SM Journal of Reproductive Health & Infertility

Current Issue

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Progesterone in Breast Cancer Angiogenesis

The involvement of steroid hormones in breast carcinogenesis is well established. Recent evidence suggests that angiogenesis can be regulated by hormones. Both oestrogen and progesterone have been implicated in the angiogenic process of hormone-dependent cancers, such as breast cancer. Vascular Endothelial Growth Factor (VEGF) is a growth factor involved in angiogenesis in breast cancer that is up-regulated by estrogens. In our study we evaluated the role of progesterone in the expression of this angiogenic growth factor commonly up regulated in breast cancer. Our findings indicate that progesterone activates an angiogenic pathway involving VEGF stimulation. The elucidation of specific angiogenic pathways promoted by progesterone can raise new therapeutic targets at least in a subset of breast cancers responsive to progesterone.

Monica C. Botelho¹,²,³*, Raquel Soares³,⁴ and Helena Alves¹


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A Decade of Social Fertility Preservation

The global phenomenon of deferment of conception has led to an increase in the age of sub fertile community and a growing demand for assisted reproductive techniques. Social fertility preservation can be considered a hedge against age-related decline in fertility and is considered as a form of elective self-donation; where healthy females collect then freeze their oocytes for autologous use at a later stage in life. From August 2005 to July 2014, 67 women presented for social fertility preservation at our institution. The mean age was 38.6±3.6 years. They were mostly single, nulliparous and professionals. They underwent a total of 128 cycles of In Vitro Fertilization (IVF) and 4 cycles of In Vitro Maturation (IVM). The number of oocytes frozen was 11.3±7.1. Only 5 women returned to achieve a pregnancy (7.5%). Embryo transfer of 4 patients did not reveal any live birth. It suggests that social fertility preservation after the age of 35 years is associated with a poor outcome. Social fertility preservation should be considered at an early reproductive age.

Nouf Alasmari¹, Atif Zeadna¹, Hananel Holzer¹, Weon-Young Son¹, William Buckett¹, Janet Takefman¹ and Togas Tulandi¹*


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Localized Drug Delivery in Prostate Cancer Treatment

Drug delivery to prostate through conventional route is associated with pharmacokinetics based and side effects related problems. Alternate localized drug delivery route is a prerequisite which may offers many advantages over oral route of drug delivery to prostate. In male reproductive system, Vas deferens forms a continuous system with prostate, so we discuss possibility of developing novel drug delivery system which may help to overcome with problems associated with the route of drug administration, including poor absorption, metabolic degradation, sub-threshold value of drug reaching the target tissue and non-specific drug distribution related side effects. And particularly, throwing light on an alternative drug delivery route may offer advantages to circumvent some of the above mentioned hurdles of oral drug administration. The current editorial promotes vas deferens as a local drug delivery route to prostate in conjunction with a concept of in-vivo self-assembly of multi component nanodrug carrier generated by a drug delivery system injected in the lumen of vas deferens

Pradeep K. Jha¹*, Rakhi Jha², Gnanasekar Sathish Kumar³, Santosh Gupta⁴ and Maidul Hossain⁵


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Maternal Plasma Levels of Antithrombin-III versus Inhibin-A in Prediction of Second Trimester Miscarriage

Objective: To study whether changes in maternal plasma thrombin inhibitor complex level and Inhibin-A are associated with second trimester miscarriages or not.

Design: Prospective study.

Setting: Tanta University Hospital.

Methods: The study included 200 asymptomatic pregnant women with singleton pregnancy of 15-20 weeks divided into two groups: 154 pregnant women with no history of abortion and 46 expectant women with a prior history of abortion. Each case was subjected to detailed obstetric and gynecological history, clinical examination, determination of gestational age, fetal viability, routine antenatal laboratory investigations, ultrasound examination and measurement of human Antithrombin-III and Inhibin-A.

Results: The mean values of maternal plasma levels of Inhibin-A and Antithrombin-III were significantly lower in patients with a history of abortion than those without a history of abortion. The area under Receiving Operating Characteristic (ROC) curve denoting sensitivity and specificity of maternal plasma levels of Inhibin-A compared to Antithrombin-III as a prognostic factor to miscarriage among pregnant women during the second trimester.

Conclusions: We concluded that Inhibin-A could be useful in monitoring of miscarriage in patients during the second-trimester pregnancy.

El-Gharib MN, El Sabae TM and Morad MA*


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Menopause Characterization, Menarche and Fertility among Rural Females of Shimla (Himachal Pradesh)

Background: Menopause marks the cessation of reproduction. Menopause rating scales have been used to measure health-related quality of life among aging women. Menopause, menarche and number of live births play important roles in the life history of women.

Objectives: To study the prevalence and pattern of various menopausal characteristics and association of age of menopause with age of menarche and number of livebirths.

Methods: The study was based on cross-sectional data of 75 postmenopausal rural women and also secondary data from published sources to study trends.

Results: Mean age at menarche was 14.23 yrs. and mean age at menopause was 45.35 yrs. About 85% of women had reported some climacteric symptom. Joint/muscle pain was the most commonly reported symptom (66.7%).Women that had early menarche had lower number of live births than those who had later menarche. Women with the intermediate fertility category having 4-5 livebirths had later age of menopause than women having less than three livebirths.

Conclusion: Early and late ages at menarche were associated with early and late ages of menopause, respectively. Fertility performance of women also seemed to be associated with menarche and menopause ages. Indian women have lower mean age at menopause than European and South Asian women while so such difference was evident for age at menarche. Menopausal symptoms had little effect on sexual functioning than other concerns.

Krishna Sharma, Mayuk Bansal, Shruti Chopra and Maninder Kaur


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Cesarean Scar Pregnancy Profile and Therapeutic Outcome: Case Series Design

Background: It is recognized that a Caesarean section presents one of the risk factors for ectopic pregnancies and placental pathologies (i.e., placenta prevue, placental abruption and placenta percreta) in the subsequent pregnancies.

Objectives: To study the incidence rate of scar pregnancy among admitted patient to ob/Gyn ward at latifa public hospital in Dubai. To study some associated factors Number of previous cesarean, parity, age of patients. To study therapeutic outcome using Methotroxate injection. Women admitted to the Hospital were of different parity status at the time of admission.

Methodology: A Retrospective records review of the caesarean scar pregnancy admitted to Latifa Hospital (Gynecology and pediatric governmental Hospital in Dubai) along the last 3 years has been recruited in the study, about 25 women age rang (20-49), cases been diagnosed as scar pregnancy at obstetrics /gynecology ward - Latifa public hospital, with positive history of previous single or multiple cesarean section. 19 cases have been went under Methotroxate injection therapy and follow up by BHCG and close clinical monitoring, about 8 cases refuse therapeutic intervention, most of the cases diagnosed on clinical base and upon admitting signs and symptoms which were mainly, bleeding in the first trimester, abdominal pain, spotting PV or asymptomatic diagnosed on routine pregnancy assessments, there is no loss of follow up of the cases yet 8 of the cases refused to receive Methotroxate injection, but no surgical treatment protocol applied to these cases . Surgery image and ultrasound were of no major role in diagnosis.

Results: The study revealed that about (16) 68% of the cases had positive history of three times and above cesarean section delivery, about (19) 76% of the cases were having multiparty of three and above, it was shown that about 60% of patients were in age group between ( 30-39). The study showed that about 64% of the case presented as bleeding in the first trimester while 20% presented either asymptomatic or simple abdominal pain and discovered on routine examination. The study revealed that about (16) 68% of the total cases have 3 more parity while only (2) 4% have 1 parity; the result showed that about (19) 76% of the total scar pregnancy cases were of the age group 30-39. As for the distribution of scar pregnancy cases according to number of cesarean section, it has been shown that (12) 66% of the total cases were of those who have history of 3 or more cesarean section while history of one CS where shown to be about (4) 16%. While the most common presenting features of scar pregnancy were shown to be bleeding in the first trimester equal to (14) 56% of the total cases and about (5) 20% were presented asymptomatically and discovered by routine investigation. Current study showed that about (8) 28% of the total cases refuse medication intervention and prefer to continue with follow up while (17) 72% received Methotroxate alone or with other medication of different doses regimen). For the outcome of management the study showed that about (9) 36% of scar pregnancy cases were responded by BHCG dropping but about (16) 60% of the cases have got bleeding, readmission and surgical evacuation and some of the got sever complications.

Conclusion: Though scar pregnancy is rare diagnoses, it has serious consequences in terms of morbidly and mortality (uterine rupture and life-threatening intraperitoneal hemorrhage during the first trimester of pregnancy) which can be avoided by early identification, accurate diagnostic and effective intervention procedures. Recommendation: Prevention and control of scar pregnancy can be achieved different level, like minimizing the frequency cesareans section program, raising index of suspension at high risk groups, earlier identification and intervention.

Isaac B, Hussain H*, Paulose L, Amro B, Lotfi G and Al Faisal W


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Toxoplasmosis Seropositivity and Male Sex Hormones

Background: Toxoplasmosis is a cosmopolitan disease with acute and chronic infections, caused by the obligate intracellular protozoan parasite Toxoplasma gondii that can infect a variety of cells in almost all warm blooded animals including humans.

The study aimed to determine the seroprevalence of T. gondii infection among males in Duhok city using ELISA (IgG and IgM).

The relationship between toxoplasmosis and reproductive hormones including testosterone, free testosterone, and Follicle Stimulating Hormone (FSH) levels and its association with male sterility were also investigated.

Mustafa Riadh Hussien¹*, Adel TM Al-Saeed¹ and Souzan H Eassa²


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Status of Artificial Insemination; Its Constraints and Estrous Synchronization in Ethiopia

Assisted reproductive technologies particularly artificial insemination (AI) and estrus synchronization are operated to enhance the genetic improvement of cattle. Estrus synchronization is one of the potential tools for the reproductive improvement of livestock. It is the manipulation of the estrus cycle or induction of estrus to bring a large percentage of groups of females into estrus at a short and predetermined time period. Estrus synchronization of fertile cows can be accomplished with various hormones; such as, progesterone, prostaglandin, gonadotropin releasing hormone (GnRH), follicle stimulating hormone (FSH) and luteinizing hormone (LH). These tools remain the most useful and widely applicable reproductive biotechnologies available for dairy cow operations. It is obvious that the AI service in Ethiopia has not been successful to improve reproductive performance of dairy industry. Artificial insemination service in Ethiopia has been given little or no emphasis at the federal and regional levels for long time though it is a widely practiced animal biotechnology all over the world. The most important constraints associated to estrous synchronization in Ethiopia are: inadequate resource in terms of inputs and facilities; absence of incentives and rewards to motivate technicians; lack awareness of this technology by animal producers; shortage of feed resources; cost of semen and synthetic hormones; cost of a bull (a self trained breeding technician), and lack of adequate transportation facilities. In general, incorporating a good management practice and selecting cows that have good body condition are the two most essential requirements for successful estrous synchronization and AI. Hence, the objective of this review is to assess the current status of artificial insemination; its constraints and estrous synchronization in Ethiopia.

Mebrate Getabalew¹ and Tewodros Alemneh²*