ABSTRACT
Objective@#Infertility can result from a diminished ovarian reserve, but a potential remedy exists in the form of platelet-rich plasma (PRP) administration. This treatment involves both biological factors and tissue trauma mechanisms, which stimulate folliculogenesis, making it a promising and effective strategy. We assessed the impact of direct PRP injections into the ovaries on the fertility outcomes of women classified as poor responders. @*Methods@#A quasi-experimental study was conducted from April 2021 to December 2022, focusing on patients classified as POSEIDON grade 3 or 4. PRP injections were administered into both ovaries. After 3 months, data were collected on anti-Müllerian hormone (AMH) level, follicle-stimulating hormone (FSH) level, and the numbers of oocytes, mature oocytes, and good-quality embryos following ovarian stimulation. We then compared the data from before and after PRP injection. @*Results@#This study included 50 women, with a mean of 39 years (interquartile range [IQR], 35 to 43) and 4 years (IQR, 2 to 6) for age and infertility duration, respectively. FSH levels decreased after treatment, while AMH levels and the numbers of oocytes, metaphase II oocytes, and high-quality embryos increased. However, only the increase in high-quality embryos was significant. The pregnancy and spontaneous pregnancy rates were 20% and 14%, respectively. Notably, women with secondary infertility exhibited a significantly higher pregnancy rate than those with primary infertility. @*Conclusion@#Ample evidence suggests that PRP can enhance ovarian function. However, further studies are needed to identify the appropriate candidates for this procedure, establish the optimal PRP preparation method, and standardize the procedure for its adjuvant use in assisted reproductive technology cycles.
ABSTRACT
Background: Small intrauterine lesions such as septum, adhesion, polyp, and submucous myoma may be of greater significance in causing implantation failure, poor reproductive performance and abnormal uterine bleeding. We studied effectiveness of therapeutic intervention through operative hysteroscopy in improvement of pregnancy outcome and cessation of abnormal uterine bleeding [AUB] in women with pregnancy and fertility problems
Materials and Methods: This prospective cohort study was performed between 2003- 2009 on 65 patients with primary or secondary infertility, recurrent abortion and structural uterine lesions reported in sonography or hysterosalpingography. After hysteroscopic metroplasty, myomectomy, adhesiolysis and polypectomy under laparoscopic guide, we evaluated reproductive outcome, early and late complications, one year after surgery
Results: Among all patients with recurrent abortion, 6 patients [75%] complete their pregnancy successfully. Our results showed that pregnancy rate after metroplasty was 58%. Reproductive outcome was poor after myomectomy and adhesiolysis. Abnormal uterine bleeding was improved in 62% of patients
Conclusion: Structural uterine lesions has been assumed to cause infertility, while several studies have shown very poor reproductive performance with high miscarriage and low term delivery rates when malformation is not treated. We show improvement in conceptional outcome and in patient's chief complaints after hysteroscopy surgery of these anomalies
ABSTRACT
Our goal was to assess the diagnostic value of creatine phosphokinase [CPK] and its isoenzyme CPK- muscle brain [MB] in ectopic pregnancy [EP] in order to locate a simpler diagnostic approach for EP. This was a prospective study that performed consecutive sampling for 20 months in two major hospitals in Isfahan, Iran. All pregnant patients in their first trimester of gestation that presented with complaints of vaginal bleeding, abdominal pain, or both enrolled in this study. Blood sampling was performed for laboratory analyses [CPK, CPK-MB]. After their diagnosis was established, patients were put in either the EP or non-EP group. We used SPSS software version 10 for data analysis, diagnostic parameters were determined, and a relative operating characteristic [ROC] curve was plotted for each biochemical marker. A total of 106 patients, 53 in the EP group and 53 in the non-EP group enrolled in this study. The results for CPK were as follows: sensitivity [69.81%], specificity [64.15%], positive predictive value [PPV; 66.07%], negative predictive value [NPV; 68%], positive likelihood ratio [PLR] [1.95], and negative likelihood ratio [NLR] [0.49]. The results for CPK-MB were: sensitivity [71.7%], specificity [56.6%], PPV [62.29%], NPV [66.7%], PLR [1.65], and NLR [0.5]. The area under the ROC curve for CPK was 0.692 and for CPK-MB it was 0.647. Although we have observed a significant elevation in CPK and CPK-MB serum levels in EP, transvaginal ultrasound [TVS] is still the better diagnostic tool for EP.
ABSTRACT
About 75% of the symptomatic patients who involved with endometriosis have pelvic pain and dysmenorrhea. Pentoxifyllin is one of the drugs that according to its mechanism could be effective for pain relief of endometriosis which has been used for endometriosis treatment recently. We conducted a comparative study for detecting the effect of pentoxifylin [as an immonomodelator] in preventing recurrence endometriotic pain with pentoxifylin plus a combined contraceptive pill with low dose estrogen [LD] and also the LD pill alone. This was a comparative clinical trial on 83 patients with the chief complaint [CC] of pain [dysmenorrheal /or pelvic pain] and with the end diagnosis of endometriosis, in an operative laparoscopy. Patients, dividing to 3 groups, were treated with pentoxifylin, pentoxifylin+LD and LD alone for 10 months. The severity of pain [dismenorhea and/or pelvic pain] was detected by visual analogue scale [VAS] before and after the treatment. The severity of endometriosis in the patients was: I in class I and II in class II and III in class III. The groups were matched for the pain. The number of the patients in group 1, 2 and 3 were 28, 28 and 27 respectively. The pain was reduced in the groups of pentoxifylin+LD [p<0.001] and LD alone [p=0.00]. The pain relief was not significant in the group of pentoxifylin alone [p=0.136]. After treatment, the severity of pain was not significantly different between the LD group and the LD+penthoxyfillin group, but there was difference between these two groups and the group of penthoxyfillin alone. This study showed that penthoxyfillin actually could not have any effect on the pain relief of endometriosis. It also made it clear that penthoxyfillin could not increase the efficacy of LD when used with this medication