The Outcome of Assisted Reproductive Techniques among Couples with Male Factors at Prince Khalid Bin Sultan Fertility Centre, Kingdom of Saudi Arabia

The Fertility Outcome of Royal Jelly versus Intra Uterine Insemination: A Pilot Randomized Controlled Trial Study

Background: The popularity of complementary and alternative medicine is on the rise. Objectives: The current study aimed to compare the effect of vaginal royal jelly with intrauterine insemination (IUI) on sub-fertility in men. Methods: The sample size was estimated as 27 subjects, based on a study power and confidence interval of 80% and 95%, respectively. The study was conducted in Mashhad, in the Northeast of Iran, from 2015 to 2017. Men with sub-fertility (asthenozoospermia, defined as total sperm motility below 40% and sperm concentration below 20 million/mL), with healthy wives, based on salpingography, participated in this study. Patients were assigned to the royal jelly group, which received 5 grams of royal jelly, and the IUI group, which received 75 units of Follicle Stimulating Hormone (FSH) from the second day of the menstrual cycle. Semen samples were collected in sterile plastic caps after 72 hours of sexual abstinence by normal sexual intercourse. Samples were prepared using the standard swim-up technique. Results: This study showed no significant difference between groups concerning spousal age, occupation, education (husband and wife), and social class (P = 0.745). Also, no significant difference was found between groups concerning fertility success rate (P = 0.573). Conclusions: Based on similar treatment success rates of royal jelly and IUI, it seems that royal jelly can be considered as an alternative to IUI.

Live Birth Rate Comparison Between Single vs. Double Ovary Women With Assisted Reproduction: A Single Tertiary Center Study

Introduction

One of the major hardships faced by married couples is the inability to conceive a child. This issue is becoming more prevalent given the increasing rate of infertility worldwide. Assisted reproductive technology (ART) has brought hope to infertile couples. We aim to estimate the live birth rate (LBR) and pregnancy rate in women with one ovary compared with those with two ovaries.

Methods

A retrospective cohort study of women who underwent ART at King Abdulaziz Medical City (Jan 2000 - Dec 2018) was conducted. Five cycles of patient data were collected. The LBR (both conditional and cumulative) was compared between women with one and two ovaries.

Results

The final analysis included 403 women. Of these, 9% (n = 37) had one ovary. The majority (59%, n = 233) had primary infertility. A male-associated factor accounted for 52% (n = 208) of the infertility cases. The total number of live births was 164; and the overall LBR from five cycles was estimated as 9%, 16%, 18%, 18%, and 15%, respectively. In the double ovary group, the highest rate was in the fourth cycle [19% (12-26)], while in the single ovary group peaked in the third cycle [27% (9-46)]. Pregnancy was at its highest in the first cycle, accounting for 88 pregnancies.

Conclusion

The outcomes of ART varied between study groups. LBR was lower in single ovary women. The average of five cycles in the single and double ovary groups was 13% and 15%, respectively. Nevertheless, there was no significant difference in LBR between single or double ovary women.

Effect of trace elements on the seminal oxidative status and correlation to sperm motility in infertile Saudi males

The impact of trace elements, especially zinc, selenium, copper, and magnesium, on male fertility has gained great interest and significance. Increased oxidative stress and altered trace element levels are probable etiological factors underlying male reproductive dysfunction and infertility. The present study focused on the evaluation of seminal oxidative markers, such as reactive oxygen species (ROS), malondialdehyde (MDA), and total antioxidant capacity (TAC), and trace element levels in the normozoospermic fertile control group (n = 40) and asthenozoospermic infertile group (n = 30). Semen from infertile men exhibited significantly higher ROS and MDA levels accompanied with significant decline in TAC and trace element (zinc and magnesium) levels. Furthermore, a significant correlation was observed between trace elements and oxidative markers with sperm motility. The current study revealed increased lipid peroxidation and oxidant-reductant imbalance that leads to deterioration of semen quality and male infertility. Thus, oxidative stress and trace elements can be considered important biomarkers of male infertility. Measurement of seminal oxidative stress with conventional seminological parameters must be integrated in fertility assessment from early stages to ensure healthy semen characteristics and fertility in men.

The relationships between urinary phthalate metabolites, reproductive hormones and semen parameters in men attending in vitro fertilization clinic

Evidence from previous studies has shown that phthalates may play a role in male reproductive function; however, results are still inconclusive, and the mechanism remains unclear. In this study, we first assessed whether exposure to phthalates is associated with altered reproductive hormones and semen parameters in 599 men attending an in vitro fertilization clinic. Secondly, we evaluated whether reproductive hormones could play a mediating role in the association between phthalates and sperm parameters. Eight phthalate metabolites were measured in two different spot urine samples: mono‑n‑butyl phthalate, mono-isobutyl phthalate (MiBP), monoethyl phthalate (MEP), monobenzyl phthalate, and four oxidative metabolites of di‑(2‑ethylhexyl) phthalate (DEHP) [i.e., mono‑(2‑ethylhexyl) phthalate (MEHP), mono‑(2‑ethyl‑5‑hydroxyhexyl) phthalate (MEHHP), mono‑(2‑ethyl‑5‑oxohexyl) phthalate (MEOHP), and mono‑(2‑ethyl‑5‑carboxypentyl) phthalate (MECPP)]. Semen parameters (concentration, volume, motility, and morphology) and reproductive hormones, i.e., follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone, estradiol (E₂), testosterone (TEST) and prolactin (PROL) were also determined and considered the main study outcomes. Separate multivariate linear regression was used to assess associations between levels of each urinary phthalate metabolite, molar sum of DEHP metabolites (∑DEHP), percentage of MEHP to ∑DEHP (%MEHP), and each outcome (natural log-transformed). Inverse associations were observed between TEST and MiBP (β = -0.099), FSH and MEHHP (β = -0.087), and PROL and MEOHP (β = -0.102), while a positive relationship was seen between E₂ and MEP (β = 0.098). %MEHP was associated positively with FSH (β = 0.118) and LH (β = 0.099), but negatively with TEST/LH (β = -0.086) and TEST/E₂ (β = -0.109). Sperm concentration was associated positively with MECPP (β = 0.131), MEHHP (β = 0.117), MEOHP (β = 0.107) and ∑DEHP (β = 0.111), but negatively with %MEHP (β = -0.135). All p-values were <0.05. Sobel's test indicated that FSH mediated significantly up to 60% of the positive relationship between sperm concentration and MEHHP, while FSH and LH mediated respectively 15 and 12% of the inverse association between sperm concentration and %MEHP. Further research on this topic is warranted.