Saeed Alborzi

Purpose: The optimal GnRH agonist (GnRHa) dosing for ovulation triggering remains controversial, particularly regarding oocyte competence versus OHSS mitigation. Here, we analyzed the repeated dose of GnRHa as a trigger of ovulation on intracytoplasmic sperm injection (ICSI) results. Methods: This single‐blinded randomized clinical trial was conducted on 362 ICSI candidates who met the inclusion criteria. The subjects underwent the antagonist protocol and based on the received trigger, were divided into two groups: single dose (group A) and repeated dose (group B) of GnRHa. Demographic and clinical data were collected and analyzed using SPSS‐24. Results: Repeated dosing of GnRH increased M2 oocyte numbers yield by 22.84% ± 6.92% (95% CI: 9.23–25.38, p = 0.001). Also, the maturity rate ( p = 0.001), the number of pronuclear embryos ( p = 0.001), and the number of good and excellent quality embryos ( p = 0.004) were higher in group B. Empty follicle syndrome was presented in no cases. Despite the high ovarian response, no OHSS cases were reported (mean oocytes> 17 ± 8). There was no significant difference regarding premature ovulation, use of Cabergoline, chemical and clinical pregnancy, miscarriage, and live birth rates between the 2 study groups. Conclusion: It seems that the administration of the second dose of GnRHa 12 h after the first dose leads to better oocyte maturation and higher quality embryos. Trail Registration: IRCT20081007001306N11; https://irct.behdasht.gov.ir/trial/60387

In this case report, we present a 43-year-old man (XY) with azoospermia and typical male appearance, at Tanner stage 5 of sexual development, who presented with severe colicky abdominal pain accompanied by nausea. A pelvic CT scan revealed a pear-shaped structure in the pelvic cavity, located entirely behind the bladder, measuring 106*44 cm with fluid accumulation inside it, extending into the right inguinal canal. There was also evidence suggesting the formation of the upper and mid-third part of a vagina, terminating in the prostatic gland. The patient underwent laparoscopic surgery for the removal of the uterus and the left gonad. The patient had a uterus with hematometra and a blind vaginal pouch measuring 4 centimeters at the end of the uterus, extending posteriorly behind the bladder to the apex of the prostate, containing old blood. Hormonal analysis showed serum estradiol < 5.0 pmol/L (11-44pg/mL), free testosterone at 1.57 ng/ mL(male reference range: 2.5–20 ng/mL), testosterone at 0.56 ng/mL (2.27–10.30),FSH at 44.8 mIU/L (0.95–11.95 mIU/L), LH at 20.4 mIU/L(0.57–12.07), and DHEA-SO4 at 199.0 µg/mL (139.7–484.4 µg/mL). Currently, the patient is under the care of a urologist and is receiving weekly treatment with hCG medication. He reports normal sexual function, including intercourse, orgasm, erection, and ejaculation.

This is the first guidelines for adenomyosis from the Asian Society of Endometriosis and Adenomyosis.

Objective: This study aimed to determine the quality of life (QOL), in patients with endometriosis ± infertility (B and C groups) and compare those to healthy women, and also infertile groups without endometriosis as a control groups (A and D), considering the fact that endometriosis and infertility reduces the quality of life in patients. Methods: The present prospective comparative study was carried out between January 2018 and September 2020. A total of 400 women were included (100 women in each group). The participants filled in a validated questionnaire of quality of life, Endometriosis Health Profile-30 (EHP-30), and a visual analog scale of pain used, at the first visit, and 3 months after the medical or surgical treatment in the endometriosis group without infertility, additionally. Results: The majority of the patients were married, categorized in the middle-class of socio-economic state and housewives. They were of Persian descent. BMI was high in the infertile groups; however, the time of infertility was not different between the two groups of B and C (P = 0.054). The mean score of QOL was significantly lower in B, C, and D groups in comparison to the healthy women as the control group (A) (P < 0.001). Moreover, the infertile group (B), in comparison to endometriosis ± infertility groups (C and D), had the lowest mean score of QOL (P < 0.001). In each group, those who were older and had better educational level reported a better quality of life than other participants in that group. Social support plays a very important role in reducing the endometriosis related pain symptoms both before and after treatment. Three months after the treatment of endometriosis (D), a significant improvement was observed in all the aspects of QOL-related endometriosis. Nonetheless, the improvement of the quality of life in the surgical group was significantly higher than that in the medical treatment. The mean visual analog score of pain decreased from 62.22 ± 22.78, to 5.15 ± 2.73 following the surgical treatment (P < 0.001). Conclusion: The lowest quality of life belonged to the infertile group, followed by the endometriosis group. The quality of life of the endometriosis group improved after the treatment. Thus, endometriotic patients’ treatment in terms of improvement of quality of life should be considered by all professional health care teams.

Aim: To report single‐center outcomes of laparoscopic management of patients with ureteral endometriosis and perform a meta‐analysis in order to select the best approach for these patients.Methods: The cross‐sectional study was conducted during a 6‐year period (2015–2021) in the referral endometriosis center on 353 patients with ureteral endometriosis. For the meta‐analysis, 10 articles, including 505 patients, were found to be eligible. In our meta‐analysis, as well as our study, all endometriosis‐related pain symptoms and complications of surgery were evaluated, analyzed, and reported.Results: Of the 326 patients whose ureteral involvement was confirmed in pathology, hydronephrosis and intrinsic ureteral lesions were detected in only 10.76% and 3.1% of the patients. Mean operating time and hospitalization were 3.25 ± 1.83 h and 86 ± 2.58 days, respectively. The most common site of concomitant involvement with endometriosis was uterosacral ligament (92.9%) and rectosigmoid (70.53%). Type II and III of Cliven–Dindo complications were seen in 5.66% and 1.13% of patients, respectively. During a follow‐up period, no evidence of bladder or ureteral re‐involvement was observed. Similar to our meta‐analysis, all endometriosis‐related pain decreased significantly following operation (p ≤ 0.001). In our meta‐analysis, the rate of ureteral endometriosis recurrence, stenosis/stricture, bladder atonia, urinary tract infection, hematuria, and fistula formation after surgery were: 2.0% (I²: 50.42%), 15.0% (I²: 0.00%), 14.0% (I²: 8.76%), 6.0% (I²: 0.00%), 7.0% (I²: 79.28%), and 2.0% (I²: 0.0%), respectively.Conclusion: The laparoscopic resection of the UE could be suggested as a feasible and safe method associated with favorable functional outcomes.

Purpose: The authors compared assisted reproductive technique (ART) outcomes and the recurrence rate of endometrioma in the infertile patients undergoing sclerotherapy vs laparoscopic ovarian cystectomy.Methods: In this prospective cross‐sectional study, a total of 101 infertile patients, with unilateral endometriomas, were divided into two groups. The first group (n = 57) underwent ART after 1 year of unsuccessful spontaneous pregnancy after laparoscopic ovarian cystectomy; the second group (n = 44) had ethanol sclerotherapy (EST) at the time of oocyte retrieval. The authors measured the number of oocytes, clinical pregnancy rate (CPR), live birth rate (LBR), complication, and recurrence of endometriomas as the primary and secondary outcomes.Results: The two groups had no significant differences in baseline characteristics and ovarian stimulation markers and also total number of oocytes. 42.1% and 34.1% of the patients (n = 24 and 15) had clinical pregnancy, and 38.6% and 29.5% (n = 22 and 13) had live birth following ART cycles in the surgery group and sclerotherapy group (P = .41, 0.34). The recurrence rates were 14.0% and 34.1% in the surgery and sclerotherapy groups (P = .017, X² = 5.67).Conclusions: Ethanol sclerotherapy can be a good alternative to surgery concerning the treatment of endometrioma; however, the recurrence of the disease in this group is significantly higher.

The novel coronavirus was recognised in December 2019 and caught humanity off guard. The virus employs the angiotensin‐converting enzyme 2 (ACE2) receptor for entry into human cells. ACE2 is expressed on different organs, which is raising concern as to whether these organs can be infected by the virus or not. The testis appears to be an organ enriched with levels of ACE2, while the possible mechanisms of involvement of the male reproductive system by SARS‐CoV‐2 are not fully elucidated. The major focus of the present studies is on the short‐term complications of the coronavirus and gains importance on studying the long‐term effects, including the possible effects of the virus on the male reproductive system. The aim of this review was to provide new insights into different possible mechanisms of involvement of male gonads with SARS‐CoV‐2 including investigating the ACE2 axis in testis, hormonal alterations in patients with COVID‐19, possible formation of anti‐sperm antibodies (ASA) and subsequently immunological infertility as a complication of SARS‐CoV‐2 infection. Finally, we suggest measuring the sperm DNA fragmentation index (DFI) as a determiner of male fertility impairment in patients with COVID‐19 along with other options such as sex‐related hormones and semen analysis. Invasion of SARS‐CoV‐2 to the spermatogonia, Leydig cells and Sertoli cells can lead to sex hormonal alteration and impaired gonadal function. Once infected, changes in ACE2 signalling pathways followed by oxidative stress and inflammation could cause spermatogenesis failure, abnormal sperm motility, DNA fragmentation and male infertility.