International Journal of

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Background: There has been an increase in number of obese infertile females booked for advanced infertility treatment procedures like in vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI). The knowledge of impact of body mass index (BMI) on reproductive outcome can help to counsel these patients.
Objective: To compare reproductive outcome in females of different BMI after ICSI.
Materials and Methods: Cross-sectional study of 323 females was conducted from June 2010 till August 2011. Females were grouped on the basis of BMI; underweight, (BMI <18 kg/m2), normal weight, (BMI 18-22.9 kg/m2) overweight (BMI 23-25.9 kg/m2) and obese (BMI ≥26 kg/m2). The procedure involved down regulation of ovaries, controlled ovarian stimulation, ovulation induction by hCG, oocyte pickup, in vitro fertilization and embryo transfer of blastocysts. The oocyte yield and embryological data of all BMI groups was compared by ANOVA (analysis of variance). Pregnancy outcome of these was categorized as; no conception βhCG <5 m IU/ml, preclinical abortion with βhCG >5 m IU/ml, no cardiac activity on trans vaginal scan (TVS) and clinical pregnancy with βhCG >5mIU/ml and cardiac activity on trans vaginal scan.
Results: Females with BMI 23-25.99 kg/m2 had maximum oocyte retrieval, fertilization, implantation and clinical pregnancy rates in comparison to obese females with BMI ≥26 kg/m2.
Conclusion: A BMI cut off value of above 26 kg/m2 in our study population is associated with a negative impact on pregnancy outcome.

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Background: Intracytoplasmic sperm injection (ICSI) is an advanced technique employed in assisted reproductive clinics for treatment of infertile couples. The reproductive endocrinologists try their level best to identify factors that enhance success rate after ICSI.
Objective: To compare estradiol progesterone ratio on ovulation induction day amongst pregnancy outcome groups following ICSI.
Materials and Methods: A cross sectional study was conducted on 323 couples of Assisted Reproductive Clinic in Islamabad from June 2010 till August 2011. Down regulation of females aged 18-40 years with gonadotrophin releasing hormone agonist was followed by calculated stimulation with gonadotrophin injections (COS). Oocytes pickup was done 36 hours after ovulation induction by 16G adapter and double lumen oocyte aspiration needle under general anesthesia. Oocytes were fertilized in vitro, graded and only blastocysts were transferred seven days after ovulation induction. Serum estradiol and progesterone were measured by enzyme linked immuno sorbent assay on ovulation induction day, ratio was compared in three groups of females; no conception with βhCG 5-25 mIU/ml, preclinical abortion with βhCG >25 mIU/ml and no cardiac activity on transvaginal scan and clinical pregnancy with βhCG >25mIU/ml and cardiac activity on transvaginal scan.
Results: Females having high estradiol/ progesterone ratio were able to achieve clinical pregnancy shown by a positive βhCG and cardiac activity on transvaginal scan. These females also had significantly high number of oocytes, endometrial thickness and implantation rate.
Conclusion: A high estradiol/progesterone ratio on the day of ovulation induction predicts the success of intra cytoplasmic sperm injection.

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Infertility affects approximately 15% of couples worldwide. Within 50% of cases, man provides reproductive function disorders (1). The cause of infertility in men with oligospermia and azoospermia seems to be due to underlying genetic abnormalities (2). Chromosomal abnormalities are one of the causes of human infertility as they interfere with spermatogenesis. The frequency of chromosomal aberrations and specific translocations in infertile men is multiplied by 10 compared with the normal population (3). Hundred patients aged between 26 and 50 years (the middle age 35 years old), oriented by specialized medical structures, are included in our study. All patients were referred for sterility (no spontaneous pregnancy despite >1 year unprotected intercourse). Only couples with infertility primary, in which men had a review of abnormal sperm: azoospermia or severe oligospermia (concentration sperm cells <5×106 ml and mobility <40%) were included in the study. 20 metaphases for each patient were analyzed by GTG banding technique (Giemsa Trypsin G bands). In our sample, there were 76 patients (76%) with an ordinary karyotype of which 5 have a known etiology. The most frequent medical history was a mumps orchitis, testicular ectopia, right and left inguinal testicles, or a bilateral varicocele. For patients without obvious etiology, it was important to mention the environmental and other genetic factors unidentified within the limits of the used technique. The chromosome abnormality rate was 24%; the numerical type 21% and structural type 3%. The chromosomal aberrations found in this study, were gonosomal (21/24: 87.5%) and autosomal 3/24: 12.5%). In 64.2% (18/28) of patients the azoospermia was determined by aneuploidy 47, XXY (Figure 1). Subjects 47, XXY (18/100 patients: 18%) had clinical signs or a complete picture mentioning Klinefelter syndrome. Aneuploidy 47, XYY was identified in three patients with the oligoasthénospermia (Figure 2). The Robertsonian translocations 45,XY,der (13)(14) (Figure 3) and reciprocal translocation 46, XY t(3q-10q) (Figure 4) explain oligozoospermia and oligoasthenoteratospermia. These findings are in accordance with those from other surveys and confirm that the XXY aneuploidy is the most frequent chromosomal abnormality in azoospermic individuals. The correlation is established between the karyotypic abnormalities and sperm characteristics. A review of the literature of somatic chromosome investigations in infertile males has shown that 10-15% of azoospermic males and 4-5% of oligozoospermic males have an abnormal karyotype. In the first group, sex chromosome abnormalities predominate (mainly 47,XXY), whereas in the latter, autosome anomalies (i.e. Robertsonian and reciprocal translocations) are the most frequent. However, the prevalence of somatic chromosomal abnormalities in male sterile population has been reported and varies in different studies and populations. For example, the prevalence of chromosomal abnormalities in Dutch or Italian infertile population is respectively 3.1% and 3.95 (4). In Iran, cases with an abnormal karyotype were 13.96% (5). The frequency of chromosome abnormalities appears higher in some Ammar-Khodja et al 836 Iranian Journal of Reproductive Medicine Vol. 12. No. 12. pp: 835-836, December 2014 countries. Thus, this frequency in infertile men from western Mexico and eastern Turkey is respectively 18.9% and 23.26% (6, 7). In Estonia, total chromosome alterations were revealed in 47.8% of infertile men (8). Interestingly, our present study shows a higher percentage of chromosomal abnormalities (24%) in comparison with previous reports where the range was between 10 and 15% (9). These frequency variations can be explained by the choice of recruitment criteria based on the results of spermiograms (azoospermia or severe oligospermia: concentration sperm cells <5×106 ml). The abnormal gonosome number (XXY) in patients with azoospermia was higher than in patients with severe oligozoospermia. Our results confirm the data of different literature sources that certify that sex chromosome abnormalities are the privilege of azoospermia. Indeed Klinefelter's syndrome in its homogeneous form (47, XXY) representing the most common aneuploidy (85.7%: 18/21). 47,XYY is a sex chromosomal abnormality observed in humans, with a prevalence of 0.1% of male births. This abnormality can be characterized by oligoasthenoszoospermia and it’s relatively uncommon and can miss clinically because of its variable clinical presentations (10). Our study reported a higher percentage of 3%. The reciprocal translocations are the most frequent structural chromosomal anomalies in oligozoospermia). In our study, two patients with Robertsonian translocation 45, XY, der (13)(14) were suffering from oligospermia. The balanced translocation 46, XY t(3q)(10q) has been identified in one patient with oligoasthenozoospermia. Acknowledgments We thank the Pr Guichaoua (Department of Reproductive Biology: Conception Hospital, Marseille), the Dr. Zerouala (Private Clinic Algiers), the clinic personnel and the patients involved in this research. We thank Dr. Farid Cherbal for reading the manuscript.