International Journal of Reproductive BioMedicine
Year:2013 | Volume:11 | Issue:2|Papers Count:11

Abstract Background: Rupture of fetal membranes can occur at any gestational age. Premature rupture of membranes (PROM) means rupture of fetal membranes before the onset of labor.Objective: The purpose of this study was to evaluate and compare the reliability of the vaginal washing fluid urea and creatinine for the diagnosis of PROM and to determine cut-off values.Materials and Methods: A total of 179 pregnant women were recruited. All patients underwent different examinations. These included nitrazine paper test, fern test, amniotic fluid pooling, vaginal washing fluid urea and creatinine sampling. The one group consisted of 126 pregnant women between 14 and 41 weeks of gestation with the complaint of vaginal fluid leakage. Patients who had positive pooling, nitrazine paper test and fern test were considered as confirmed PROM group (group 1). On the other side, patients with pooling (-) and/or nitrazine paper test (-) and/or fern test (-) were taken as suspected unconfirmed PROM cases (group 2) The control group consisted of 53 pregnant women between 14 and 41 weeks of gestation without any complaint or complication. Weconducted one-way ANOVA test on the urea and creatinine measures and post-hoc comparison test. Cut-off value was determined by receiver operating characteristic (ROC) curve.Results: Vaginal fluid concentrations of urea and creatinine were significantly different between the three groups (p<0.001). The sensitivity, specificity, positive and negative predictive values and accuracy were all 100% in detecting premature rupture of membranes by evaluation of vaginal fluid creatinine concentration with a cut-off value of 0.45 mg/dl, respectively.Conclusion: This study demonstrates that of two markers investigated creatinine has the higher diagnostic power.

Background: Despite clear reasons for necessity of sexual health education for adolescents, it is a contested issue and has faced challenges in most cultures. Providing sexual education for non-married adolescents is culturally unacceptable in most Muslim societies.Objective: This qualitative study addressed socio-cultural challenges to sexual health education for female adolescents in Iran.Materials and Methods: Qualitative data from female adolescents (14-18 yr.), mothers, teachers, authorities in health and education organizations, health care providers and clergies were collected in two large cities of Iran including Mashhad and Ahvaz through focus group discussions and individual in-depth interviews. Data were analyzed using conventional qualitative content analysis with MAXqda software.Results: Our results revealed that the main socio-cultural challenges to sexual health education for adolescents in Iran are affected by taboos surrounding sexuality. The emergent categories were: denial of premarital sex, social concern about negative impacts of sexual education, perceived stigma and embarrassment, reluctance to discuss sexual issues in public, sexual discussion as a socio-cultural taboo, lack of advocacy and legal support, intergenerational gap, religious uncertainties, and imitating non-Islamic patterns of education.Conclusion: It seems that cultural resistances are more important than religious prohibitions, and affect more the nature and content of sexual health education. However, despite existence of salient socio-cultural doubtful issues about sexual health education for adolescents, the emerging challenges are manageable to some extent. It is hoped that the acceptability of sexual health education for adolescents could be promoted through overcoming the cultural taboos and barriers as major obstacles.

Background: Acyclovir (ACV), a synthetic purine nucleoside analogue, is known to be toxic to gonads.Objective: The current study evaluated cytotoxicity of ACV on histopathological changes in testis tissue and serum testosterone and lipid peroxidation concentrations of male rats.Materials and Methods: Animals were divided into five groups. One group served as control and one group served as control sham. In the drug treated groups ACV administered for 15 days. 18 days after the last injection, animals were sacrificed. Histopathological and histomorphometrical analysis of the testis was carried out. Serum levels of testosterone and Lipid Peroxidation and potential fertility of animals was evaluated.Results: Male rats exposed to ACV had significant reduction in serum testosterone concentrations at 16 and 48mg/kg dose-levels (p<0.01). ACV induced histopathological changes in the testis and also increase the mean number of mast cells in peritubular or interstitial tissue in the testis at at 16 and 48mg/kg dose-levels (p<0.01). In addition ACV caused increase of serum level of Lipid Peroxidation at 48mg/kg dose-level (p<0.05). As well ACV decreased potential fertility in male rats.Conclusion: The present results highly support the idea that ACV has adverse effect on the reproductive system in male rat.

Background: Galectin-3 (Gal-3), a b-galactoside-binding lectin, is a multifunctional lectin that involves in a number of critical biological processes.Objective: The purpose of this study was to investigate the expression pattern of Gal-3 in mouse endometrium during estrus phase of estrous cycle and pre-implantation.Materials and Methods: In this experimental study 42 NMRI female mice were divided in seven different groups. Ovulation in NMRI female mice was stimulated by injecting hMG and hCG. Estrus phase was considered as stimulated and un-stimulated groups. The other groups of mice were mated, and the day of vaginal plug formation was considered as the day 1 of pregnancy. The mice of all groups were sacrificed on different days of pre-implantation period and their uterine horns were fixed and avidin- biotin complex method of immunohistochemistry (IHC) was applied.Results: In estrus group, Gal-3 immunoreactivity in luminal epithelium was strong, in stromal cells very strong, in glandular epithelium very weak and endothelial cells very strong. No identifiable difference was observed in un-stimulated and stimulated estrus phase. In test groups, days 1-2, insignificant difference of Gal-3 expression was observed. On day 3, luminal epithelium and stromal cells showed significant decrease in comparison to estrus and day 1 (p=0.001). On the 4th and 5th days, luminal epithelium and stromal cells showed significant decrease in comparison to estrus phase and days 1-3 (p=0.0001).Conclusion: The data suggested that successful implantation is probably associated with the downregulation of Gal-3 in the mouse endometrium at the beginning of pregnancy.  

Background: Considering the effect of preterm delivery in morbidity and mortality of newborns, its precaution and prevention is so important.Objective: To investigate the association between second trimester maternal serum biomarkers (Human Chorionic Gonadotropin, Alpha-fetoprotein, Non-conjugated estrogen, Inhibin A) and pre-term delivery.Materials and Methods: This is a historical cohort study that has been performed for 700 pregnant women, clients of Nilou Lab in the second trimester of pregnancy to take the Quad Marker test between March to September 2008. The information of mothers having required conditions to enter to study has been registered and after delivery, they called again to be interviewed. These data sets using statistical tests: chi-square test and Roc Curve was analysis.Results: There is a direct relationship between preterm delivery and increase of Alpha-fetoprotein (p=0.011) and inhibin A (p=0.03) serum level and. Also, there is an inverse relationship between the non-conjugated estrogen (p=0.002) serum level and preterm delivery. Moreover, there is not any relationship between the increase human chorionic gonadotropin (p=0.68) serum level and preterm delivery.Conclusion: The increase in the Alpha-fetoprotein and Inhibin A and decrease in Non-conjugated estrogen serum levels in the second trimester of pregnancy lead to enhance the probability of preterm delivery. Moreover, if the current study is done with higher samples and different sampling environment, it may have different results.

Background: Gonadotrophin-releasing hormone (GnRH) agonist is used for controlling ovarian stimulation in assisted reproductive technology (ART) cycles which has some benefits.Objective: To compare the efficacy of two different formulations of GnRH agonist: short-acting and long-acting, for ART protocols.Materials and Methods: In a prospective randomized study, one hundred women who underwent ART cycles were randomly divided into two groups. In group I, the patients received one single injection of 1.87 mg Triptorelin in previous mid-luteal phase. In group II, Decapeptyl 0.1 mg per day started from previous mid-luteal phase. Pregnancy outcome in in vitro fertilization (IVF) cycle was compared between two groups.Results: There were no statistically significant differences in the number of retrieved oocyte (p=0.545), fertilization (p=0.876), implantation (p=0.716) and pregnancy rate (p=0.727) between the two groups. Conclusion: There were not any advantages in IVF outcome between half-dose long-acting and short-acting GnRH agonist groups in ART cycle.

Background: Aggressive embryo and receptive endometrium are necessary for successful implantation. On this time endometrium transformates to receptive state, which permits embryonic implantation. Studies about embryonic implantation and endometrial receptivity are always a hot spot in the field of reproductive medicine.Objective: To investigate the expression pattern of Meis1 during peri-implantation in mice endometrium.Materials and Methods: Mice for experiment were raised in SPF environment. The mice were mated with a female/male ratio of 2:1. The female mice with detected plugs were regarded as pregnant day 1 (pd1). Endometrial tissues were collected respectively on pd1, pd2, pd4, pd5 and pd6. Immunohistochemistry was used to detect the location of Meis1 in mice endometrium. The expression level of mRNA and protein of Meis1 were further detected using Quantitative PCR and Western blotting, respectively.Results: We found that Meis1 is located in the cytoplasm and membrane of endometrial glandual epithelium cells and the nucleus of endometrial stromal and decidual cells. Both Quantitative RT-PCR and western blotting showed that Meis1 expressed regularly in mice endometrium. Meis1 mRNA expressed weakly on pd1, then significantly increased on pd4 (p=0.018), and achieved to a peak on pd5 (p=0.0012), it showed a decrease trend on pd6. Meis1 protein expressed weakly on pd1 and pd2, then significantly increased on pd4 and pd5 (p=0.0019), it showed a decrease trend on pd6 Conclusion: Meis1 is dynamically expressed in mice endometrium during peri-implantation. The time that Meis1 expression reaches its peak value is coincident with the implantation window, which implied that Meis1 is closely related with embryonic implantation.

Background: During the month of Ramadan, millions of Muslims abstain from food and drink daily from dawn to sunset and people actually experience repeated cycles of fasting and refeeding. Menstruation is a normal physiological process that its regularity is controlled by hypothalamic-pituitary-ovarian axis. Etiology of menstrual dysfunction includes weight loss, hypoleptinemia, abnormal eating behaviors, exercise, and psychological stressors.Objective: To investigate the effects of Ramadan fasting on menstrual cycles.Materials and Methods: This analytic cross-sectional study was performed on 80 female college students resident in a dormitory of Hamedan University of Medical Sciences. A questionnaire including demographic characteristics and menstrual calendar was filled by all participants. All analyses were performed using the statistical software SPSS for Windows version 11.5.Results: We found 11.3%, 30%, and 16.3% of participates had abnormal menstrual pattern three months before, during and three months after Ramadan, respectively. In participates who fast more than 15 days, menstrual period had significantly more abnormality than participants who fast less than 15 days. Considering our results we demonstrated that menstrual abnormalities during Ramadan month reach to their peak and three months after Ramadan reduce but do not return to previous condition.Conclusion: This study confirms that menstrual abnormalities including oligomenorrhea, polymenorrhea and hypermenorrhea increased during Ramadan especially in participates with more than 15 days of fasting.

Background: Sildenafil citrate may increase endometrial thickness and affect the outcome of frozen-thawed embryo transfer cycles.Objective: The aim of this study was to estimate the effect of sildenafil citrate on ultrasonographic endometrial thickness and pattern and to investigate the estrogen level on the day of progesterone administration, the implantation rate and chemical pregnancy rate in frozen embryo transfer cycles. Materials and Methods: This randomized controlled trial was conducted on 80 patients who had an antecedent of poor endometrial response and frozen embryos. 40 patients were given estradiol by a step up method with menstruation to prepare the endometrium, and the other 40 were given sildenafil citrate tablets (50 mg) daily in addition to the above treatment protocol from the first day of the cycle until the day progesterone was started. This was discontinued 48-72 hours prior to the embryo transfer.Results: The endometrial thickness was significantly higher in the sildenafil citrate group (p<0.0001), the triple line patterns of the endometrium were significantly higher in the sildenafil citrate group (p<0.0001), while the intermediate patterns of the endometrium were not significantly different in the two groups. The echogen patterns of the endometrium were significantly higher in control group (p<0.0001). Finally, implantation rate and the chemical pregnancy rates were higher in the sildenafil citrate group but not significantly.Conclusion: As our study shows, the oral use of sildenafil citrate is a good way to improve the endometrial receptivity. We recommend the routine use of oral sildenafil citrate in patients with a previous failure of assisted reproduction technology cycles due to poor endometrial thickness

Background: Uterine arteriovenous malformation is a rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of uterine bleeding can be lead to massive hemorrhage.Case: We describe here a case of uterine arteriovenous malformation. A 32-year-old woman presented abnormal vaginal bleeding following the induced abortion. A diagnosis of uterine arteriovenous malformation made on the basis of Doppler ultrasonraphy was confirmed through pelvic angiography. The embolization of bilateral uterine arteries was performed successfully.Conclusion: Uterine arteriovenous malformation should be suspected in patient with abnormal vaginal bleeding, especially who had the past medical history incluing cesarean section, induced abortion, or Dillation and Curethage and so on. Although angiography remains the gold standard, Doppler ultrasonography is also a good noninvasive technique. The transcatheter uterine artery embolization offers a safe and effective treatment.

Dear Editor, Estrogen deficiency in women is an important risk factor for serious disorders such as severe cardiovascular diseases (1). Several different conditions can lead to estrogen deficiency with premature ovarian failure (POF) being an important one (2, 3). POF includes the cessation of normal ovarian function before age 40, causing menopausal symptoms and general health problems. Although there are several known causes of ovarian failure i.e chromosomal defects, autoimmune disease, exposure to radiation and certain drugs: but most cases of POF are of unknown etiology. Consequently, further work is required to understand the etiology, possible prevention and treatment of POF (4). The most influential Iranian physician between 9th and 14th centuries AD was Ibn-Sina or Avicenna (980-1037 A.D). He was a great physician and has written more than 335 books on various subjects. His chief medical book is "Al-Qanon fi Al-Tibb" or "The Canon of Medicine" (5). According to "The Canon of Medicine", the basis of health is the right proportion and specific equilibrium of humors (Akhlat) according to their quality and quantity (6). Based on Iranian traditional medicine, there are four humors in the body: "Phlegm, Blood, Yellow bile and Black bile" (7). Each of them is related with a pair of qualities, including cold and wet, hot and wet, hot and dry, and cold and dry, respectively (6). In Iranian traditional medicine, premature ovarian failure is not defined the same as known today, but in many cases, it has been described as a disorder (8). Due to lack of biochemical analysis of blood parameters, almost all disease states have been defined based on clinical symptoms (9). The most obvious manifestation of POF is amenorrhea (10). The twenty-first chapter of third book of Al-Qanon fi Al-Tibb deals, principally with various kinds of uterine diseases. In this section, amenorrhea is described under a different title: "Ehtebase Tams" which means lack of menstruation. Avicenna has stated that one of the major causes of "Ehtebase tams" is abnormal black bile predominance (8). Based on The Canon of Medicine other symptoms that are seen in the "Ehtebase tams" of abnormal black bile predominance are as follows: vaginal dryness, dry eye, dry skin, anxiety, depression, somatization, sensitivity, hostility, forgetfulness, tiredness, headache, appetite disturbance, sleep disorder and depression and less satisfaction with sexual life (8). New studies have proven all of these symptoms (10). Black bile is divided into two categories: normal and abnormal. In contrast to normal black bile, abnormal black bile has affinity to deposit in any tissue and organ. As a consequence, in cases of abnormal black bile predominance, a high level of its deposition in the ovaries can lead to their dysfunction similar to its effect on other organs and tissues (arteries) (5, 7). According to this letter, it seems that the treatment of "black bile predominance” can be used as one of the first steps in treating POF patients. This finding can be used as an important theory to design the prevention and treatment plan of POF based on Iranian traditional medicine text books. Most obviously further clinical study is recommended to investigate this issue