women of reproductive age, with a prevalence as high as 40% to 75%. There are different treatment modalities for increasing the chance of pregnancy in PCOS patients. Since most of the PCOS patients suffer from ovulatory problems, therapeutic efforts are focused mainly towards restoring normal ovulation. However, even after pharmacological interventions to ameliorate ovulatory irregularities, women with polycystic ovary are still at high risk of fetal loss. Thus, assisted reproductive techniques (ARTs) have become popular approaches which significantly increase the chances of successful pregnancy in these women, bypassing the conditions of PCOS. The present mini-review ‘pinpoints’ on the suitability of ARTs for PCOS patients who fail to ovulate following the conventional infertility treatment. The article also briefly explains how intracytoplasmic sperm injection (ICSI), the most effectiveART, correlates with better biological parameters, fertilization rate and better quality of embryos in PCOS women.
Autoimmunity is a condition in which the immune system cannot recognize the self from nonself-antigens. Autoimmunity is relatively more common in females than males. The process of embryo implantation is considered the most significant restricting factor in female reproduction. The immunological system of the females may affect the success or failure of pregnancy by its effect on extremely important steps from ovulation to implantation processes, thus ensuring the importance of autoimmunity for women in sub-fertility. The association between autoimmunity and female reproduction receives increased attention nowadays. A successful conception is a result of multiple complex interactions between the developed embryo and the receptive uterus and is usually under immune-hormonal control. In certain circumstances, the female ovary can be a target of an autoimmune attack, like some organ-specific or systemic autoimmune disorders subsequently resulting in clinically significant ovarian dysfunction, implantation failure, and sub-fertility. Consequently, the effect of a specific auto-antibody on the etiology of infertility remains unknown. This review focused on auto-antibodies that may affect female fertility.
Polycystic ovary syndrome (PCOS) is one of the major causes of decreased fertility in young females. Multiple extra- and intra-ovarian factors which are worked together or separately are responsible for sub-fertility. However, still, ovulatory dysfunction is the cornerstone that occurs as a result of hormonal dysfunction and consequently affects oocytes' quality, embryonic development and finally, implantation failure with a significant number of females seek assisted reproduction for getting pregnancy.
Controlled ovarian stimulation (COS) has been used during an assisted reproduction cycle to improve the success rate. The gonadotropins which are most frequently used during COS/ICSI cycles are r-FSH and r-HMG (FSH+LH). Over many years, outcomes achieved with using both gonadotropins during COS have been compared and the superiority of using both or only r-FSH is still a controversial topic that necessitates further studying. The aim of this research is to study the effectiveness of adding r-HMG to r-FSH on ICSI outcome in infertile patients who underwent COS. Fifty infertile couples were included who attended fertility clinic due to either female factor or male factor infertility and all of them were treated by ICSI and subjected to COS by r-FSH with or without r-HMG. ICSI outcome was assessed in the form of the total number of retrieved oocytes, FR, CR, embryo quality and chemical PR.The study showed that there was no significant difference between using both gonadotropins or FSH alone regarding the total number of oocytes produced, fertilization rate (FR), cleavage rate (CR), embryos number and quality except pregnancy rate (PR) which was lower with adding r-HMG 41.66% VS 50 % with r-FSH alone. We concluded that the combined use of r-HMG+r-FSH is effective as r-FSH alone in terms of oocytes' and embryos' quality while the effect on PR is still undetermined.
Sperm DNA fragmentation is common in infertile male. Besides, sperm DNA integrity is essential for fertilization and healthy offspring development. Numerous genetic and environmental elements are associated with impacting sperm DNA integrity negatively. Such as lifestyle, ageing, industrial toxins, and infection. The mechanisms behind SDF are many, but apoptosis and reactive oxygen species are considered the main SDF mechanisms. The management of male infertility has led to the desire for more advanced SDF diagnostic tools to diagnose sperm DNA. Numerous sperm DNA damage assays such as terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelling (TUNEL) assay and in situ nick translation (ISNT) are available to enhance SDF diagnosing and ultimately to better SDF management. Clinical SDF can lead to a low pregnancy rate, defects in embryo development and impaired offspring health. Moreover, SDF can impact the effectiveness of assisted reproductive technology through transfer genetics impartment to the embryo b in vitro fertilization or intracytoplasmic sperm injection. SDF can be mange through lifestyle changing, treating existing infection in the male reproductive tract and reactive oxygen species.
Introduction: Prolactin is a hormone secreted from anterior pituitary gland which has different functions throughout the body of the fertile females. Women with polycystic ovary syndrome (PCOS) may exhibit a mild elevation of serum prolactin level. High prolactin level can affect the fertility potential causing ovulatory dysfunction. Even those with normal ovulation, failure of producing a sufficient amount of progesterone after ovulation may occur which resulted in a deficient endometrium; less liable for embryo implantation( luteal phase defect). Thus, this research is aimed to study the frequency of elevated prolactin in women with PCOS and to evaluate its' effect on pregnancy rate. Methods: Fifty-three infertile females were included. They divided in to two major groups: Group I: females with PCOS and Group II: females with no PCOS. Both groups sub-divided in to two subgroups: Group A with serum prolactin more than 20 ng/dl and Group B with normal serum prolactin 2-20 ng/dl. All females were included in ICSI program followed by assessment of pregnancy rate in both groups. Results: The study was showed that 69.44% of women who suffered from PCOS had an elevated serum prolactin level with a mean of 31.17±10.24. Pregnancy rate was lower in the females with high serum prolactin level in both PCOS and non-PCOS women. Conclusion: Hyperprolactinemia is more frequent in the females with PCOS than normal ovulatory females. Elevated serum prolactin level negatively affects implantation and decreases the chance of getting a pregnancy following ICSI.
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