سال:1391 | دوره: | شماره: |تعداد مقالات:15

Background: GnRH agonist and antagonist were developed to control the premature release of LH surge. There is some difference between two protocols.Objective: We compared the outcome of frozen-thawed embryo transfer in infertile women who used GnRH agonist or antagonist protocol for previous COH cycle and evaluation of any adverse effect of GnRH antagonist on oocyte and embryo.Materials and Methods: The study group included all infertile women who referred to Yazd Research and Clinical Center for Infertility. Overall 20-35 years old women who were candidate for frozen-thawed embryo transfer with regard to inclusion and exclusion criteria were participated in the study. The patients based on previous control ovarian stimulation (COH) protocol divided in to two groups: GnRH agonist long protocol (n=165) and GnRH antagonist multiple dose protocol (n=165). Frozen-thawed embryos were transferred after endometrial preparation in both groups. Main outcome measures were: implantation, chemical and clinical pregnancy rate.Results: The implantation and clinical pregnancy rate following cryopreserved embryo transfer in GnRH agonist group and antagonist group were 16.3% vs. 15.7% (p=0.806) and 38.1% (63.165) vs.36.9% (61.165) (p=0.915) and chemical pregnancy rate was 44.8% (74.165) vs.43.6% (72.165) (p=0.915) respectively.Conclusion: There was no statistically difference between two groups in terms of implantation and pregnancy rate. Although pregnancy rate in fresh embryo transfer in antagonist cycles was lower than agonist groups, Therefore decrease in these parameters might be due to detrimental effect of GnRH antagonist on the endometrium, not embryo or oocyte.

Background: Vaginal sonograghy and serial b-hCG are the most common diagnostic methods for ectopic pregnancy but about 50% of cases are initially misdiagnosed. In tubal pregnancy the zygote lies next to the muscular layer, and this invasion causes an increase in creatine phosphokinase (CPK) in blood.Objective: assessment of CPK and its isoenzyme CPK-MB as a diagnostic marker for tubal pregnancy.Materials and Methods: In this case-control study, 111 women between 16-40 years in first-trimester pregnancy admitted to emergency ward of Rasht Alzahra hospital with abdominal pain or vaginal bleeding were included and according to sonography and bCG divided into 3 groups (N=37): tubal pregnancy (1), threatened abortion (2) and normal pregnancy (3). Blood samples were taken for totalCPK and CPK-MB before any invasive procedure.Results: Mean total CPK level were 96.27±63.9 u/lit (group 1), 55.37±14.1 u/lit (group 2) and 48.94±19.2 u/lit (group 3) and was significantly higher in tubal pregnancy compared to other groups. Mean CPK-MB levels in 3 groups were 15.62±5.2 u/lit, 17.32±6.9 u/lit, and 15.1±4.7 u/lit, respectively which was not significant.Conclusion: It seems that determination of total CPK can enhance the diagnostic value of tubal pregnancy.

Background: Polycystic ovary syndrome (PCOS) is the most common cause of hyperandrogenism in women. Non-classic congenital adrenal hyperplasia (NCAH) is very close to PCOS. The diagnosis of hyperandrogenism is not based on the finding of decreased or increased levels of a single hormone.Objective: In our paper, we are going to test correlation between clinical signs and biochemical markers of hyperandrogenism.Materials and Methods: In this prospective study, we calculated free testosterone (cFT), bioavailable testosterone (cBT), free androgen index (FAI), free estrogen index (FEI), total testosterone (TT), sex-hormone binding globulin (SHBG), estradiol (E2), dehydroepiandrosterone-sulfat (DHEA-S), 17a-hydroxyprogesterone (17a-OHP), prolactin (P), C-peptid and homeostasis model assessment for insulin resistance (Homa-IR) were measured in two groups of young untreated women with PCOS and NCAH.Results: In our research, we did not find any significant differences between PCOS and NCAH groups by age, hormonal and calculated parameters of androgens. Waist to hip ratio (WHP) and body mass index (BMI) values were higher in the group of patients with PCOS than NCAH group. But in all patients we found positive correlation between hirsutism score and FAI, cFT, cBT, as well as we found negative correlation between hirsutism score and SHBG. We also tested hormonal and calculated parameters of androgens between PCOS patients by upper body and lower body obesity, but we did not find any significant differences. There was not any difference by the hirsutism score in these groups either.Conclusion: In our research we found that the calculated values of cFT, cBT and FAI are helpful for determinate hirsutism score in all hirsute patients, despite of ovarian or adrenal hyperandrogenemia.

Background: About 10% of infertilities with obstructive azoospermia are congenital and caused by CF gene mutations. M469I mutation was observed for the first time in Taiwanese patients. This mutation not only causes CF, but also may be the origin of infertility too.Objective: In this study, we aimed in designing a rapid, reliable RFLP-PCR procedure for detection of M469I mutation. The correlation and association between M469I mutation with infertility was investigated in this study.Materials and Methods: one hundred ten patients (90 non obstructive and 20 obstructive) and 60 normal individuals were considered in this study. M469I mutation was detected using RFLP-PCR. This technique was completely designed for M469I genotyping, for the first time in our study. Amplification of the region surrounding the mutation in exon 10 of CFTR gene was then performed. RFLP analysis was carried out using the Nde I restriction enzyme.Results: All genomic DNA samples were genotyped successfully. M469I mutation was observed only in patients group. Therefore, genotype containing mutant allele (GT) has been detected only in the patients group. There was no significant correlation between GT and TT genotypes with infertility (p=0.437).Conclusion: The M469I mutation has only been observed in Exon 10 CFTR gene of infertile patients, not in the control group. This mutation causes congenital bilateral absence of vaz deferens and finally infertility. This indicates a strong association between the M469I mutation and male infertility. Therefore, this is a CF-causing CFTR mutation that could be considered as a cause of infertility.

Background: Endometriosis is a common chronic inflammation which leads to infertility and chronic pelvic pain in affected women. Secretory phospholipase A2 type IIa (sPLA2IIa) is an acute phase reactant that is markedly increased in inflammatory disorders.Objective: To assess the effects of ω-3 and ω-6 polyunsaturated fatty acids (PUFAs) administration in endometrial cells culture on sPLA2IIa level and cell survival comparing homolog ectopic versus eutopic endometrial cells from endometriosis patients.Materials and Methods: In this experimental study, ectopic and eutopic endometrial tissue samples obtained from 15 endometriosis patients were immediately frozen. After thawing and tissue digestion, mixed stromal and endometrial gland cells were cultured for 8 days in three different culture media; balanced w-3/w-6, high w-3 and high w-6 PUFAs ratio. Cell survival was measured using 2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl) -5- (phenylamino) carbonyl-2H- tetrazolium hydroxide (XTT) method and sPLA2IIa level assessed with ELISA technique.Results: The sPLA2IIa level was significantly higher in the ectopic endometrial cell culture compared to the eutopic group for each of the three matched treatments (balanced, high w-3 and high w-6). Also the sPLA2IIa level in the ectopic endometrial cell group was remarkably increased by each of the three PUFAs treatments compared to control condition (p<0.05, p<0.01, p<0.05 respectively). Cell survival in the eutopic group was significantly decreased by high w-6 culturing compared to control medium (p<0.05).Conclusion: The increase in sPLA2IIa level in ectopic endometrial cells by fatty acid treatments (especially high w-3), strengthens the hypothesis that PUFAs stimulate secretion of cytokines leading to increased sPLA2IIa level.

Background: Histones are replaced by protamines to condensate and package DNA into the sperm head during mammalian spermatogenesis. Protamine genes defects have been reported to cause sperm DNA damage and male infertility.Objective: In this study relationship among some protamines genes family SNPs include PRM1 (C321A), PRM2 (C248T) and TNP2 (T1019C), (G1272C), (G del in 1036 and 1046 bp) were studied in 96 idiopathic infertile men with azoospermia or oligospermia and 100 normal control men.Materials and Methods: Analysis of SNPs was performed using restriction fragment length polymorphism (PCR-RFLP), single strand conformational polymorphism (PCR-SSCP) and PCR sequencing.Results: No polymorphisms were found for tested SNPs except for PRM1 (C321A) and TNP2 (G1272C) in which frequency of altered AA and GG genotypes were slightly higher in infertile case group. Statistical analysis showed no significant association related to PRM1 (C321A) p=0.805 and TNP2 (G1272C) loci p=0.654.Conclusion: These results are consistent with previous studies and indicating that all tested SNPs was not associated with oligospermia and azospermia and idiopatic male infertility in Iranian population.

Background: Menarche, a milestone in the reproductive life span of a woman, is influenced by several genetics and environmental factors. There is no consensus regarding the impact of body mass index (BMI) and lipid profiles on the age of menarche, as the results of various studies demonstrate.Objective: To investigate the correlation between age of menarche and BMI/lipoprotein profile in a community sample of Iranian girls.Materials and Methods: In the study, 370 girls, aged 10-16 years, who began their menarche within six months prior to the study, were recruited from the Tehran Lipid and Glucose Study (TLGS) population. Information was documented regarding their body composition, including height, weight, BMI, waist and hip circumference were collected and their lipid profiles were assessed after a 12-hour fast.Results: In this study, the mean±SD of age of menarche and BMI were 12.6±1.1 years and 21.7±3.9 kg/m2, respectively. There were statistically significant relationships between age of menarche and height, BMI, waist circumference, and the maternal educational level. The relationship between age of menarche and the weight and lipid profiles of subjects was not statistically significant.Conclusion: Age at menarche is not influenced by lipid profiles but it is influenced by BMI.

Background: In vitro maturation (IVM) of human oocytes is an emerging procedure quickly incorporated into the world of assisted reproductive technologies. As an effective method of in vitro maturation, several studies have reported the critical role of differentions on activating the complex process involved in both gamete maturation and fertilization.Objective: In this study, we supplemented a chemically defined medium with different combinations of selenium, calcium and calcium ionophore concentrations to obtain the best rate of human oocytes maturation, survival, and fertilization.Materials and Methods: As an experimental study, Three combinations of [selenium (5 mg/ml), calcium (5 mg/ml) and calcium ionophore (1 mg/ml)], [selenium (10 mg/ml), calcium (7 mg/ml) and calcium ionophore (2 mg/ml)] and [selenium (15 mg/ml), calcium (10 mg/ml) and calcium ionophore (5 mg/ml)] added to the chemically defined medium and the morphology of oocytes assessed after 22-24 hours in vitro maturation of the oocytes.Results: The highest percentage of MII (meiosis II) oocytes (68%), developing beyond the morula (20.1%) and the blastocyst formation (11.1%) observed in oocytes treated with 15 mg/ml selenium, 10 mg/ml calcium and 5 mg/ml calcium ionophore. Moreover, we showed the significant rate of survival in each three combinations after 36, 72 and 96 hours.Conclusion: Maturation and activation of oocytes may be triggered by changes in intracellular ion concentrations as second messengers in signal transduction pathways. Here, we received the highest percentage of in vitro maturation and fertilization among three combinations of selenium, calcium and calcium ionophore treatments. Using this combination of ions beside other factors might be useful for the enrichment of the human oocytes IVM medium.

Abstract Background: Polycystic ovarian syndrome is one of the most common causes of endocrine disorders and main reason of infertility due to anovulation and recurrent abortions. Progesterone has been shown to have an important role in fertilization of oocyte and fetal implantation.Objective: The purpose of this study was to compare the predictive value of progesterone level on IVF success in women with infertility due to tubal factor or PCOS.Materials and Methods: In a stratified cohort study, we assigned 76 infertile women of 20-38 years old who referred to women hospital into two equal groups with fallopian tube factor infertility and PCOS. We measured the plasma levels of progesterone and estradiol on the day of HCG administration. The patients were divided into two groups based on progesterone level cut off point of 1.2ng/ml. Thereafter the incidence of pregnancy (chemical by b-HCG measurement and clinical by ultrasonography up to the 6 weeks after fetal transfer) was compared in these groups.Results: Total pregnancy rates were 15.8% in patients with tubal factor infertility and 26.3% in women with PCOS. In women with PCOS, the pregnancy rate was less in patients with progesterone level <1.2 ng/ml. However this difference was not statistically significant. Likewise, we did not observe any significant differences in pregnancy rate in patients with fallopian tube factor infertility.Conclusion: Serum progesterone level on the day of HCG administration is not well predictive of the IVF success in infertile women due to fallopian tube factor or PCOS. To obtain more uniform results, we recommend use of larger samples while the bias variable is taken into account and the ROC curve is used for determination of the unique serum progesterone level.

Background: The task force on plants for fertility regulation in men continued with its program to identify novel prototypes in plants alleged to have fertility regulating properties. Nigella Sativa seeds are frequently used in folk medicine in the Middle East and some Asian countries for the promotion of good health and treatment of many ailments.Objective: To evaluated the role of alcoholic extract of Nigella sativa on fertility potential, Pituitary-testicular axis hormones and Testosterone in male rats.Materials and Methods: 24 male rats were randomly divided into 3 groups; control, group A and group B, each group comprising of 8 rats. Animals in control group received 1 ml of normal saline and treatment groups (A and B) received (gavage) graded doses of 200 and 400 mg/kg body weight of alcoholic extract of Nigella sativa seeds on a daily basis for 60 days. At the end of treatment period, fertility parameters such as body and reproductive organs weight, sperm motility, viability and count, epididymal sperm reserve (ESR), daily sperm production (DSP), blood testosterone concentration, Gonadotropins levels and fertility index were measured.Results: There was a significant difference in testes and epididymidis weight, sperm count, ESR, DSP, blood testosterone concentration, LH and fertility index in both the lower dose group and the higher group as compared to the control group.Conclusion: The results of this study showed that alcoholic extract of Nigella sativa seed especially in higher doses could increase fertility potential, LH and testosterone concentration in male rats.

Background: Osteoporosis is a chronic disease characterized by a decrease in bone mineral density (BMD) and corruption of the microarchitectural structure of bone tissue.Objective: It was investigated whether methylprednisolone had a favorable effect on osteoporotic bone tissue in Oophorectomy induced osteoporotic rats whose endogenous adrenaline levels are suppressed with metyrosine.Materials and Methods: Bone Mineral Density, number of osteoblast-osteoclast, bone osteocalcin levels and alkaline phosphatase (ALP) measurements were performed. Obtained results were compared with that of alendronate.Results: Oophorectomy induced osteoporosis was exacerbated by methylprednisolone. Alentronate prevented ovariectomised induced osteoporosis, but it couldn’t prevent methylprednisolone +ovariectomised induced osteoporosis in rats.Conclusion: Combined treatment with methylprednisolon and metyrosine was the best treatment for preventing osteoporosis but metyrosine alone couldn’t prevent osteoporosis in ovariectomised rats.

Background: Recurrent pregnancy loss (RPL) is defined as two or more consecutive pregnancy losses before twenty weeks of gestation. It is caused by a variety of genetics and non-genetics factors. Thyroid autoimmunity could associate with pregnancy loss.Objective: To investigate the effectiveness of Levothyroxine in treatment of RPL in women with high auto-thyroid antibodies.Materials and Methods: In this observational cross sectional study, 900 women who had a history of recurrent pregnancy loss were studied. All women with high anti-TPO antibody without any other problems entered in this study. Levothyroxine was given to them two months before pregnancy till the end of pregnancy. The doses of levothyroxine were depended on the anti-TPO levels, which were decided by endocrinologist. Women followed for the results of pregnancies.Results: The success rate of pregnancy in women with abnormal anti-TPO with Levothyroxine therapy was 82.85%. Mean of anti-TPO in women with treatment before taking medication was 488.35 and after that it was 123.35 UI/ml. This difference was significant (p<0.05). The mean of the antibodies was not significantly different in women without treatment.Conclusion: This study showed that Levothyroxine reduces the incidence of spontaneous abortions in women with high Anti-TPO antibody. It decreased anti-TPO antibody levels after 2-3 months treatment.

Background: Hysteroscopy is a safe and high efficient procedure so it is changing to a widespread procedure in dealing with many gynecologic and obstetrical conditions.Objective: This study aimed to evaluate the diagnostic and therapeutical efficiency of hysteroscopy in managing the common conditions including abnormal uterine bleeding, abortion and infertility.Materials and Methods: This was a descriptive cross-sectional study to compare hysteroscopy as a minimally invasive approach with conventional laparatomy and hysterectomy or repair of mulerian anomalies and watch the uterine cavity for intrauterine pathology in cases of infertility. Overall 277 women underwent hysteroscopy were evaluated in three groups: with AUB 226 cases, with infertility 34 cases and with recurrent abortions with septate uterus17 cases. The overall success rate was recorded and analyzed after six months in order of indication of hysteroscopy Results: Hysteroscopy as sole diagnostic procedure in 16.5, 8.8 and 14.3% of AUB, infertility and abortion cases, respectively. In AUB cases, curettage, myomectomy, polypectomy and hysterectomy were the main diagnostic-therapeutical approaches along with hysteroscopy. In infertiles, myomectomy, polypectomy were the main diagnostic-therapeutical approaches. In abortion group, laparoscopy guided, septum resection adhessiolysis, curettage and myomectomy were the main aproach. There was not any major complication. The diagnostic-therapeutically measures accompanying with the hysteroscopy were successful in 73.5% of the bleeding group and 33.3% of the infertility group in follow-up period.Conclusion: Based on our results, hysteroscopy is a safe, accurate and highly-efficient procedure in managing women with abnormal uterine bleeding, recurrent abortion due to septate uterus.

Background: Evidences shows that menopause affects women’s health, but women’s knowledge of proper care and maintenance is insufficient.Objective: To determine knowledge of hormone therapy (HT), reproductive physiology, and menopause in a population of 40-60 year old women.Materials and Methods: This cross-sectional study was conducted through a cluster sampling among 330 women in Yazd, Islamic Republic of Iran, in 2010. Data was collected using a questionnaire containing questions about reproductive physiology related to menopause and HT by interviewing. Inferential and descriptive statistics via SPSS.15 software were used for data analysis.Results: Overall, 2.1% of women were current takers of HT, 13.4% had taken it in the past but had stopped and 84.5% had never taken hormone replacement therapy. Iranian women had low knowledge of HT, reproductive physiology, and menopause. Most of the women (85.5%) knew that hot flashes are common around menopause and only 77.2% knew decreasing estrogen production causes the menopause. They knew little about the effects of progestagens and the effects of HT on fertility. Logistic regression determined that age, educational level and BMI were the most important factors predicting use of HT after adjusting for other variables.Conclusion: Iranian women have a low HT usage rate and the majority of them are lacking of the knowledge about HT and menopause. Women need improved knowledge of the risks and benefits of HT as well as education about the reproductive system around menopause.

A 27 year old patient presented with primary infertility of 3 years’ duration and also a history of myomectomy (5 years ago) was referred to our infertility clinic for investigation of infertility. The latest Hysterosalpingography (HSG) revealed an obstructed left fallopian tube with apparently a unicornuate uterus with luminal contour irregularity and normal left fallopian tube (Figure 1). Significant information in her past medical history revealed that she had another HSG two years before and her first hysterosalpingography (HSG) showed a apparently unicornuate uterus. Additional significant information in comparison with second HSG revealed that both fallopian tubes were opacified (Figure 2).