Publications by authors named "Roshan Nikbakht"

25 Publications

  • Page 1 of 1

Metabolic and hormonal effects of melatonin and/or magnesium supplementation in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial.

Nutr Metab (Lond) 2021 Jun 6;18(1):57. Epub 2021 Jun 6.

Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. This study was designed to investigate the effects of melatonin and/or magnesium supplementation on metabolic profile and levels of sex hormones in PCOS women.

Methods: In an 8-week randomized double-blind placebo-controlled trial, 84 subjects with PCOS aged 18-40 years were randomly assigned based on the random block procedure to take magnesium, melatonin, magnesium plus melatonin, and placebo. Fasting blood samples were obtained at the beginning and end of the study.

Results: After intervention, the mean Pittsburg Sleep Quality Index score decreased significantly in both co-supplementation and melatonin groups (P < 0.001). Magnesium supplementation in combination with melatonin resulted in a significant greater decrease in testosterone concentrations compared with the placebo (P < 0.05). Co-supplementation of magnesium-melatonin had significantly reduced serum insulin levels (geometric means difference: - 1.11 (mIU/mL) (percent change: - 15.99)), homeostasis model of assessment-insulin resistance (HOMA-IR) (- 0.28 (- 18.66)), serum cholesterol (mean difference: - 16.08 (mg/dl) [95% CI - 24.24, - 7.92]), low-density lipoprotein cholesterol (LDL-C) - 18.96 (mg/dl) [- 28.73, - 9.20]) and testosterone levels (- 0.09 (ng/ml) (- 25.00)), as compared to the baseline values (P < 0.05). An increase in serum high-density lipoprotein cholesterol (HDL-C) levels was also observed following the administration of the melatonin alone (2.76 (mg/dl) [0.57, 4.95]) or in combination with magnesium (2.19 (mg/dl) [0.61, 3.77]) (P < 0.05).

Conclusions: Co-supplementation with magnesium and melatonin had beneficial effects on sleep quality and total testosterone. Additionally, melatonin supplementation alone was found to be associated with a significant reduction in PSQI score. Moreover, combined melatonin and magnesium supplementation was more effective in improving serum levels of cholesterol, LDL-C, HDL-C and insulin, and HOMA-IR.

Trial Registration: Iranian Registry of Clinical Trial. http://www.irct.ir : IRCT20191130045556N1, January 2020.
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http://dx.doi.org/10.1186/s12986-021-00586-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183043PMC
June 2021

Effects of Melatonin and/or Magnesium Supplementation on Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial.

Biol Trace Elem Res 2021 May 19. Epub 2021 May 19.

Nutrition and Metabolic Disease Research Center, Clinical Science Research Institute, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

Magnesium and melatonin are known to exert multiple beneficial effects including anti-inflammatory and antioxidant actions. This study was designed to determine the effects of magnesium and/or melatonin supplementation on metabolic profiles in women with polycystic ovary syndrome (PCOS). This randomized double-blind, placebo-controlled trial was conducted among 84 subjects with PCOS aged 18-40 years old. Patients were randomly assigned based on the random block procedure to take magnesium, melatonin, magnesium plus melatonin, or placebo for 8 weeks. Fasting blood samples were taken at baseline and after the intervention to quantify related variables. After the 8-week intervention, an insignificant marginal difference was seen in waist circumference (WC) between groups (P = 0.085). Magnesium-melatonin co-supplementation resulted in more reductions in hirsutism compared with other groups (P < 0.001). Serum levels of tumor necrosis factor-α (TNF-α) declined significantly in the melatonin and co-supplementation groups compared to baseline (P < 0.05). Also, magnesium plus melatonin was associated with a more increase in total antioxidant capacity (TAC) levels, as compared to the other treatment groups (P = 0.001). Overall, we found a favorable effect of co-supplementation of magnesium and melatonin for 8 weeks in women with PCOS on hirsutism, serum TNF-α, and TAC levels. Furthermore, melatonin independently contributed to decreased serum values of TNF-α.Clinical trial registration number http://www.irct.ir : IRCT20191130045556N1, January 2020.
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http://dx.doi.org/10.1007/s12011-021-02725-yDOI Listing
May 2021

Utilizing Calcium Alginate for the Assessment of Bone Morphogenetic Protein 15 Induction Effect on the Differentiation of Mesenchymal Stem Cell Derived from Human Follicular Fluid to Oocyte-Like Structure.

Adv Biomed Res 2020 23;9:80. Epub 2020 Dec 23.

Fertility, Infertility and Perinatology Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Follicular fluid (FF)-derived mesenchymal stem cells (MSCs) are possible new source of cells in the study of oogenesis and regenerative medicine. Several biomaterials have been used as scaffolds to mimic ovarian tissue stroma. Using good matrix is essential for increasing the cell survival rate, proliferation, and differentiation. However, no study has been performed to investigate the effects of BMP15 and calcium alginate hydrogel on the differentiation potential of FF-derived MSCs to oocyte-like structures (OLSs).

Materials And Methods: In this work, FF MSCs, which were collected from women in routine fertilization procedure, were capsulated with 0.5% calcium alginate, and then the encapsulated cells were cultured in medium containing BMP15 for 2 weeks. Trypan blue staining was carried out to determine cell viability. Real-time polymerase chain reaction (PCR) and immunofluorescence (ICC) staining method were performed to characterize the expression of OCT4, Nanog, ZP2, and ZP3 genes and protein. The encapsulation process did not change the morphology and viability of the encapsulated cells.

Results: Reverse-transcription-PCR and ICC showed that MSCs expressed germ line stem cell markers such as OCT4 and Nanog. After 4 days of culture, OLSs formed and expressed zona pellucida markers. OLSs at least reached 180-230 μm in diameter in the control and BMP15-treated groups. Finally, a reduction in the expression pattern of pluripotency and ZP markers was detected in the encapsulated cells cultured in the BMP15-supplemented medium.

Conclusion: The three-dimensional alginate culture system seems to be a promising method of getting differentiation and development of ovarian cells, which could mimic the native ovarian condition.
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http://dx.doi.org/10.4103/abr.abr_200_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059453PMC
December 2020

Evaluation of oocyte quality in Polycystic ovary syndrome patients undergoing ART cycles.

Fertil Res Pract 2021 Jan 5;7(1). Epub 2021 Jan 5.

Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: To evaluate factors affecting oocyte/embryo quality in PolyCystic Ovary Syndrome (PCOS) patients undergoing Assisted Reproductive Technology (ART) cycles.

Methods: This case-control retrospective study was performed on PCOS patients referred to the infertility department of Imam Khomeini Hospital in Ahvaz from October 2017 to September 2019. Demographic and reproductive characterizations including age, gender, abortion history and infertility type (primary and secondary infertility) were extracted from patient's records. TSH, AMH, LH, FSH, prolactin, lipid profile and blood glucose was measured. Biochemistry pregnancy was checked by determination of serum βHCG level and then, clinical pregnancy was confirmed by observing of pregnancy sac and fetal heart rate using Transvaginal USS.

Results: One-hundred thirty-five patients include 45 PCOS and 90 Non-PCOS patients with mean age of 31.93 ± 5.04 and 30.8 ± 5.38 (p = 0.24) were considered as case and control groups respectively. Retrieved oocyte numbers were significantly higher in PCOS patients (p = 0.024), but there was no significant difference in number of oocyte subtypes (MI, MII and GV) between two groups. The embryo numbers and its subtypes did not differ significantly in both groups. The clinical pregnancy rate was insignificantly lower in PCOS patients (p = 0.066) and there was a significant correlation between retrieved oocyte numbers with age(r= -0.2, p= 0.022) and AMH level (r = 0.433, p < 0.0001) respectively. Cholesterol level had shown a positive significant correlation with number of MI oocytes (r = 0.421, p = 0.026) and MII oocytes significantly affected by age (r= -0.250, p = 0.004) and AMH level (r = 0.480, p < 0.0001). Using Receiver operation characteristic (ROC) curve analysis, the cut-off value of total number of oocytes was > 10.5 with area under curve of 0.619±0.054(sensitivity 55.56% and specificity 69.66%) CONCLUSIONS: The results of this study showed that although the number of oocytes in PCOS patients was significantly higher than non-PCOS patients, the quality of oocytes was not statistically different. The number and quality of embryos were not significantly different in both groups. Our results indicated a significant relationship between the level of AMH and the number of retrieved oocytes and embryos. We found there is a significant correlation between cholesterol level and number of MI oocytes.
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http://dx.doi.org/10.1186/s40738-020-00094-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784377PMC
January 2021

Spontaneous pregnancies and determinant factors in infertility: A cross-sectional study.

Int J Reprod Biomed 2020 Oct 13;18(10):905-910. Epub 2020 Oct 13.

Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: The phenomenon of infertility may be derived from different factors - either in males or females or both genders, including few unexplained factors. It is generally managed by medical and surgical treatments.

Objective: To find a relation of occurrence of spontaneous pregnancy (SP) with effective factors in infertility.

Materials And Methods: This cross-sectional study was conducted at two referral infertility centers (university and privacy center) in the southwest of Iran from March 2015 and March 2016 on 655 infertile couples, who were divided in two groups of with (n = 31) and without (n = 624) SP. The variables included female and male age, male smoking, male job, the place of living, the causes of infertility, the type and duration of infertility, and the subgroups of infertility causes.

Results: Infertility may be caused due to both male- and female- related factors (47.5%). While female-related infertility was found in 31.5%, male-related infertility in 14.5%, and infertility due to unexplained factors in 6.6% of our patients. The rate of SP was 4.7%, which had a significant relation with the duration of infertility (p = 0.01), with women's age (p = 0.048), unexplained infertility (p = 0.001), and husband's job (p = 0.004).

Conclusion: The occurrence of SP in infertile couples was related to age of the female partner, the duration of unexplained infertility, and the male partner's job.
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http://dx.doi.org/10.18502/ijrm.v13i10.7775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569715PMC
October 2020

Identification of the PRM1 gene mutations in oligoasthenoteratozoospermic men.

Andrologia 2020 Dec 28;52(11):e13872. Epub 2020 Oct 28.

Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Mutations or altered expression of PRM1 gene have been associated with male infertility. This study aimed to analyse pathogenic variations of PRM1 gene in Iranian Arab infertile men with oligoasthenoteratozoospermia that was carried out for the first time in this population. Genomic DNA was used to perform PCR sequencing in PRM1 untranslated regions, exons and intron. Also, bioinformatics analysis was recruited to discover the possible effect of detected variations. Two pathogenic variations were seen in two men with oligoasthenoteratozoospermia, which were not found in the control group. The cDNA.384G>C variation is novel and was located in the 3' untranslated region, and cDNA.42G>A variation is reported for the first time related to male infertility and was found in 5' untranslated regions. Bioinformatics analysis showed that the minimum free energy was increased from -19.9kcal/mol to -13.1kcal/mol due to the cDNA.384G>C variation at hsa-miR-4326's seed site. More analysis revealed cDNA.42G>A located in transcription factors binding site, E1 and MYOD, which was detected as a promoter-associated region, and generally have regulatory features for acetylation and methylation. In conclusion, two pathogenic variations were recognised in regulatory areas of PRM1 gene, which might interfere with some critical factors related to PRM1 gene expression, hence cause male infertility.
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http://dx.doi.org/10.1111/and.13872DOI Listing
December 2020

Bone morphogenetic protein 15 induces differentiation of mesenchymal stem cells derived from human follicular fluid to oocyte-like cell.

Cell Biol Int 2021 Jan 10;45(1):127-139. Epub 2020 Oct 10.

Cellular and Molecular Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Follicular fluid (FF) is essential for developing ovarian follicles. Besides the oocytes, FF has abundant undifferentiated somatic cells containing stem cell properties, which are discarded in daily medical procedures. Earlier studies have shown that FF cells could differentiate into primordial germ cells via forming embryoid bodies, which produced oocyte-like cells (OLC). This study aimed at isolating mesenchymal stem cells (MSC) from FF and evaluating the impacts of bone morphogenetic protein 15 (BMP15) on the differentiation of these cells into OLCs. Human FF-derived cells were collected from 78 women in the assisted fertilization program and cultured in human recombinant BMP15 medium for 21 days. Real-time polymerase chain reaction and immunocytochemistry staining characterized MSCs and OLCs. MSCs expressed germline stem cell (GSC) markers, such as OCT4 and Nanog. In the control group, after 15 days, OLCs were formed and expressed zona pellucida markers (ZP2 and ZP3), and reached 20-30 µm in diameter. Ten days after induction with BMP15, round cells developed, and the size of OLCs reached 115 µm. A decrease ranged from 0.04 to 4.5 in the expression of pluripotency and oocyte-specific markers observed in the cells cultured in a BMP15-supplemented medium. FF-derived MSCs have an innate potency to differentiate into OLCs, and BMP15 is effective in promoting the differentiation of these cells, which may give an in vitro model to examine germ cell development.
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http://dx.doi.org/10.1002/cbin.11475DOI Listing
January 2021

Effects of Vitamin D on Apoptosis and Quality of Sperm in Asthenozoospermia.

JBRA Assist Reprod 2020 Jul 14;24(3):316-323. Epub 2020 Jul 14.

Fertility, Infertility and Perinatology Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objective: Vitamin D receptor (VDR) is expressed in human spermatozoa. However, the role of vitamin D (VD) in human male reproduction has not yet been clarified. In this study, effects of VD on sperm parameters and its apoptosis in asthenozoospermic and healthy men were evaluated.

Methods: The study was carried out on discharged semen samples of 80 asthenozoospermic and healthy men. The samples were divided into control and experimental groups (received 20 µMol of VD). This study assessed sperm motility using the Makler chamber, their morphology by Diff quick, apoptosis and necrosis by Annexin-V and TUNEL assays, and their chromatin integrity was assessed by Aniline blue and Toluidine blue staining, according to WHO guidelines.

Results: The results revealed that: 1) the total number of motile sperms was increased by VD in both groups, but it was only significant in the asthenozoospermia group. 2) The progressive motility was increased with significant difference in both groups.3) Morphology of sperm did not show any changes due to VD in any of the groups. 4) Early apoptosis and necrosis of sperms were reduced in both groups, but the results of late apoptosis showed no statistical difference in these groups. 5) The percentage of positive toluidine blue was significantly decreased after using VD in the asthenozoospermia group.

Conclusion: VD could improve motility, early apoptosis, and sperm necrosis, especially in asthenozoospermic men and it could be used for therapeutic opportunities.
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http://dx.doi.org/10.5935/1518-0557.20200009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365542PMC
July 2020

A successful pregnancy following recurrent implantation failure with clinical laboratory strategy.

JBRA Assist Reprod 2020 10 6;24(4):507-509. Epub 2020 Oct 6.

Reproductive Biology research, Infertility Research and Treatment Center of ACECR, Khuzestan, Ahvaz, Iran.

In treatment cycles of in vitro fertilization (IVF), 15% of the oocytes are immature and in the germinal vesicle (GV) phase. In rare occasions, more than 50% of the oocytes of a patient in a cycle are immature. Selecting fertility treatment for patients in this situation can be very challenging. The patient described in this report was a 35-year-old woman with primary infertility for 10 years. She had undergone fertility treatment six times, with no success. In her cycles, more than 50% of the oocytes were immature and in the GV phase. To address the situation, we developed a coordinated protocol involving medical and embryology procedures, analyzed the patient's medical records, and looked into the reasons of prior treatment failure. The development of a special and coordinated effort - instead of having medical and embryology teams working in isolation - proved efficient at providing better outcomes to the patient.
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http://dx.doi.org/10.5935/1518-0557.20190093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558906PMC
October 2020

Maternal serum levels of C-reactive protein at early pregnancy to predict fetal growth restriction and preterm delivery: A prospective cohort study.

Int J Reprod Biomed 2020 Mar 29;18(3):157-164. Epub 2020 Mar 29.

Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: A considerable evidence suggests that maternal inflammation dysregulation may play as a risk factor for both maternal and neonatal outcomes. The study's objectives were designed to evaluate the correlation between serum C-reactive protein (CRP) levels, as an inflammation factor, preterm delivery, and small for gestational age (SGA) births.

Materials And Methods: This prospective cohort study was conducted on 120 singleton pregnant women with gestational age less than 20 wk. Maternal CRP serum concentration was measured before 20 wk gestation. Patients were followed-up until the delivery and final outcomes of pregnancy were recorded in terms of preterm delivery and SGA births. : Serum CRP levels in participants with normal fetuses and SGA births were 4.09 1.35 mg/l and 6.04 3.29 mg/l, respectively (p = 0.19), while in cases of preterm delivery, it was 9.63 5.78 mg/l (p 0.001). By using receiver operating characteristic (ROC) curve, serum CRP levels (cut-off point 5.27 mg/l, area 0.836) had acceptable diagnostic accuracy value in distinguishing preterm delivery (sensitivity (75%), specificity (86.1%), positive predictive value (37.5%), negative predictive value (96.87%), accuracy (85%)) and serum CRP levels (cut-off point 6.67 mg/l, area 0.673) in distinguishing SGA births (sensitivity (50%), specificity (91.2%), positive predictive value (23.07%), and negative predictive value (97.19%), and accuracy (89.16 %)).

Conclusion: Higher maternal serum CRP levels measured early in pregnancy may associate with higher risk of preterm delivery and SGA.
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http://dx.doi.org/10.18502/ijrm.v18i3.6710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142318PMC
March 2020

Insulin Resistance and Free Androgen as Predictors for Ovarian Hyperstimulation Syndrome in Non-PCOS Women.

Horm Metab Res 2020 Feb 23;52(2):104-108. Epub 2020 Jan 23.

Fertility Infertility and Perinatology Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran.

We evaluated the effect of insulin resistance and free androgen index (FAI) in non-PCOS (polycystic ovary syndrome) infertile women following controlled ovarian hyperstimulation. A prospective study was done on 144 infertile non-PCOS women with regular menstrual cycle. At first, insulin resistance (IR), free androgen index (FAI), PCOM (polycystic ovary morphology), AFC (antral follicle count), and AMH (anti-Müllerian hormone) were assessed. The patients underwent assisted reproductive technology (ART), and then preovulatory follicles and oocytes retrieved were recorded. The variables of the study were compared between two groups of patients with ovarian hyperstimulation syndrome (OHSS) (n=66) and non-OHSS patients (n=78). Of the 9 variables: BMI, HOMA-IR, FAI, AFC, AMH, PCOM, and preovulatory follicles were risk factors, while the age and retrieved oocytes were not. The 7 variables that showed significance in the univariate analyses were determined as independent variables included in the multivariable logistic regression analysis, as a result, a total of 5 risk factors, BMI, HOMA-IR, FAI, PCOM, and preovulatory follicles entered the equation. The maximum contribution was HOMA-IR followed by PCOM, FAI, preovulatory follicles and BMI. Patients with OHSS had higher chance to have ovaries with polycystic morphology (74%), about three times more than patients who did not develop OHSS (29%) (p<0.001). The best cut-points for IR, FAI, AFC, AMH, and preovulatry follicles were 2.36, 3.9, 8, 3.3 ng/ml, and 10, respectively. Patients with a higher value of BMI, FAI, HOMA-IR, and preovulatory follicles and the presence of PCOM are more likely to develop OHSS, which are not confined to PCOS patients.
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http://dx.doi.org/10.1055/a-1079-5342DOI Listing
February 2020

Association Between Fetal Middle Cerebral Artery and Umbilical Artery Doppler Ratio with Fetal Distress in 38-40 Weeks of Gestation.

J Obstet Gynaecol India 2019 Dec 17;69(6):509-513. Epub 2019 Jul 17.

Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Prinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background And Objective: Knowing the factors affecting fetal distress is of particular importance in improving prognosis in newborns. The study aimed to determine the relationship between fetal middle cerebral artery pulsatility indexes and umbilical artery Doppler ratio with fetal distress at 38-40 weeks of gestation.

Materials And Methods: In this prospective cohort, 181 consecutive pregnant women with 38-40 weeks of gestational age were selected by a non-random convenience sampling method from January 2016 to January 2017. Women with labor pain and embryos with chromosomal and structural disorder were excluded. Color Doppler sonography was done for all of them, and the association of this ratio with fetal distress consequently was assessed as well.

Results: In this study, abnormal amniotic fluid index (AFI) (1.1%), low birth weight (< 2500 g) (5.5%), emergency cesarean (11.6%), neonatal intensive care unit (NICU) admission (12.2%), low 5th minute Apgar (< 7) (0.6%), abnormal fetal monitoring (10.5%), fetal distress (11.6%), meconium aspiration syndrome (10.5%), and respiratory distress (3.9%) were present. The mean cerebroplacental ratio was 1.9. There was a significant association between low fetal middle cerebral artery pulsatility index and umbilical artery Doppler ratio with fetal distress, abnormal monitoring, and urgent cesarean ( = 0.006). The cutoff 1.94 led to sensitivity, specificity, positive predictive value, and negative predictive value of 80.95, 50, 17.5, and 95.2%, respectively.

Conclusion: It may be concluded that in our study a cutoff for fetal middle cerebral artery to umbilical artery ratio of 1.94 at 38 weeks was considered statistically significant in predicting fetal distress at 38-40 weeks. However, further studies with larger sample size and multi-center sampling would develop more definite results for wider application.
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http://dx.doi.org/10.1007/s13224-019-01250-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888801PMC
December 2019

Effect of vitamin D on apoptotic marker, reactive oxygen species and human sperm parameters during the process of cryopreservation.

Iran J Basic Med Sci 2019 Sep;22(9):1036-1043

Fertility, Infertility and Perinatology Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objectives: Sperm cryopreservation plays an undeniable role in assisted reproductive technology. However, this process significantly reduces the motility, viability, morphology and nuclear integrity of sperm. Reasons of these changes were oxidative stress and apoptosis. The aim of this study was to evaluate the influence of vitamin D on the survival and integrity of fertile sperm after cryopreservation.

Materials And Methods: Semen sample of 18 males with normal parameters was used. After swimming up, each sample was divided into two parts. 20 µmol vitamin D was added to one part as experimental group and the other part was left untreated as control group. The samples in all groups were frozen for 14 days. Post-thawing, the groups were evaluated for sperm motility, and viability using eosin staining, morphology using the Diff-Quick staining and apoptosis by TUNEL, Annexin-V and caspase-3 activity assay. By using nitrobluetetraxolium test and thiobarbituric acid, the reactive oxygen species (ROS) and lipid peroxidation of sperms were measured, respectively.

Results: In comparison with control groups, motile and viable sperm concentration was substantially higher in treated groups (-value<0.05); however, morphological analysis did not show any remarkable changes. Also, ROS and lipid peroxidation values were dramatically reduced by vitamin D (-value<0.05). TUNEL and Annexin assay for apoptosis were considerably lower in treated groups (-value<0.05), but caspase activity assay revealed no significant difference between groups.

Conclusion: The results have shown that the addition of vitamin D to a freezing medium leads to higher quality and function of human sperm.
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http://dx.doi.org/10.22038/ijbms.2019.36258.8634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880532PMC
September 2019

Evaluating Chronic Endometritis in Women with Recurrent Implantation Failure and Recurrent Pregnancy Loss by Hysteroscopy and Immunohistochemistry.

J Minim Invasive Gynecol 2020 01 6;27(1):116-121. Epub 2019 Mar 6.

Research Center for Thalassemia and Hemoglobinopathy, Ahvaz, Iran (Dr. Choghakabodi).

Study Objective: The identification of less invasive methods with acceptable diagnostic value for evaluating intrauterine abnormalities can improve the satisfaction of patients and physicians. Although hysteroscopy plus biopsy has favorable predictive and diagnostic values, limited studies have evaluated its value, and the exact value of this method is not completely understood. The aim of this study was to evaluate the prevalence of chronic endometritis in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) by hysteroscopy and immunohistochemistry.

Design: A cross-sectional study.

Setting: An infertility clinic at Jundishapur University Hospital, Ahvaz, Iran.

Patients: Women with RIF after IVF and RPL.

Interventions: Hysteroscopy on the third to fifth day after finishing the menstruation cycle and then a biopsy for immunohistochemistry by a specific monoclonal antibody against the CD138 marker.

Measurements And Main Results: In total, 85 patients with a mean age of 36.08 ± 5.76 years underwent hysteroscopy on the third to fifth day after finishing the menstruation cycle. At the end of hysteroscopy, a biopsy was taken and assessed using immunohistochemistry by a specific monoclonal antibody against the CD138 marker. Immunohistochemical staining findings of >5 plasma cells per 20 high-power fields were considered the gold standard. The prevalence of chronic endometritis (CE) in both groups and the diagnostic value of hysteroscopy were evaluated. All data were analyzed using the Fisher exact test and analysis of variance. The prevalence of RIF-related CE was 23.4% (11); 21.3% (10) of the cases were diagnosed by hysteroscopy. The prevalence of RPL-related CE was 36.8% (14) and 31.6% (12) based on hysteroscopy and immunohistochemistry staining, respectively. Subsequently, 10 patients (RIF/RPL-related CE with a positive hysteroscopic outcome) were selected randomly for in vitro fertilization therapy, and 3 (30%) of them eventually became pregnant. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy in diagnosing CE were 86.36%, 87.30%, 70.37%, and 94.82%, respectively.

Conclusion: Hysteroscopy is a reliable diagnostic technique in patients with RIF after in vitro fertilization and RPL that can reliably diagnose chronic endometritis.
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http://dx.doi.org/10.1016/j.jmig.2019.02.016DOI Listing
January 2020

The Effect of Tranexamic Acid on Preventing Post-partum Hemorrhage Due to Uterine Atony: A Triple-blind Randomized Clinical Trial.

Curr Clin Pharmacol 2018 ;13(2):136-139

Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Postpartum haemorrhage (PPH) is an important cause of early maternal death which needs to be controlled.

Objective: This study was designed to compare the effect of intravenous tranexamic acid (TXA) and prostaglandin analogue on reducing PPH resulted from uterine atony in women undergoing C section or vaginal delivery.

Method: A randomized, triple-blind, placebo-controlled study was conducted on 248 pregnant women with PPH due to uterine atony who were randomly assigned into two groups of TXA as the intervention group (n=124) and prostaglandin analogue as the control group (n=124). The intervention group received 4 g TXA for an hour and then 1 g over 6 hours infusion intravenously and the control group received prostaglandin analogue.

Results: Postoperative bleeding did not significantly differ between the two groups (68.2±6.1 ml and 69.1±175.73 ml, respectively, P =0.6). Moreover, hemoglobin declines were 1±0.4 g/dl and 1.2±0.5 g/dL in TXA and prostaglandin group respectively, indicating that the difference was not statistically significant (P =0.7).

Conclusion: The results of the present study showed that administrating intravenous TXA had comparable effects with prostaglandin analogue on reducing PPH in women with uterine atony and in those undergoing C section or vaginal delivery. Therefore, TXA can be used instead of prostaglandin in managing such patients.
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http://dx.doi.org/10.2174/1574884713666180507101002DOI Listing
June 2019

Comparison Between Effects of Acupuncture and Metoclopramide on Postoperative Nausea and Vomiting after Gynaecological Laparoscopy: A Randomized Controlled Trial.

Anesth Pain Med 2017 Oct 22;7(5):e12876. Epub 2017 Aug 22.

Assistant Professor, Gynecology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Gynaecological laparoscopy one ofthe most common operations thatis accompanied by postoperative nausea and vomiting (PONV). A non-pharmacological method of preventing PONV is acupuncture therapy.

Objectives: This study is conducted to compare the effects of acupuncture and metoclopramide on post-operative nausea and vomiting (PONV) after gynaecological laparoscopy.

Methods: In this double-blind, randomized, clinical trial study,122female, ASA I, aged 19 - 46, who had been referred to the Imam Khomini Hospital (Ahvaz, Iran) and were candidates for gynaecological laparoscopy were enrolled. Eligible patients were randomly allocated into three groups group I (acupuncture; n = 40), group II (metoclopramide 0.2 mg/kg IV; n = 41), and group III (control; n = 41). In group I, acupuncture was done by inserting a special needle at point P6 in front of the elbow immediately after induction of anaesthesia and removing it before extubation and transfer of the patient to the recovery room. The occurrences of nausea and vomiting during the period of stay in the recovery room (one and two hours after surgery) were recorded through questions or clinical observation. Statistical analysis was conducted using SPSS V. 19, descriptive statistics, and the Chi-square test.

Results: The acupuncture group (11.1%) showed a significant decrease in the incidence of nausea one hour after surgery compared to the metoclopramide group (33.3%) (P = 0.02), but there was no significant difference between the acupuncture and metoclopramide groups in terms of postoperative vomiting (POV) incidence one and two hours after surgery. Incidence of PONV in the acupuncture group (2.7%) was statistically significantly lower than that in the control group (28.5%), two hours after surgery (P < 0.01).

Conclusions: Acupuncture is better for controlling nausea after laparoscopic surgery, compared to metoclopramide. Acupuncture is an effective method for reduction of PONV in gynaecological laparoscopy.
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http://dx.doi.org/10.5812/aapm.12876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903383PMC
October 2017

Comparison between Conventional Blind Embryo Transfer and Embryo Transfer Based on Previously Measured Uterine Length.

Int J Fertil Steril 2014 Oct 1;8(3):249-54. Epub 2014 Nov 1.

Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Embryo transfer (ET) is one of the most important steps in assisted re- productive technology (ART) cycles and affected by many factors namely the depth of embryo deposition in uterus. In this study, the outcomes of intracytoplasmic sperm injec- tion (ICSI) cycles after blind embryo transfer and embryo transfer based on previously measured uterine length using vaginal ultrasound were compared.

Materials And Methods: This prospective randomised clinical trial included one hun- dred and forty non-donor fresh embryo transfers during January 2010 to June 2011. In group I, ET was performed using conventional (blind) method at 5-6cm from the external os, and in group II, ET was done at a depth of 1-1.5 cm from the uterine fundus based on previously measured uterine length using vaginal sonography. Appropriate statistical analysis was performed using Student's t test and Chi-square or Fisher's exact test. The software that we used was PASW statistics version 18. A p value <0.05 was considered statistically significant.

Results: Chemical pregnancy rate was 28.7% in group I and 42.1% in group II, while the difference was not statistically significant (p=0.105). Clinical pregnancy, ongoing preg- nancy and implantation rates for group I were 21.2%, 17.7%, and 12.8%, while for group II were 33.9%, 33.9%, and 22.1, respectively. In group I and group II, abortion rates were 34.7% and 0%, respectively, indicating a statistically significant difference (p<0.005). No ectopic pregnancy occurred in two groups.

Conclusion: The use of uterine length measurement during treatment cycle in order to place embryos at depth of 1-1.5cm from fundus significantly increases clinical and ongo- ing pregnancy and implantation rates, while leads to a decrease in abortion rate (Registra- tion Number: IRCT2014032512494N1).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221510PMC
October 2014

A proteomic analysis of human follicular fluid: comparison between younger and older women with normal FSH levels.

Int J Mol Sci 2014 Sep 29;15(10):17518-40. Epub 2014 Sep 29.

Fertility and Infertility & Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6193673166, Iran.

The follicular fluid (FF) is produced during folliculogenesis and contains a variety of proteins that play important roles in follicle development and oocyte maturation. Age-related infertility is usually considered as a problem that can be solved by assisted reproduction technology. Therefore, the identification of novel biomarkers that are linked to reproductive aging is the subject of this study. FF was obtained from healthy younger (20-32 years old) and older (38-42 years old) women undergoing intracytoplasmic sperm injection (ICSI) due to male factor infertility. The FF was analyzed by two-dimensional gel electrophoresis (2-DE). The power of two-dimensional gel electrophoresis and the identification of proteins were exploited using matrix-assisted laser desorption-ionization time-of-flight/time-of-flight (MALDI-TOF-TOF) mass spectrometry. Twenty three protein spots showed reproducible and significant changes in the aged compared to the young group. Of these, 19 protein spots could be identified using MALDI-TOF-TOF-MS. As a result of MASCOT search, five unique downregulated proteins were identified in the older group. These were identified as serotransferrin, hemopexin precursor, complement C3, C4 and kininogen. A number of protein markers were found that may help develop diagnostic methods of infertility.
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http://dx.doi.org/10.3390/ijms151017518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227176PMC
September 2014

Increase of CD69, CD161 and CD94 on NK cells in women with recurrent spontaneous abortion and in vitro fertilization failure.

Iran J Immunol 2014 Jun;11(2):84-96

Department of Immunology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, e-mail:

Background: Recurrent spontaneous abortion (RSA) and in vitro fertilization (IVF) failure with unknown causes are the controversial issues that are probably related to the immune system.

Objective: To compare circulating NK cells expressing activation and inhibition surface markers between patients with RSA and IVF failure with those of healthy multiparous and successful IVF control women, respectively.

Methods: In this case-control study peripheral blood samples were collected from 43 patients who included 23 women with RSA and 20 with IVF failure, plus 43 healthy control women comprising of 36 normal multiparous women and seven women with successful IVF. The expression of CD69, CD94 and CD161 surface markers on CD56+NK cells were assessed using specific monoclonal antibodies by flowcytometry.

Results: The percentage of NK cells increased significantly in patients with RSA and in women with IVF failure in comparison to healthy multiparous and successful IVF control groups (p<0.001). The overall expression of CD69, CD94, CD161 were also increased significantly on NK cells in both patient groups compared to control groups (p<0.001).

Conclusion: Elevated expression of CD69 and CD161 on NK cells can be considered as immunological risk markers in RSA and IVF failure. However, it is not clear if high expression of CD94 on peripheral blood NK cells is related to abnormal activity of endometrial NK cells.
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http://dx.doi.org/IJIv11i2A3DOI Listing
June 2014

Nifedipine compared to magnesium sulfate for treating preterm labor: A randomized clinical trial.

Iran J Reprod Med 2014 Feb;12(2):145-50

Department of Obstetrics and Gynecology, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran.

Background: Preterm labor is the leading cause of infant morbidity and mortality so it may be necessary to administer tocolytics for treatment of it.

Objective: The aim of this study was to compare the efficacy and safety of magnesium sulfate and nifedipine in the management of preterm labor.

Materials And Methods: 100 women with documented preterm labor were randomly assigned to receive magnesium sulfate (n=50) and nifedipine (n=50) as tocolytic therapy. Before tocolysis, patient did not receive any sedation. After tocolysis, if patient continued to have contractions, they received other tocolytic agents. The main outcome variables examined were days gain in utero, success rate and side effects of tocolysis.

Results: Both drugs were equally effective in prevention of labor and delaying delivery >7 days, 56% vs. 64% in the nifedipine and magnesium sulfate groups, and the days gain in utero was no statistically different in two groups. 6% of nifedipine group and 2% of magnesium sulfate group required drug discontinuation due to severe symptoms. There were also no significant differences in maternal characteristics between two groups. The total success rate and side effects were similar in two groups.

Conclusion: Oral nifedipine could be a suitable alternative for magnesium sulfate with the same efficacy and side effects in the management of preterm labor. Registration ID in IRCT: IRCT2013090914603N1.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009567PMC
February 2014

Comparison of leptin concentrations between infertile women with polycystic ovary syndrome and fertile women.

Iran J Reprod Med 2013 Dec;11(12):1033-4

Department of Biochemistry, Medicine Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Some studies propose that changes in leptin concentrations (above or under the normal range) result in infertility. Therefore, we investigated serum and follicular fluid leptin concentrations in infertile women with polycystic ovary syndrome (PCOS).

Objective: To study serum and follicular fluid leptin concentrations in infertile women with PCOS.

Materials And Methods: We conducted a case-control study. The case group consisted of 30 infertile women with PCOS who were admitted to the Infertility Department of Imam Khomainy Hospital in Ahvaz, Iran. The control group consisted of 30 healthy fertile women adjusted for age and body mass index (BMI) with the case group. On day 14 of the menstrual cycle, 5 ml of blood was obtained from subjects in both groups. Serum and follicular fluid leptin concentrations were determined by the enzyme linked immunosorbent assay (ELISA). A Biovendor kit was used for the measurement of leptin concentrations. All data were analyzed using statistical package for the social sciences (SPSS) software (version 17.0, Nie, Bent & Hull, USA).

Results: There was a significant correlation between BMI and serum leptin concentrations in both the control (p=0.005, r=0.516) and case groups (p=0.006, r=0.547). In the case group, serum leptin concentrations were consistent with follicular fluid leptin concentrations (p<0.001, r=0.839). Comparison of serum leptin concentrations between the case and control groups revealed no significant difference (p=0.56).

Conclusion: Infertility among women with PCOS was not a consequence of changes in leptin concentrations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941400PMC
December 2013

Ketotifen, a mast cell blocker improves sperm motility in asthenospermic infertile men.

J Hum Reprod Sci 2013 Jan;6(1):19-22

Infertility and In Vitro Fertilization Center, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: This study aimed to evaluate the efficacy of ketotifen on sperm motility of asthenospermic infertile men.

Setting And Design: It is a prospective study designed in vivo.

Materials And Methods: In this interventional experimental study, a total of 40 infertile couples with asthenospermic infertility factor undergoing assisted reproductive technology (ART) cycles were enrolled. The couples were randomly assigned to one of two groups at the starting of the cycle. In control group (n = 20), the men did not receive Ketotifen, while in experiment group (n = 20), the men received oraly ketotifen (1 mg Bid) for 2 months. Semen analysis, under optimal circumferences, was obtained prior to initiation of treatment. The second semen analysis was done 2-3 weeks after stopped ketotifen treatment and sperm motility was defined. Clinical pregnancy was identified as the presence of a fetal sac by vaginal ultrasound examination.

Statistical Analysis Used: All data are expressed as the mean ± standard error of mean (SEM). t test was used for comparing the data of the control and treated groups.

Results: The mean sperm motility increased significantly (from 16.7% to 21.4%) after ketotifen treatment (P < 0.001). This sperm motility improvement was more pronounced in the primary infertility cases (P < 0.003). The rate of pregnancy was 12.5% in infertile couples that their men receiving 1 mg/twice a day ketotifen. In 52% of infertile men's semen, the percentage of sperm motility was increased from 5% to 35% and this sperm motility improvement was also observed in 33% of necrospermia (0% motility) cases.

Conclusion: These results suggest that ketotifen may represent as a novel therapeutic approach to improve sperm motility in the infertile men with cause of asthenospermia or necrospermia.
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http://dx.doi.org/10.4103/0974-1208.112373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713570PMC
January 2013

A new look at tamoxifen: co-administration with letrozole in intrauterine insemination cycles.

Arch Gynecol Obstet 2013 Feb 25;287(2):383-7. Epub 2012 Sep 25.

Emam Khomeini Hospital, Ahvaz Jundishapur University of Medical Science (AJUMS), Ahvaz, Iran.

Objective: To assess the effectiveness of tamoxifen administration with letrozole in the context of intrauterine insemination (IUI) cycles.

Materials And Methods: This prospective double-blinded study included 130 patients. After randomization, 65 patients in group A received letrozole + tamoxifen and human menopausal gonadotropin (HMG), whereas 65 patients in group B received placebo instead of tamoxifen. In both groups, the parameters recorded were total number of follicles with ≥16 and 18 mm diameter, endometrial thickness and appearance, and total HMG administered. The results were compared between groups after single-stage IUI was performed.

Results: Total dominant follicles in both groups were similar (mean number of follicles with diameter ≥16 and 18 mm was 1.5 ± 1.4 and 1.6 ± 1.1, respectively, in group A and 1.5 ± 1.1 and 1.6 ± 1, respectively, in group B; at the same time with less HMG usage in group A (255 ± 167 vs. 313 ± 174 IU), and higher pregnancy rate in group A (18.7 vs. 11.7 %); but none of them was statistically significant). Surprisingly, endometrial thickness was significantly higher in group A (7.7 ± 1.5 vs. 7 ± 1.3 mm; P value 0.008).

Conclusion: In addition to the efficacy of tamoxifen in co-administration with clomiphene citrate, it has promising effects with letrozole in induction of ovulation cycles with or without IUI.
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http://dx.doi.org/10.1007/s00404-012-2556-3DOI Listing
February 2013

Enhancement of peripheral blood CD56(dim) cell and NK cell cytotoxicity in women with recurrent spontaneous abortion or in vitro fertilization failure.

J Reprod Immunol 2012 Sep 30;95(1-2):87-92. Epub 2012 Jul 30.

Department of Immunology, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran.

Recent studies support the concept that NK cells play an important role in the success or failure of embryo implantation. Recurrent spontaneous abortion (RSA) is the most common complication of pregnancy. Some couples suffer from infertility of unknown cause. In vitro fertilization (IVF) is one of the useful treatment methods used for treatment of this type for infertility with variable outcomes. The aim of this study was to compare the percentage of peripheral blood CD56(+) (CD56(dim) and CD56(bright)) cells and the level of NK cell cytotoxicity in patients with RSA and patients with IVF failure with those of healthy multiparous and successful IVF control women. In this case-control study peripheral blood samples from 43 patients, which included 23 women with RSA and 20 with IVF failure, plus 43 healthy control women comprising 36 normal multiparous women and 7 women with successful IVF, were collected. The percentage of peripheral blood NK cells (CD56(+)) was identified by flow cytometry, then peripheral blood mononuclear cells (PBMC) were isolated by density centrifugation (Ficol-Hypaque) and incubated with NK-sensitive K562 cells. The NK cell cytotoxicity level was determined by lactate dehydrogenase (LDH) release assay. The percentage of CD56(dim) cells and the level of peripheral blood NK cell cytotoxicity in RSA patients and women with IVF failure were significantly higher than in both the healthy multiparous and successful IVF control groups (P<0.001). The findings of the present study suggest that increases in the percentage of CD56(dim) cells and NK cytotoxicity in peripheral blood may be important contributing factors for both RSA and IVF failure.
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http://dx.doi.org/10.1016/j.jri.2012.06.005DOI Listing
September 2012

The influence of sperm morphology, total motile sperm count of semen and the number of motile sperm inseminated in sperm samples on the success of intrauterine insemination.

Int J Fertil Steril 2011 Oct 22;5(3):168-73. Epub 2011 Dec 22.

Fertility and Infertility Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

Background: The present study aimed to analyze the prognostic value of sperm morphology , total motile sperm count (TMSC) and the number of motile sperm inseminated (NMSI) on the outcome of intrauterine insemination (IUI).

Materials And Methods: This cross sectional study was carried out 445 women undergoing 820 IUI cycles. All of the patients underwent controlled ovarian hyper stimulation with clomiphen citrate and human menopausal gonadotropin (HMG) followed by intrauterine insemination with the husband's sperm. Pregnancy rate (PR) per cycle in correlation to sperm morphology, TMSC and NMSI was obtained. Statistical analysis of the data was done by the SPSS version 13 (Chicago,USA).

Results: A total of 81 clinical pregnancies were obtained for a pregnancy rate per cycle of 9.9%. When the TMSC was 5×10(6)to <10×10(6), the PR per cycle was significantly higher than the subgroups <1×10(6), 1×10(6)to <5×10(6)and ≥10×10(6)(15%, 5.6%, 5.1%, 10.8%, respectively). Sperm morphology was in itself a significant factor that affected the likelihood of IUI success. Nonetheless, the most significant difference of the PR per cycle with sperm morphology was in the subgroup <5 % (2.1% vs. 97.9%).When the NMSI was ≥10×10(6), the PR per cycle was significantly higher than the subgroups<5×10(6)and 5×10(6)to< 10× 10(6)(11.2%, 4.1%, 5.2%, respectively).

Conclusion: The study showed that TMSC 5×10(6)to < 10×10(6)and normal sperm morphology ≥ 5% and NMSI ≥ 10×10(6)are useful prognostic factors of IUI cycles.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122832PMC
October 2011