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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 2 | Issue 4
Page Nos. 191-255

Online since Friday, January 11, 2019

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ORIGINAL ARTICLES  

Monoclonal antibodies reveal novel localization of SPAG11E in spermatozoa and the antifertility potential of SPAG11E motifs p. 191
Zhi-Kai Wang, Yi-Ting Yang, Xin-Yu Chen, Shuang-Gang Hu, Ping Zhu, Wan-Xiang Xu, Li Ma, He-Guo Yu, Hua Diao, Yong-Lian Zhang
DOI:10.4103/2096-2924.249890  
Objective: SPAG11E is the first β-defensin that has been reported to activate Ca2+ uptake and sperm motility. However, the exact subcellular localization and interaction of SPAG11E with sperm remain controversial because of the lack of qualified antibody tools. SPAG11E is also a potential male antifertility target because SPAG11E fragment conjugated with a carrier protein exhibits male contraceptive vaccine potential. However, the fine B-cell epitope motifs of SPAG11E have not been analyzed, which hampered further exploration of the potential target. Methods: Polyclonal and monoclonal antibodies (mcAbs) of mature SPAG11E were raised and qualified with Western blotting. Subcellular localization of SPAG11E was revealed by Western blotting, immunohistochemistry staining, and electron microscopy. B-cell epitopes of rat SPAG11E were mapped by Western blotting using polyclonal and mcAbs. Based on the conservation of the identified epitope motifs between rat and mouse SPAG11E, antifertility potential of the epitope motifs was evaluated by the offspring of the males compromised with specific mcAbs. Results: SPAG11E antibodies of high quality were obtained and all B-cell epitope motifs of rat SPAG11E were mapped, in which conserved epitope motifs of SPAG11E in various species were discovered. The epitope motifs recognized by mcAbs were identified respectively. With mcAbs, rat SPAG11E was proved to be expressed in the caput region of epididymis. A novel finding was that SPAG11E was located in the flagella and nuclei of sperm as revealed by immunoelectron microscopy. In addition, the males treated with mcAbs (3#-1 and 10#B4) showed apparently fewer offspring. Conclusions: SPAG11E revealed a β-defensin with novel localization in sperm flagellum and nucleus with qualified antibodies. All B-cell epitope motifs of rat SPAG11E were determined, and the antifertility potential was proved by corresponding mcAbs.
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Effect of uterine anomalies on pregnancy rates and reproductive outcomes in women undergoing artificial insemination by husband p. 201
Zi-Yin Chang, Hao Shi, Zhi-Qin Bu, Jun Zhai
DOI:10.4103/2096-2924.249889  
Objective: Congenital uterine anomalies are common; however, their effects on artificial insemination by husband (AIH) and the period during which AIH is converted to in vitro fertilization (IVF) are unclear. We examined the influence of uterine malformations on reproductive outcomes following AIH and the optimum number of AIH cycles before resorting to IVF-embryo transfer (IVF-ET). Methods: We retrospectively recruited 168 patients with uterine malformations (anomalous group) undergoing AIH between January 2011 and December 2016. Meanwhile, 168 patients with infertility but with normal uteri (normal group) were matched as controls according to age. Results: The clinical pregnancy rate was similar in both groups (12.4% vs. 12.3%, P = 0.950); the cancellation (21.6% vs. 4.4%, P < 0.001), early pregnancy loss (35.7% vs. 11.4%, P = 0.032), and preterm birth rates (21.4% vs. 2.9%, P = 0.038) were higher in the anomalous group, resulting in lower term birth (32.1% vs. 74.3%, P = 0.001) and live birth rates (50.0% vs. 77.1%, P = 0.034). After two AIH cycles, the clinical pregnancy rate was lower (3.6% vs. 23.1%, P = 0.037) among women with uterine anomalies than among those with normal uteri. There was no difference in the pregnancy rates (52.5% vs. 53.7%, P = 0.908) between the two groups of patients with unsuccessful AIH who then underwent IVF-ET. Conclusions: IVF-ET can be performed immediately after two unsuccessful AIH cycles in patients with uterine malformations. In patients undergoing AIH or IVF, uterine malformations increase the risk of adverse obstetric outcomes.
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CLINICAL GUIDELINE Top

Chinese expert consensus on clinical application of female contraceptive methods p. 208
Li-Nan Cheng, Wen Di, Yan Ding, Guang-Sheng Fan, Xiang-Ying Gu, Min Hao, Jing He, Li-Na Hu, Ke-Qin Hua, Wei Huang, Li Jin, Bei-Hua Kong, Jing-He Lang, Jin-Hua Leng, Jian Li, Cai-Xia Liu, Guan-Yuan Liu, Lei Song, Xiao-Ye Wang, Shang-Chun Wu, Min Xue, Hui-Xia Yang, Qing Yang, Shu-Zhong Yao, Zhen-Yu Zhang, Ying-Fang Zhou, Lan Zhu
DOI:10.4103/2096-2924.249891  
Unintended pregnancy is a global issue, with approximately 85,000,000 women around the world having unintended pregnancy annually. The contents of clinical application of women's contraceptive methods are very wide, involving multiple areas. This consensus deeply discusses the specific contraceptive needs at different statuses, combined with gynecological diseases, postabortion contraception, and postpartum family planning, ensuring the correct use of contraceptive methods under the corresponding status. The top priority of the consensus is the specific contraception consensus section for women combined with gynecological diseases because medical treatment effect as well as side effects should be weighed carefully. The consensus is to make high-efficiency and individual contraceptive strategy for different groups based on multidisciplinary (gynecology, obstetrics, and family planning) and multidimensional aspects, which can provide uniform guidance for medical and health organizations under the condition as relevant global guidance or consensus is still lacking.
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REVIEW ARTICLES Top

Predictive modeling in reproductive medicine p. 224
Jing Lin, Xiao-Xi Sun
DOI:10.4103/2096-2924.249888  
The accurate prediction of fertility outcomes is an extremely interesting and challenging task in reproductive medicine. Efforts in this area focus on classic statistical models and newer technologies, including machine learning. The modeling process has three steps, namely, data preparation, model selection and data fitting, and model validation. Here, we present a review of studies on these methods of fertility prediction. Various databases were searched using relevant keywords. Original studies with full-text available on this topic were included for review. Earlier studies explored prediction models for spontaneous pregnancy prognosis, reproductive outcomes after intrauterine insemination and in vitro fertilization, and implantation potential based on embryo morphology and morphokinetic data. Future directions for predictive modeling in reproductive medicine include solving problems presented by big data, identifying novel informative features, balancing predictive power and result interpretability, and validating models with gold-standard study designs.
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In Vitro growth of human ovarian follicles for fertility preservation p. 230
Diego Marin, Min Yang, Tianren Wang
DOI:10.4103/2096-2924.249892  
Young female cancer survival rates significantly increased due to the great progress of cancer therapy. In fact, cryostorage and transplantation of ovarian tissue have already resulted in the birth of healthy babies. Follicle in vitro growth (IVG) has the great potential of restoring fertility by achieving functional oocytes from the most immature stages to maturation. This is suitable for a wide range of patients, from pubertal to perimenopause women. Notable achievements have been achieved in human follicle IVG in the past decade. Mature oocytes have been successfully collected from long-term sequential follicle IVG. However, it is still a major challenge to establish a stable and efficient follicle IVG system able to generate mature and competent oocytes. Hereby, we review the approaches being taken so far using ovarian tissue to support follicle growth at different stages in vitro.
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Strategies of infertility treatment with human immature oocytes p. 237
Ri-Cheng Chian, Ling Wang, Zhi-Yong Yang
DOI:10.4103/2096-2924.249885  
Human immature oocytes can be matured in vitro following culture. In vitro maturation (IVM) refers to maturation in culture of immature oocytes at different stages that may or may not have been exposed to short courses of gonadotropins. The source of immature oocytes is an important feature for the subsequent embryonic development and pregnancy, as well healthy live births. IVM is an efficient treatment that has already achieved significant outcomes in terms of acceptable pregnancies and implantation rates and resulted in the births of several thousands of healthy babies. As the development of IVM treatment continues, an attractive possibility for improving the already successful outcome is to combine a natural cycle in vitro fertilization (IVF) treatment with an immature oocyte retrieval followed by IVM of those immature oocytes. If the treatment processes can be simplified with immature oocyte retrieval, different types of infertile women may be able to take advantage of these treatments. Although IVM treatment is still considered experimental by the society, it is time to reconsider the IVM technological evolution. Mild stimulation IVF combined with IVM treatment represents a viable alternative to the standard treatment, and as data accumulate over time, it may prove to be an optimal first-line treatment approach.
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CASE REPORTS Top

Tear up the paper tiger and rediscover fertility and ovarian function p. 249
Yu-Kai Liu, Wei Zhang, Xiao-Yong Zhu, Ying-Li Shi
DOI:10.4103/2096-2924.249886  
Follicle-stimulating hormone (FSH), as the main indicator of ovarian function, plays an important role in the clinical activities of gynecologic endocrinology. Although anti-Müllerian hormone and antral follicle count are also the indictors evaluating ovarian function, many clinicians are still relentless in their decision to impose the death penalty of ovaries when high FSH levels (especially more than 40 IU/L) are observed. We recently encountered four patients whose FSH levels were inconsistent with actual fertility because all patients had successfully conceived after treatment. In our study, we found the culprit (macro-FSH) of false-positive FSH levels by applying the polyethylene glycol protein precipitation technique. The biological functions of macro-FSH were further evaluated by using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis. This study suggests that ovarian reserve function should be comprehensively assessed in clinic, and the causes of serum test indicators inconsistent with clinic should be identified.
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Mistaken oophorectomy in an adolescent with mccune–Albright syndrome: A case report and literature review p. 252
Jun Guan, Hai-Yun Guan, Lu Wang, Wei Zhang
DOI:10.4103/2096-2924.249887  
McCune–Albright syndrome (MAS) is a rare disease characterized by café au lait spots, bone fibrous dysplasia, and precocious puberty. Most MAS cases are diagnosed before adolescence. Here, we reported an adolescent girl underwent mistaken oophorectomy for suspected ovarian tumor, and later, she was diagnosed with MAS. An 11-year-old girl was found to have an irregular pelvic mass measuring 9.74 cm × 9.01 cm × 7.30 cm with a cyst–solid component and a clear boundary by magnetic resonance imaging. She underwent right oophorectomy for the suspected ovarian tumor. However, histopathological examination showed ovarian tissue with many antral follicles. One week after the surgery, ultrasonography revealed a left pelvic irregular echo-free mass measuring 60 mm × 53 mm × 48 mm. The patient was then examined by endocrine specialists, and café au lait spots were found predominantly located on the right side of her waist, hip, and thigh. She had her first period before the surgery, and her serum concentrations of sex hormones were normal. Thus, MAS was diagnosed. The patient has been taking dydrogesterone 20 mg/d for 10 days from the 14th day of her period for 2 years. Ultrasonography performed every 3–6 months revealed no enlargement of her left ovary. Awareness of MAS and careful physical and imaging examination should be emphasized, even in the absence of full classic triad of syndromes. Hence, unnecessary oophorectomy and irreversible loss of fertility potential can be avoided in these patients.
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