The Journal of Family & Reproductive Health (JFRH) is the quarterly official journal of Vali–e–Asr Reproductive Health Research Center. This journal features fulllength, peerreviewed papers reporting original research, clinical case histories, review articles, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology including genetics, endocrinology, andrology, embryology, gynecologic urology, fetomaternal medicine, oncology, infectious disease, public health, nutrition, surgery, menopause, family planning, infertility, psychiatry–psychology, demographic modeling, perinatalogy–neonatolgy ethics and social issues, and pharmacotherapy. A high scientific and editorial standard is maintained throughout the journal along with a regular rate of publication.
Objective: Male infertility is involved in about half of the casess of infertility and the only sole reason for infertility in 20%-30% of the cases. Following the recent interest in the use of medicinal plants, scientists have sought to clarify their effects on male fertility. This review aimed to summarize the results of studies available to determine the effectiveness, safety and mechanism of herbal treatments in the improvement of male fertility.
Materials and methods: Medline/PubMed, Scopus, Science Direct, and the Cochrane Central Register of Controlled Trials (Central) databases were searched for randomized controlled trials (RCTs) published during 2000-2020. Studies were only included if they adhered to the CONSORT checklist. The methodological quality of the selected studies was assessed using the Cochrane risk of bias tool.
Results: Finally, 20 studies recruiting a total of 1519 individuals were reviewed. These studies compared the effects of eleven different medicinal plants, i.e. ginseng, saffron, Nigella sativa, palm pollen, ADOFON, TOPALAF, sesame, and Mucuna pruriens, on male fertility with those of placebo. All studies (except one) confirmed the beneficial effects of medicinal plants on the improvement of sperm and reproductive parameters and thus male infertility.
Conclusion: The existing RCTs indicated the positive effects of medicinal plants on male fertility. Therefore, in order to develop a novel approach to the treatment of male infertility, further clinical trials are warranted to determine the maximum dosage and duration of treatment with herbal medicines and evaluate any potential side effects of such interventions.
Multiple Logistic Regression Model for Determinants of Injectable Contraceptive Uptake Among Women of Reproductive Age in Kenya
Objective: The recent increase in the uptake of injectable contraceptives has occurred at the expense of the other modern contraceptive methods but the knowledge gap still exists on modeling dynamics and determinants associated with the use of the injectable. This study sought to model for injectable contraceptive usage to bridge the knowledge gap on the use of injectable contraceptives among women of childbearing age in Kenya.
Materials and methods: Analytical cross-sectional study design was adopted. Secondary data for women collected during the (Performance Monitoring for Action) PMA2020 survey was used. PMA2020 survey used multistage stratified sampling with urban-rural representation. To establish the factors associated with the uptake of injectable contraceptives, a multiple logistic regression model was fitted using Stata version 13 and R version 3.5.3 statistical software. Hosmer-Lemeshow Test statistic was used to evaluate the goodness of model fit in predicting injectable contraceptive usage.
Results: Multivariable analysis showed that women with post-primary/vocational levels of education were 54% less likely to use an injectable contraceptive compared to those who had no education at all. Hosmer-Lemeshow (HL) goodness of fit test statistic indicated that the model was a good fit for prediction. Education, marital status, wealth quintile, place of residence and number of births were significant predictors of the injectable contraceptive uptake among women of reproductive age in Kenya.
Conclusion: The findings of this study will inform the design of targeted interventions aimed at addressing the increasing demand for injectable devices among women of reproductive age in Kenya.
Effect of lysophosphatidic Acid on the Vascular Endothelial Growth Factor Expression in Autotransplanted Mouse Ovaries Encapsulated in Sodium Alginate
Objective: The aim of this study was to evaluate the effect of lysophosphatidic acid (LPA) supplementation during in vitro culture and transplantation of mouse ovaries on the follicular development and expression of vascular endothelial growth factor (VEGF) as an angiogenesis factor at the mRNA and protein levels.
Materials and methods: Three weeks old mice ovaries were cultured in the presence and absence of LPA for 24 hours, then they were capsulated in sodium alginate in the presence and absence of LPA as four experimental groups. After transplantation the vaginal smears were performed daily to evaluate the initiation of the estrous cycle. The morphology and follicular distribution were analyzed at the first and fourth estrous cycles using hematoxylin and eosin staining. Then in the groups that showed higher and lower follicular development the immunohistochemistry assay was conducted to identify VEGF protein expression, and the real time RT-PCR was done to analyze the expression of Vegf gene at the first estrus cycle.
Results: The large size follicles and also the corpus luteum were prominent in all transplanted groups at fourth estrus cycle in comparison with intact control groups. The statistically lowest percentage of small size follicles and the highest percentages of large size follicles were seen in LPA+/LPA- group (p<0.05). The expression ratio of Vegf to β-actin was significantly higher in this group in comparison with non-LPA treated and intact control groups (p <0.05).
Conclusion: LPA as an angiogenesis factor increases the follicular development in transplanted ovaries but it causes early discharge of ovarian reserve.
Serum Vitamin D Deficiency in NICU Hospitalized Neonates and Its Association with Neonatal Outcomes Vitamin D deficiency in NICU hospitalized neonates
Objective: Vitamin D deficiency is a major health problem in all age groups. In the present study, we aimed to determine the prevalence of vitamin D deficiency in neonates hospitalized in an intensive care unit (NICU) and its association with clinical neonatal outcomes.
Materials and methods: A prospective cross-sectional study was carried out on all neonates hospitalized in the NICU of Children's Medical Center over a period of one year (January–December 2018). Immediately on admission, a serum sample for vitamin D measurement was obtained with another routine blood sampling. Demographic and clinical data including sex, gestational age, the season of birth, serum levels of vitamin D and calcium, the causes of hospitalization, age at admission and neonatal outcomes including length of hospital stay and mortality during hospitalization were assessed.
Results: One hundred neonates entered the study. Vitamin D deficiency and insufficiency were present in 95% of neonates. There was a significant association between vitamin D status and birth during winter (p=0.014); hypocalcemia (p=0.025) and older age at NICU admission (p<0.001). The mean value of vitamin D in term neonates was significantly lower than in preterm neonates (p=0.031). There were no correlations between length of hospital stay and neonatal mortality rate with vitamin D status (p=0.876).
Conclusion: Vitamin D deficiency and insufficiency were highly prevalent among NICU patients. Maternal vitamin D supplementation during pregnancy may prevent or reduce the risk of low levels of vitamin D in neonates.
The Effect of Twisted Uterus Caused by Endometriosis or Myomatosis on Reproductive Treatment Outcomes
Objective: Twisted uterus is detected when the body of the uterus is rotated from the cervical canal. This anomaly may be due to different causes, such as uterine fibroids, endometriosis or the presence of both. The study has aimed to compare the effect of the twisted uterus cause in terms of reproductive treatment outcomes.
Materials and methods: It consisted of a retrospective study of twisted uterus cases with repeated implantation failure (more than three embryo transfers or four blastocysts transferred unsuccessfully) in our ultrasound department. The twisted uterus was defined when the vaginal probe needed to be rotated to assess the endometrial line thoroughly or when the coronal view was seen by 2D scan. From 2017 to 2020, 879 gynecological ultrasounds were performed. For statistical analysis, we carried out a logistical regression analysis adjusted by confounding factors.
Results: From 145 patients included only 92 patients underwent reproductive treatments. With the known cause of uterine torsion. 56 patients with endometriosis, 18 with uterine myoma and the remaining 18 suffered from both. After assisted reproductive treatment, the endometriosis group showed the highest clinical pregnancy rate (53.57%) compared to myoma (22.22%) and endometriosis and myoma (38.89%) groups.
Conclusion: Uterine myoma capable of causing uterine torsion may affect embryo implantation more than endometriosis. Prospective randomized studies with a larger number of patients would be needed to confirm these findings.
Comparison of the Effect of Nifedipine Alone and the Combination of Nifedipine and Sildenafil in Delaying Preterm Labor: A Randomized Clinical Trial
Objective: Recently, sildenafil as a drug effective in relaxing smooth muscles can be used as an adjunct to delay the onset of uterine contractions and therefore the occurrence of preterm labor. The aim of this study was to evaluate the effect of nifedipine combination with sildenafil on preterm delivery compared with nifedipine alone.
Materials and methods: This randomized double-blinded clinical trial was performed on pregnant women with a gestational age of 26-34 weeks with singleton pregnancy and symptoms of preterm delivery. The mothers were randomly assigned into two groups receiving nifedipine plus sildenafil or those receiving nifedipine alone. The time of delivery, maternal and neonatal complications were compared between the two groups.
Results: Mothers who received the combination therapy experienced significantly lower preterm delivery within 72 hours of intervention compared to nifedipine alone (4.5% versus 27.3%, p = 0.002). The rate of delivery during the first 7 days after discharge was 7.6% and 31.8% in nifedipine plus sildenafil and nifedipine alone, respectively (P = 0.001). The prevalence of neonatal respiratory distress syndrome (RDS) as well as mean birth weight was higher in the nifedipine group alone. Treatment protocol with nifedipine and sildenafil compared with nifedipine alone was associated with a significant increase in preterm delivery delay (beta =-5.819, p = 0.001).
Conclusion: The use of sildenafil in addition to nifedipine causes more delay in delivery in cases of preterm labor, followed by lower risk for RDS, reduces neonatal intensive care unit (NICU) admission, and preserves neonatal birth weight.
Ectopic Fat Depots and Cardiometabolic Burden: A Possible Dangerous Liaison in Women Planning Assisted Reproduction Ectopic fat and Assisted Reproduction
Objective: We evaluated cardiometabolic burden in women planning assisted reproduction in order to identify subgroups at higher risk of pregnancy complications and cardiovascular disease.
Materials and methods: In this cross-sectional study we investigated 60 infertile women with BMI≥25 kg/m2 referred to the Center for Assisted Reproduction. All women underwent metabolic, anthropometric parameters and ultrasound evaluation of ectopic fat depots.
Results: All women had waist ≥80 cm. We found that 93.3% of women had pathological subcutaneous, 58.3% visceral and 80% para-perirenal fat; all women had fatty liver. Visceral fat and severity of steatosis were significantly related to the presence of metabolic syndrome (OR =5.7; p=0.03). A significant negative correlation between low HDL-c and para-perirenal fat (p<0.0001), a significant positive correlation with fasting plasma glucose and para-perirenal fat (p=0.001) were found. We observed a significant positive correlation between visceral fat and hs-CRP (p=0.002), HOMA-IR (p=0.04) and triglycerides (p=0.002), a significant negative correlation with HDL-c (p=0.05).
Conclusion: This study by highlighting a clinically “dangerous liaison” between ectopic fat depots and metabolic/inflammatory markers, might permit to identify women with a worse metabolic phenotype and encourage lifestyle changes for improving their general and reproductive health together.
Objective: Endometrial cancer (EC) is the most commonly diagnosed malignancy and has the second-highest mortality rate among gynecological cancers. Adenomyosis is well-known for abnormal uterine bleeding and is a widely reported entity; however, an EC arising from the adenomyosis is a rare event; even rarer is the occurrence of serous endometrial carcinoma.
Case report: A 60-year post-menopausal female presented with post-menopausal bleeding. Subsequently, she underwent a hysterectomy, which showed atrophic and cystic endometrium with extensive adenomyosis and atypical endometrial glands, which are diffusely P53 positive with intervening negative benign and focally positive dysplastic endometrial glands. A final diagnosis of serous endometrial carcinoma arising from adenomyosis was rendered. In a table format, previously reported serous endometrial carcinoma Arising cases from adenomyosis using PubMed search had been described.
Conclusion: Serous endometrial carcinoma arising from adenomyosis (<20 cases reported) and has a slightly more dismal prognosis than those deriving from the endometrial cavity. Hence, this case report highlights the occurrence, rarity, and importance of such an entity.
Fragile X Syndrome Secondary to in Vitro Fertilization with a Family Egg Donor, A Case Report and Review of the Literature
Objective: To evidence the need for screening fragile X syndrome (FXS) in egg donors in assisted reproduction protocols.
Case report: This is the report of a boy with FXS who inherited the mutated allele from an ovule donated by the mother´s sister through an assisted reproduction protocol. Identifying premutation (PM) carriers of FXS amongst gamete donors isn’t part of the obligatory genetic analysis for donors and is only considered by most of the in vitro fertility societies and guidelines as part of the extension screening tests.
Conclusion: It is cost-effective to do pre-conceptional screening for the PM or full mutation (FM) of the FMR1 gene affected in FXS in every woman undergoing assisted reproductive methods, including gamete donors even without a positive family history of intellectual disabilities. This case supports the need of rethinking the guidelines on the necessary gamete donor screening tests in assisted reproduction protocols.
Recurrent Dermatofibrosarcoma Protuberans of the Vulva: A Rare Occurrence and Review of Literature Dermatofibrosarcoma protuberans of the vulva
Objective: Dermatofibrosarcoma protuberans (DFSP) of the vulva is an uncommon soft tissue tumor with fewer than 60 cases reported previously. Distant metastasis is rare with a high propensity for local invasion. Surgical management is the gold standard with adequate margin excision to prevent future recurrences. We report a case of vulvar DFSP requiring three resections to achieve primary clearance. To the best of our knowledge, this is the first case report from India.
Case report: A 35-years-old female, presented with nodular vulvar mass for the third time arising from the upper part of right labia majora for the last year. She had a history of two similar episodes in the past for which excision was done and histopathology confirmed DFSP. The third wide local resection was performed with 3 cm margins and the margins were sent for intra-operative frozen section analysis, which was confirmed clear by the pathologist. The patient has been free of recurrence for two years.
Conclusion: DFSP is a challenging condition presenting as a non-tender nodular mass characterized by local invasion and recurrence. Early diagnosis and appropriate management using wide local excision with accurate margin assessment can achieve optimal results and prevent future recurrences.