30 THE IMPACT OF SPERM DNA FRAGMENTATION ON MISCARRIAGES

Innovations in Assisted Reproductive Technologies critically dependent on ultrasound and mainly on transvaginal sonography (TVS). Its role in the IVF cycle includes evaluation of the uterus and ovaries at the beginning of cycle, monitoring all phases of the induction of ovulation protocols, by monitoring, also automated, the follicular response and maturation, timing of HCG, oocyte retrieval and embryo transfer (ET). Proper use of TVS allows also prediction and sometimes avoidance, monitoring and treatment of peri- and post-operative complications of IVF, like bleeding, infections and ovarian hyperstimulation syndrome (OHSS). And yet, the role of TVS is much more profound then merely assisting these procedures. It begins with selection of the adequate pre-operative approach in cases of uterine malformations, myomas, hydrosalpinges and endometriosis, and continues with predicting ovarian reserve and ovarian response, by estimation of the ovarian volume and the AFC and its effect on the starting dose of gonadotropins and identification of possible high and poor responders. TVS also allows monitoring changes in endometrial and uterine morphology and vascularity, enabling a better functional assessment and prediction of the uterine and endometrial receptivity, including rescue by increasing Progesterone dosage in cases of non-hyperechogenic endometrium. This is especially important in the era of efforts to reduce the occurrence of multiple pregnancies, leading to the introduction of single embryo transfer protocols. This approach necessitates optimization of the IVF process including the consistent use of AFC (and AMH), markers of ovarian reserve, as predictors of excessive response, and of ultrasound guided ET, controlling embryo replacement depth, to maximize the pregnancy rate. 30 THE IMPACT OF SPERM DNA FRAGMENTATION ON MISCARRIAGES J. Mehta. Queens Hospital, Sub-Fertility Unit, Romford, UK Recurrent miscarriages, defined as the loss of three or more consecutive pregnancies before 20 weeks of pregnancy as been suggested to be caused by chromosomal aberration in the embryo [1]. It is further assumed that the chromosomal anomalies in the fetus are due to a balanced aberration in one of the parents being inherited by the offspring in an unbalanced form. During fertilisation, in addition to the epigenetic factors, the spermatozoa contribute a haploid genome (with intact coding and regulatory regions for essential genes), the centrosome, necessary for the division of the cell, and important factors for the development of the placenta. Therefore, for normal embryogenesis to take place it is necessary that the paternal DNA contains the proper copy number of essential genes, and should not have increased single-or-double stranded DNA breaks [2]. Theories proposing the exact mechanisms leading to the paternal strand breaks are still widely elusive. However, defective sperm chromatin packaging, abortive apoptosis and oxidative stress have been suggested. Further, abnormal chromatin packaging due to defective protaminosis makes sperm more vulnerable to environmental insults like excessive ROS [3]. Cigarette smoking, genital tract infection, testicular cancer and Hodgkin’s disease, iatrogenic damage, as in sperm preparation protocols for ART as well as hyperthermia, exposure to pesticides and air pollution are some external factors which have also been associated with an increase in the percentage of ejaculated spermatozoa with DNA damage [4]. Recently, sperm DNA fragmentation has been promoted as a promising alternative predictive outcome factor [5]. However, meta-analysis of thirteen studies of varying quality has shown a weakly significant association with pregnancy rates after

S13 standard IVF and ICSI (OR = 1.44, 95% CI; 1.03, 2.03). This weak association can not be considered clinically important to justify the routine use of DNA fragmentation as a prognostic factor of pregnancy after IVF or ICSI procedures. In conclusion, although DNA fragmentation promises to be a new parameter for evaluation of male factor infertility and a possible predictor of the outcome of ART, its impact on miscarriages, still needs to be evaluated. Reference(s) [1] Carp H., Feldman. B. Oelsner G. and Eyal S. 2004 Parental karyotype and subsequent live births in recent miscarriage. Fertility and Sterility. 81, 1296 1301. [2] Carrell DT. 2008 Contributions of spermatozoa to embryogenesis assays to evaluate their genetic and epigenetic fitness. Reproductive BioMedicine Online. 16, 474 484. [3] Desai N, Sharma R, Makker MD, et.al. 2009. Physiologic and pathologic levels of reactive oxygen species in neat semen of infertile men. Fertility and Sterility92, 1626 1631 [4] Barroso G, Valdespin C, Vega E. et. Al., Developmental sperm contributions: Fertilization and beyond. Fertility and Sterility. 92, 835 845. [5] American Society of Reproductive medicine 2010. Sperm function and seminal oxidative stress as tools to identify sperm pathologies in infertile men. 93 297 300. 31 17 ALPHA HYDROXY PROGESTERONE AND ITS ROLE IN PREVENTION OF SPONTANEOUS TERMINATION BEFORE MATURATION OF FETUS F. Nanbakhsh, F. Broomand, Z. Yekta, A. Hosseini. Urmia University of Medical Sciences, Iran Introduction: Progesterone is used to prevent from abortion and to continue pregnancy in the first trimester of pregnancies due to IVF and microinjection. Preterm labor is defined to delivery before 37 weeks of pregnancy. Diagnostic signs and symptoms include crampy pain dilatation higher than 2 cm and effacement higher than 80%. Despite interventions such as administration of antibiotic and tocolytic agents and severe repeated care before of delivery, preterm labor has remained inconclusive. Recently, some studies have shown that progesterone and its derivatives play an important role in prevention of preterm labor. Materials and Methods: In this study, only pregnant women by the age between 26 35 weeks of their pregnancy and labor (preterm labor) to look to Kosar Women’s Center of Urmia University of Medical Sciences and tocolytic therapy for 36 48 hours is began and labor in this group be inhibit. After 48 hours for patients intervention group, 250 mg 17 alpha hydroxy progesterone and for control group distilled water are injected intramuscular weekly. Weekly intramuscular injection until 35 weeks of pregnancy is done. This study is double blind. Patients in both groups are received progesterone and distilled water weekly. Injection by clinics’ midwives or is done by gynecology residents. Results: Intervention period until the start of labor groups treated with 17 alpha hydroxy progesterone longer than the placebo group was treated, this association was statistically significant.(P = 0.0001). Beginning of the intervention period compared to delivery based on cervical dilatation and effaceman group treated with 17 alpha hydroxy progesterone as active treatment groups of placebo was statistically significant. (P = 0.001) and (P = 0.0001). Comparison of neonatal outcomes between the intervention group and placebo group from 5 minute Apgar score was significant (P = 0.03). Comparison of birth weight between the two groups was not statistically significant (P = 0.07). Comparison