Objective: To compare the effectiveness, safety, acceptability, and confounding factors of the two-rod levonorgestrel implants between the Indoplant and Sinoplant implant brands.

Methods: The study was a double-blind, randomized controlled trial at three different centers in Indonesia. A total of 531 participants that met inclusion and exclusion criteria were randomized into two groups, with 264 participants in the Sinoplant group and 267 participants in the Indoplant group. At each center, participants were divided into two groups for Sinoplant and Indoplant. The participants were followed up for 36 months. Four parameters were evaluated: implant effectiveness, safety, acceptability, and confounding factors.

Results: A total of 531 eligible participants were enrolled in this study. Both Sinoplant and Indoplant showed 100% efficacy in preventing pregnancy, with no significant differences in side effects. 24.22% of the Sinoplant group and 22.18% of the Indoplant group reported weight changes. 8.60% of the Sinoplant group and 9.73% of the Indoplant group reported menstrual changes, and 1.17% of the both groups experienced intermenstrual bleeding. Implant acceptability was 96.61%, with 3.39% dropout rates. Confounding factors such as age, parity, and contraceptive history did not significantly differ between the two groups.

Conclusions: Sinoplant and Indoplant did not differ significantly in contraceptive effectiveness, safety, acceptability, and confounding factors.

Objective: To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.

Methods: Cytogenetic investigation was conducted with mitogen (Phytohemagglutinin-M, Gibco) stimulated blood T lymphocytes by Giemsa trypsin Giemsa banding and Ag-NOR banding on 580 couples with a history of idiopathic recurrent pregnancy loss and 240 couples from the general population. Thirty good chromosomal spreads were captured, karyotyped, and analyzed. The karyotypes were designated using the International System for Human Cytogenomic Nomenclature 2024. Pearson Chi-square test was used to compare the frequency of chromosomal polymorphism variations in the idiopathic recurrent pregnancy loss group with the general population group.

Results: A conventional cytogenetic investigation revealed that 45.43% of couples experiencing idiopathic recurrent pregnancy loss presented with various types of chromosomal polymorphic variants, compared to 11.88% in the general population. The overall frequency of these chromosomal polymorphic variants was significantly higher in the idiopathic recurrent pregnancy loss group compared to the general population group (OR 9.97, 95% CI 6.9914.21; P<0.05). Additionally, the prevalence of polymorphic variants was higher among males (49.14%) than females (41.72%) (P=0.01).

Conclusions: Chromosomal polymorphic analysis may play a crucial role in the assessment and careful clinical management of cases with idiopathic recurrent pregnancy loss, especially when no other conclusive reasons are identified during the initial evaluation. Therefore, heteromorphism should not be overlooked while investigating the causes of idiopathic recurrent pregnancy loss.

Objective: To characterize placental morphologic features in Moroccan women with adverse outcomes, across different clinical contexts, based on the Amsterdam consensus classification.

Methods: A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1, 2024 and July 15, 2024 from women with adverse pregnancy outcomes. Clinical data (age, parity, gravidity, complications) were retrieved. Macroscopic parameters (weight, dimensions, cord insertion, membranes, lesions) were assessed, followed by systematic sampling. Tissue was processed by standard histology (formalin fixation, paraffin embedding, hematoxylin and eosin staining), and lesions were classified per Amsterdam criteria.

Results: 16 placentas from patients with adverse pregnancy outcomes were included. The median maternal age was 30 years. Adverse conditions included placental abruption (50%), intrauterine growth restriction (IUGR, 38%), intrauterine fetal death (IUFD, 31%), pre-eclampsia/eclampsia (19%), premature rupture of membranes (13%), and oligohydramnios (13%). Several placentas were associated with more than one adverse condition. Histopathology revealed maternal vascular malperfusion lesions in 94%, particularly in pre-eclampsia, IUGR, and IUFD. Fetal vascular malperfusion was found in 88%, mainly in IUGR and IUFD. Inflammatory lesions, dominated by acute maternal and fetal responses stage 3 (necrotizing chorioamnionitis and funisitis), were primarily linked to IUFD.

Conclusions: Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes, supports diagnostic confirmation, and guides preventive strategies for recurrence. This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.

Objective: To investigate the sterilizing potential of zinc gluconate, calcium chloride (CaCl₂) and cadmium chloride (CdCl₂) following a single intratesticular administration in adult male rats.

Methods: 60 adult male Wistar albino rats (Rattus norvegicus) weighing 160-200 g and aged 5-6 months randomly received a single intratesticular injection of normal saline (Group A), zinc gluconate 13.3 mg/mL plus L-Arginine (Group B), 20% CaCl₂ (Group C), and CdCl₂ 0.5 mg/kg body weight plus ethylenediaminetetraacetic acid (EDTA) (Group D), respectively, along the entire route from the caudoventral aspect of each testis. They were euthanized up to 180 days to evaluate reproductive tract toxicology.

Results: The reproductive organ weights were markedly reduced, with testes severely atrophied in group B, pea-sized and stony hard in group C, and moderately reduced in group D. Azoospermia was evident in groups B and C, while sperm concentration was reduced to <1 million/mL with zero sperm motility in group D. Rats of groups B and C failed to show mounting and copulatory behaviour. A completely disorganized mesh of cellular elements was observed in the seminiferous tubules of group B, while pyknotic germ cell and arrest of spermatogenesis, exfoliated germ cells, occasional syncytial bodies and smaller Leydig cells were evident in groups C and D. Significantly reduced testosterone levels, increased luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, returned to normal after 90 days in group D.

Conclusions: Zinc gluconate and CaCl₂ injections severely affected the reproductive organs and libido and rats treated with CdCl₂ exhibited diminished spermatogenesis with normal libido. Thus, the need-based selection of intratesticular agents should consider their distinct effects on spermatogenesis, libido, and hormonal balance for achieving targeted sterilization outcomes.

Rationale: This case report describes a couple with recurrent fertilization failure despite undergoing multiple cycles of intracytoplasmic sperm injection (ICSI). The principal clinical concern was suspected oocyte activation deficiency (OAD), in which fertilization is impeded due to the oocyte’s inability to initiate embryogenesis, commonly attributed to inadequate intracellular calcium (Ca²⁺) release following sperm injection.

Patient concerns: The couple repeatedly experienced complete or near-complete fertilization failure in previous ICSI cycles, raising suspicion of an underlying oocyte activation defect.

Diagnosis: Based on the repeated absence of fertilization post-ICSI and clinical history, a diagnosis of suspected OAD leading to recurrent ICSI fertilization failure was considered.

Interventions: Artificial oocyte activation (AOA) using the calcium ionophore A23187 was performed. After ICSI, unfertilized oocytes were exposed to the ionophore to induce Ca²⁺ influx, simulating physiological calcium oscillations essential for oocyte activation. The efficacy of intervention was evaluated through subsequent embryonic development, morphological grading, and chromosomal integrity.

Outcomes: Following AOA treatment, successful oocyte activation occurred, resulting in the formation of high-grade embryos with normal developmental progression. Chromosomal analysis revealed no detectable abnormalities, indicating genomic stability.

Lessons: Calcium ionophore-mediated AOA may serve as an effective adjunct in cases of recurrent ICSI failure attributed to OAD. This case highlights the importance of individualized therapeutic strategies in assisted reproduction; however, further research is needed to refine protocols, validate broader clinical efficacy, and assess long-term safety, including potential epigenetic risks.