Journal of Reproduction & Infertility
Year:2005 | Volume:6 | Issue:3 (23)|Papers Count:11

Introduction: From half a century ago, exogenic gonadotropins have been used by different methods for ovulation induction in the treatment of ovulatory problems and in ART. According to the extensive use of step-down and fixed-dose regimens of hMG in ovulation induction and in view of the fact that previous studies have not provided similar results, are expensive and have some complications, this study was performed to compare the aspects of the two methods that follows: hMG dosage, the need for increasing the dosage during therapy, endometrial thickness, pattern of endometrium and pregnancy rates.Materials and Methods: In this historical cohort study, 245 cycles of each regimen used in infertile patients who had been admitted to Shariati Hospital in Tehran during 2003-2004, were reviewed. All patients were under 35 and had not volunteered for zygote donation and were not suffering from PCOS or hypothalamic amenorrhea too. After the pituitary gland suppression by long-term GnRH agonist protocol, employing the step- down regimen, the initial dose of hMG, 2-4 ampoules (150 IU each), was administered and then in several stages the dosage was lowered, about 0.5 ampoule every 2-3 days based on sonographic findings. In the fixed dose regimen, 2-4 ampoules of hMG were administered without any decrease throughout the cycle. After injection of hCG, the resultant oocytes were used in ZIFT. The data were analyzed by SPSS software, using t-test, 2and Fishers exact test. Differences were considered significant at 5% level (p-value 0.05). Results: In the two mentioned regimens, the mean number of oocytes which were retrieved, grades of zygotes, endometrial thickness and pregnancy rates didn't have significant statistical differences. There were significantly more triple lines and less echogenic patterns of endometrium in step- down regimen (p-value=0.001). The mean number of used hMG ampoules in step- down regimen was significantly lower than the fixed- dose (26.4 versus 32.2 respectively, p-value= 0.000) as the need for increasing the dosage during treatment was_42 cycles (17.1%) versus 99 cycles (40.4%) respectively; p-value=0.000.Conclusion: According to significant differences in pregnancy rates and outcomes between the two regimens, the step- down regimen, by administering less hMG, seems to be better but further investigations by including patients suffering from PCOS, hypothalamic amenorrhea, etc in the study are needed to generalize these results.

Introduction: Infertility affects about 10-15% of couples in their reproductive age. Disorders of ovulation account for about 30-40% of all cases of female infertility. Ovarian reserve decreases in older women, causing decreased ovulation and lower quality of oocytes, resulting in infertility. Clomiphene Citrate Challenge Test (CCCT) is a screening test for the detection of ovarian reserve depletion and its abnormal results predict poor pregnancy rates following the use of assisted reproductive technologies. This study was undertaken to identify the clinical characteristics of infertile patients associated with CCCT results. Materials and Methods: The medical records of 75 women were reviewed in IVF and Infertility Center of Montaserieh Hospital in Mashad. The subjects had a CCCT as a part of their infertility work up. The pa-tients height, weight, age at work up, infertility type and duration, length of menstrual bleeding, cycle intervals, onset age of menarche, hirsutism and a history of their mother's menopausal onset age were recor-ded. The data were analyzed by t, Chi-square and Fisher s exact tests. 5% was considered as the significance level of the study (p<0.05). Results: 46.7% of the patients had abnormal and the rest of the participants normal CCCTs. Women with abnormal CCCTs were significantly older (p=0.003). 43% of the women with abnormal CCCTs were over the age of 35, versus 17.5% of similar age groups in the normal test group. Women with abnormal CCCTs had lower BMIs than the ones with normal CCCTs but no significant differences were seen between the two groups concerning the age of menarche (p=0.192), cycle intervals, duration of menstrual bleeding, infertility type and duration, and finally hirsutism (p>0.1). The percentage of women in whom their mothers had experienced menopause before 50 and with abnormal CCCTs, was significantly higher than women with normal tests (p=0.013).Conclusion: Infertile women who were older, had idiopathic infertility and their mothers had undergone menopause before the age of 50, had a higher prevalence of abnormal CCCTs. Abnormal CCCTs predict diminished ovarian reserves well and offer valuable information on the chances of pregnancy rates to whether choose higher doses of medications for ovulation stimulation or resort to zygote donation.

Introduction: Postpartum hemorrhage is one of the main causes of death in women, especially in deve-loping countries. The prevalence of postpartum bleeding is reported to be between 2-6% in normal and 0.6% in caesarian deliveries. Atonic uterus is responsible for 75-90% of postpartum bleedings, and in case the condition in not corrected, the risk of mortality increases considerably. Oxytocin is one of the commonly available drugs with minimal side-effects for the control of atonic uteri. The objective of this study was to compare the effectiveness of two different dosages of oxytocin in preventing atonic uteri.Materials and Methods: This is a clinical trial study performed on 566 patients who referred for normal vaginal deliveries or C/S to the labor ward of Sadoughi and Mojibian Hospital from late September to early March in 2003. The cases were randomly allocated to two groups. Both groups were similar regarding the risk factors for atonic uteri. Those in group I were each given 20 units while those in group II 100 units of oxytocin in 500 milliliters of Ringer s solution. The infusion was started 1 minute after expulsion of the fetus and continued for half an hour. The bleeding rate, uterine contraction, blood pressure, need for transfusion and hematocrit of patients during the first stage of labor and 6 hours postpartum were assessed and recorded. Results were analyzed by using SPSS software, descriptive statistics and 2 statistical test. The significance level was considered 0.05. Results: In the low dosage oxytocin group (group I) 16 cases (5.7%) experienced atonia, while in group II with a higher dosage of oxytocin only 2 cases (0.7%) had atonia (p<0.001). In group I, 10 cases (6.5%) and in group II, 1 case (0.6%) needed manual placental removal (p<0.005). Fall in HCT was higher in group I (41.4%) as compared to group II (17.1%) and the difference was statistically significant (p<0.001). Despite the higher fall in blood pressure in group I (13.6%) as compared to group II (8.8%), the difference between the two groups was not statistically significant (p<0.072). Conclusion: Infusions of high doses of oxytocin (3330mU/min) as compared to low doses of the drug, (666mU/min) over half an hour after delivery result in decreased rates of atonia and need for manual removal of placenta and also decreased fall of hematocrit postpartum. This mode of treatment had no special side-effects or complications. Therefore, based on the results of this study, use of high doses of oxytocin in comparison with various prostaglandins and methyl ergonovine, is cheaper, more available and with fewer complications, especially in developing countries.

Introduction: Hypogonadotropic amenorrhea is one kind of primary amenorrhea which is caused by a decrease in GnRH secretion and results in infertility. As infertility is an important problem in 10-15% of couples, the present study was undertaken to determine the prevalence of the disease in infertile women and pregnancy rates in response to its treatment. Materials and Methods: This cross-sectional, analytical study included 35 subjects suffering from hypothalamic amenorrhea, pulled from 2150 patients who referred to the infertility center of Montaserieh Hospital in Mashad during 2000-2002. The gathered data included: the patients age, infertility duration, menstrual cycles, history of prior surgeries or illnesses, food regimens and drug history. A gynecologic exam, hormonal assays and sonographic evaluations were carried out. The patients underwent 3 cycles of ovulation induction procedures. A serum β -hCG measurement and a vaginal sonography were used to confirm pregnancy. The data were analyzed by SPSS 11. For the descriptive analysis, t-test and logistic regression were used and the significance level was considered 5% (p<0.05). Results: The patients aged 20-35 and their infertility period varied from 1.5 to 14 years. Three of them were excluded from the study because of loss to follow up. The prevalence rate was 1-6%. In all of the patients, the serum FSH and LH levels were <5IU/ml. Serum prolactin levels were 21.7%±34.8 IU/ml and TSH 1.2±0.6 IU/ml. 14 patients out of 32, responded to treatment and became pregnant after three cycles of treatment (43.7%). Conclusion: The prevalence rate of infertility due to hypogonadotropic amenorrhea in this study was 0.016. Infertility due to hypogonadotropic amenorrhea is a disease that can respond to common ovulation induction treatment schedules quite well and despite the short period of treatment (3 cycles) in this study, 43.7% of the patients became pregnant. It is expected that by increasing the treatment period, better results will follow as it has in studies following 6 cycles of treatment with 83-90.1% success rates.

Introduction: It is well known that most of marital and emotional problems are due to sexual dissatisfaction and ignorance of human sexual instincts, which impose irreparable damage on social and marital relations and have destroyed family foundations. Therefore, an investigation on sexual satisfaction of the members of societies is necessary for improving sexual health. Physical and mental problems often result in sexual disorders, which pelvic relaxation is one of them. This disorder induces pelvic dysfunction that causes sexual dissatisfaction in couples. There have been few researches on the effects of colporrhaphy on sexual satisfaction in Iran; therefore this research was conducted to answer the scientific hypothesis of whether colporrhaphy has an influence on women's sexual satisfaction. Materials and Methods: This quasi-experimental study (before and after treatment) was carried out on 67 women with prolapse of pelvic organs who referred to Tabriz Medical University's Educational Hospitals in the years 2003-2004. All of the subjects were married and had no previous histories of divorce, pelvic or breast surgeries, chronic diseases, addiction to narcotics or other problems resulting in sexual dysfunction. The last three mentioned items were considered for both subjects and their husbands. The subjects did not have urinary tract infections too. All the subjects had indication for colporrhaphy because of pelvic organs prolapses. All the operations were carried out by 4 surgeons following unique procedures for anterior, posterior or anteroposterior colporrhaphies. Sampling was non-random. The research data were collected through a sexual satisfaction questionnaire which its validity and reliability were tested by content validity and Alpha Cronbatch (r=0.89) test respectively. All the subjects had indication for colporrhaphy because of pelvic organs prolapses. All the operations were carried out by 4 surgeons following unique procedures for anterior, posterior or anteroposterior colporrhaphies. Sampling was non-random. The research data were collected before and 12-16 weeks after the operation and they were analyzed by employing Wilcoxon and McNemar s statistical tests and a significance level of 5% ( α=0.05).Results: From the 60 women participating in the study who came back 12-16 weeks after surgery to be evaluated number of coitus per week, degree of sexual desire, number of orgasms experienced, and mental relaxation after coitus had been increased after the operation. The prevalence of vaginal dryness, pelvic cramps after coitus and dyspareunia were all decreased. The overall sexual satisfaction difference, based on PISQ and a 20- question sexual satisfaction questionnaire, was not statistically significant before and after the operations. Conclusion: Sexual satisfaction did not have any significant difference before and 3 months after the operation but sexual problems were improved. Therefore, colporrhaphy seems to have no positive effects on sexual satisfaction however, it should be mentioned that these results are valid for a three-month follow up and cases should be followed up 6-12 months after the operation too.

Introduction: Considering the remarkable prevalence of toxoplasma parasite in the world and the possibility of abortion, premature labor and congenital anomalies of the fetus in infected mothers, identification of non-immune women to toxoplasma parasite is necessary. Therefore, determining the prevalence rate and titration of anti-toxoplasma antibodies before pregnancy is a beneficial step in determining the rate of positive cases and the relation of these positive cases to a series of epidemiological variables of infection such as age, keeping cats, eating underdone or rare meat, educational status, etc enable us to decrease the incidence of congenital toxoplasmosis and its side- effects. Considering different side-effects of toxoplasmosis, such as abortion, premature labor, pathological changes of the CNS, etc, prevention of congenital infection is essential. One way for the prevention of infection in susceptible groups, especially women in their fertility years (14 to 45-year-olds) is by health education. One of the special objectives of this study was the identification of serum-negative girls in one of east Azerbaijan regions, to be used for planning in providing necessary education and taking precautions for its prevention. Materials and Methods: Blood samples were collected by random sampling from 1000 high- school girls in Jolfa during 10 months in 2003-2004 and were examined by indirect immunofluorescence antibody test (IFAT). In this study, titers of 1:20 and higher were considered positive. Then a questionnaire was prepared and information such as previous contacts with cats, previous histories of eating raw meat and raw liver were gathered. Chi-square (x2) test was used for determining the relation between epidemiological findings of infection and antibody titers. SPSS statistical software was used to analyze the data. Results: The prevalence rate of anti-toxoplasma IgG antibody by indirect immunofluorescence test was determined 21.8%. The individuals" titers by indirect immunofluorescence tests, were 1:20 to 1:100, for 198 people (91.8%) and the titers >1:100 for 20 people (2%) and the highest percentage of infection was in those who kept cats at home (37.5%) and students who had general symptoms of the disease (fever, lymph-adenopathy and dermal rashes) (37.7%). Chi-square test indicated that there was a significant statistical correlation between infection and contact with cats, eating raw liver and disease symptoms (p<0.001), but this correlation was not significant with age, knowledge on disease, eating raw food, keeping domestic animals at home and student's parent's jobs.Conclusion: Results of this study indicate that 78.2% of people in this community were serum negative; this means that they had not acquired any immunity against the infection, so there is the probability for their newborns to become toxoplasmic. The researchers suggest that tests for toxoplasmosis identification be included in the compulsory tests before pregnancy and health education of mothers be emphasized to prevent birth of infants with congenital anomalies.

Introduction: In order to prevent the risk of thromboemboli in patients with prosthetic heart valves, anticoagulants are prescribed, but in spite of this precaution thromboemboli are seen in these patients. During pregnancy, because of changes in the hemostatic system, the risk of prosthetic heart valve thrombosis is increased. The use of warfarin, especially in the first 3 months of pregnancy or its change to heparin afterwards, may endanger the mother or the fetus. So, the general recommend dation for these patients is prevention of pregnancy during reproductive years. This study was carried out to determine the best method of contraception in patients with prosthetic heart valves.Materials and Methods: In this descriptive study which was undertaken in Shahid Rajaie Heart Center in the first 6 months of 2004, 155 married female patients, with a history of prosthetic heart valve replacement during the years 1973-2002 participated. A questionnaire was completed by a researcher for each patient according to the information given by her, her medical records and reproductive histories before and after surgeries. The collected data were analyzed by using SPSS software. Results: Patients aged 24- 55 (mean age 39.67±6.09 years). The most prevalent surgical replacements were mitral valve replacement (57.4%), mitral and aortic valves replacement (23.2%) and isolated aortic valve replacement (14.2%). 9% of the patients had no pregnancies before the ope-ration but 91% had 1-8 prior ones. 35.5% had undergone T.L. surgery and 16.8% of the patients husbands had undergone vasectomy. Of these patients, 2.6% took oral contraceptive pills, 9% used IUDs, 33.5% withdrawal method, 9.7% condoms, 1.3% ingectable progesterone, and 17.4% two methods and 5.5% had undergone hysterectomy and 4.5% used no methods at all after valve replacement. 38 patients (24.5%) had 1-5 pregnancies after surgery, which were unwanted in 57.9% of the cases. The outcomes of these pregnancies were 51.7% normal births, 1.7% I.U.F.D.s and 46.6% abortions. In the majority of these patients the most prevalent contraceptive method was withdrawal. 81.82% of unwanted pregnancies occurred in women using withdrawal method, 9.09% in IUD group and 9.09% in those who used condoms. Conclusion: Considering the high rate of unwanted pregnancies reported in this study and the accompanied fetal and maternal risks in patients with prosthetic heart valves, educating the patients postoperatively and use of the best contraceptive methods, vasectomy or tubal ligation, are recommended in these kinds of patients.

Introduction: Female Sterilization is the second most frequent method of contraception (%17.1) after oral contraceptive pills (%18.4) in Iran. Sexual function following the use of this method has not been adequately addressed. The effects of sterilization are different in different individuals. Female sterilization may lead to psychological changes. The positive effects result from the disappearance of the fear of unwanted pregnancies and also side effect of other contraceptive methods and negative effects arise from the sense of preserving the reproductive ability. Retrospective studies usually show an improvement or worsening of sexual functions, but prospective studies show no changes or improvement of female sexual functions. Regarding the importance of sexual function and the high percentage of female sterilization in Iran, the present study was conducted to determine the changes in sexual function of sterilized women referring to some selected hospitals of Tehran in 2004. Materials and Methods: In this study 106 women volunteering for sterilization were selected by stratified sampling and underwent the study before the operation and 3 months after sterilization. All subjects were Ira-nian and monogamous with an anxiety and depression score lower than 2 (by SCL90 test) and had no major stressful events six months before the study. None of them were in postpartum period at the time of surgery. The study included an interview form with two parts: demographic questions (18 items) and questions on sexual function (16 items regarding different phases of sexual desire, sexual arousal, orgasm and resolution) as well as sexual satisfaction items scored by Likert scale. The tool was validated by content validity and its reliability was measured by Cronbach's alpha test. The data were gathered by completion of the forms before and three months after sterilization by one of the researchers (a midwife). Data analysis was done by SPSS (10) software and paired t-test was performed. The significance level was considered 0.05.Results: Findings showed that mean age of women undergoing sterilization was 33.7 ±4.2 years. Most subjects were illiterate (%56.6), housewives (%87.7) and their husbands mostly had non-governmental jobs (%51.9). Mean number of gravidity and number of children were 3.7±1.3 and 3.2± 0.9 respectively. The last contraceptive method used in most of them was OCPs. Their family income was mostly between 110- 165 dollars (%32.1) and most of them (%54.7) had a house of their own. The average percentages of sexual des-ire, sexual arousal, orgasms and sexual functions had no statistically significant differences before and after surgery but resolution phase and sexual satisfaction showed a significant difference (p<0.05) and changed from 68.2±20.7 to 71.6±21.4 and from 60.1±20.5 to 64.3±21.5 respectively. Conclusion: It seemed that sexual function would not change after 3 months of sterilization, except for the resolution phase and sexual satisfaction which improved postoperatively. There was also a slight increase in other phases over three months of follow-up. As different factors such as culture, religion, individual differences, walks of life and the picture of women portrayed by mass media in the country and factors aside from contraceptive methods, have an exclusive effect on sexual function, these findings are justifiable. However, Long-term studies with longer follow-up periods are suggested for future studies.