Effect of piroxicam on ART outcome: a pilot study

One of the most important factors affecting success rates in assisted reproductive techniques [ART] besides the number of oocytes retrieved and high quality embryos derived from them is the technical aspects of embryo transfer. It seems that pretreatement with uterine relaxants can be helpful in preventing unpleasant cramps which can have an adverse effect on ART outcome. In this respect, some drugs such as prostaglandin inhibitors or sedatives have been evaluated but not confirmed yet remain controversial. This study was performed in order to assess the effect of administrating Piroxicam prior to embryo transfer on pregnancy rates in ART cycles. This pilot study was performed from August 2010 through December 2011 on 50 infertile women in ART cycles. Recombinant follicle stimulating hormone [rFSH] with a long gonadotropin releasing hormone [GnRH] analogue protocol were used for controlled ovarian hyperstimulation. The subjects were randomly allocated into two groups of 25 patients after obtaining written consent. Group A received a 10 mg Piroxicam capsule 30 minutes before embryo transfer and group B was the control group with no treatment. Data were analyzed by Chi-square and analysis of variance [ANOVA]. Pregnancy rate was 34% [n=17] totally, with 32% [n=8] in group A and 36% [n=9] in group B [p=0.75]. Uterine cramps were experienced by 4 women [16%] in group B, while none were reported by women in group A [p=0.037]. It seems that Piroxicam administration 30 minutes prior to embryo transfer cannot increase pregnancy rates, but can prevent or reduce uterine cramps after the procedure

Sexual dysfunction in patients with polycystic ovary syndrome and its affected domains

Background: Polycystic Ovary Syndrome [PCOS] is presented with characteristic complications such as chronic an ovulation, obesity, and hyperandrogenism which can affect sexual function in women of reproductive age

Objective: Herein we evaluated the frequency and predisposing factors of sexual dysfunction in infertile PCOS patients

Materials and Methods: In this cross-sectional study, 130 married women with a definite diagnosis of PCOS who were referred due to infertility were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index [FSFI] questionnaire

Results: The frequency of sexual dysfunction was verified 57.7% in PCOS patients with the domains of desire and arousal being commonly affected in 99.2% and 98.5%of cases respectively. BMI had a significant effect on sexual desire and arousal [p=0.02] while the effect of hirsutism was significant on all domains [p<0.001 for total FSFI score] except for dyspareunia

Conclusion: PCOS patients markedly suffer from sexual dysfunction as comorbidity. It seems appropriate to screen all PCOS patients for sexual function with a simple short questionnaire such as FSFI. Targeted interventions could be considered to help improve their quality of life along with other treatments

review of pioneer physicians' work on maternal health in pregnancy in ancient Iran; narrative systematic review

Maternal lifestyle and behaviors during pregnancy have been associated with future health outcomes for mothers and babies. Iranian Traditional medicine, which is a holistically-oriented medical discipline, has special attitudes towards pregnancy. The purpose of the study is the investigation of maternal health in medical books of ancient Iran. This study is a systematic review scrutinizing issues concerning lifestyle during pregnancy based on "Avicenna's Canon medicine" and "Rhazes Al-Havi" and for complete discussion, other reliable sources in traditional medicine which was conducted following the categorization and analysis of the gleaned data. Based on approaches by Iranian Traditional Medicine, the most important topics in lifestyle habits during pregnancy are divided into four main groups: Nutrition, physical exercise, sexual activity and psychological stress. Then special recommendations are suggested which include a regimen to facilitate labor. Eating behaviors and other lifestyle habits have a major role in optimizing the health of women in pregnancy. Regarding to traditional medicine viewpoints paying special attention to correcting diet, life style and preventive attitude with effective and simple therapeutic procedures, it seems that traditional medicine can offer efficient managements to alleviate some pregnancy complications

[Serum zinc level in infertile women with and without polycystic ovary syndrome: a comparative study]

We are in new era of knowledge and treatment of women with PCOS. We should find management modalities that can improve their life quality. Due to high prevalence of PCOS, and zinc deficiency in Iran, importance of antioxidants such as zinc on treatment and improvement of PCOS complications, and due to the disadvantages of the current treatment for the disease [i.e. OCPs], finding an efficient alternative therapy with no or less side effects seems to be as important as some methods for changing the life style of these women. This study was performed to assess zinc levels in PCOS versus non PCOS patients to determine if zinc can be helpful in PCOS management. This is a case-control study which was performed from January 2012-2013 in 100 infertile women aged 20-45 years who were referred to Vali-e-Asr infertility clinic. Fifty patients had PCOS according to Rotterdam Criteria [case group] and 50 were infertile women without PCOS [control group]. In both group, serum Zinc levels were determined and the data was gathered using the SPSS software and analyzed by descriptive [percent, mean, standard deviation] and analytical x[2], ANOVA, Mann-Whitney and Correlation]. Results did not show a significant difference between case group and control group in respect to serum Zinc levels [P>0.05]. Due to no difference between case group and the control one in zinc levels, it seems that zinc supplementation in PCOS patients is not necessarily useful or of clinical importance. Obviously studies with larger sample size can probably define the role of zinc in these patients.

Comparison of highly purified urinary versus recombinant FSH: effect on ART outcomes in polycystic ovary syndrome

Polycystic ovary syndrome [PCOS] is a common cause of ovulatory disorders and infertility with high LH to FSH ratio. In order to prevent further increase of LH and follicle atresia, different regimens for ovulation induction have been recommended using FSH alone. This study was performed in PCOS patients to compare ART outcomes in cycles induced by FSH alone, using either recombinant or urinary products. In a randomized trial, from 623 patients who underwent down regulation with GnRH analogue in a long protocol, 160 PCOS patients were randomly divided into two groups of 80. Group A received 150 IU/d recombinant FSH [Gonal-F] and group B 150 IU/d urinary FSH [Fostimon]. 33 cases [41.2%] in group A and 36 [45%] in group B achieved clinical pregnancy, which was not significantly different [p=0.67]. Total number of oocytes retrieved [13.03 +/- 5.56 vs. 14.17 +/- 4.89, p=0.17], quality and number of embryos [7.42 +/- 3.35 vs. 7.63 +/- 3.28, p=0.68] and OHSS rate were similar in group A compared to group B. Endometrial thickness which was 9.66 +/- 1.67 mm in group A and 10.36 +/- 1.35 mm in group B, showed a significant difference [p=0.004]. It seems that in PCOS patients, both pure FSH products used for controlled ovarian hyperstimulation have similar effects on ART outcome and can be used according to availability and patient acceptance without significant difference

Comparison of two embryo scoring systems for prediction of outcome in assisted reproductive techniques cycles

Cumulative embryo score [CES] is one of the many embryo scoring methods which have been developed to help clinicians to transfer high quality embryos and predict pregnancy rate in assisted reproductive techniques [ART] cycles. Regarding the existing difference in CES calculation this study was done to compare two methods in order to determine the more practical and preferable one. In a retrospective, cross sectional descriptive analytical study, a total of 508 ART cycles in infertile patients treated from November 2002 until March 2004, were evaluated using two methods of CES calculation in embryonic scoring to predict ART outcome. According to one method, CES was obtained by adding the individual scores of all transferred embryos. Whereas in the other reference method, CES was calculated by the sum of each embryo score multiplied by its number of blastomeres on the day of transfer. The mean score of transferred embryos [MSTE] was referred to CES divided by the total number of embryos transferred in either method. A total of 109 clinical pregnancies [pregnancy rate 21.5%] including 96 singletons, 10 twins and triplets occurred in the 508 ART cycles. The pregnancy rate was strongly correlated to CES and MSTE. According to one method, CES was 12.6 +/- 6.4 in pregnant versus 9.2 +/- 5.8 in non-pregnant group [P<0.0001]. According to the other one, in the pregnant group CES was 86.7 +/- 48 versus 68.7 +/- 55 in the non-pregnant group [P<0.002]. Both methods showed a significant difference. Regarding MSTE. using the first method, in the pregnant group it was 3 +/- 0.6 versus 2.8 +/- 0.7 in the non-pregnant group [P<0.011] whereas with the other approach it was 21.3 +/- 8.6 in the pregnant group versus 19.9 +/- 9.07 in non-pregnant [P<0.152] showing that the first method can also predict pregnancy outcome with MSTE. Considering that both MSTE and CES in the first method can significantly predict outcome in ART cycles, it seems this method is preferable and more useful in practice. Moreover, sometimes due to continuous division, on the third post oocyte retrieval day the blastomere number cannot be counted precisely which can be misleading if taken into account according to the method introduced by Steer

Cabergoline versus coasting in the prevention of ovarian hyperstimulation syndrome and assisted reproductive technologies outcome in high risk patients

Coasting is the most common method used in the prevention of ovarian hyperstimulation syndrome [OHSS] acting through vascular endothelial growth factor [VEGF] reduction. However, the pregnancy rate is reported to fall with coasting when it takes more than three days. Recently low-dose cabergoline, a selective D2 dopamine receptor agonist has been proven to selectively reduce vascular permeability without affecting angiogenesis and seems to be able to decrease the rate of OHSS without affecting pregnancy rate. This clinical trial was performed on 60 women in assisted reproductive technologies [ART] cycles at risk of OHSS, having at least 20 follicles in their ovaries [mostly /= 3000pg/mL. Patients were divided into two equal groups. In group A, oral cabergoline 0.5 nig/day was given for seven days after hCG administration; while in group B gonadotropin administration was halted until serum estradiol levels reached less than 3000pg/mL before hCG administration. The main outcome measurements compared were rates of pregnancy and severity of OHSS. Total number of oocytes, metaphase II oocytes, fertilization and clinical pregnancy rates were higher in group A [p<0.05]. Severe OHSS was not found in either group. Moderate OHSS was seen in one subject in the cabergoline group versus seven in the coasting group. Cabergoline seems to be a safe drug for prevention of moderate-severe OHSS

Knowledge and attitudes of infertile couples about assisted reproductive technology

Knowledge of infertile couples about assisted reproductive technology is a fundamental parameter to optimize the infertility treatment and conduct it cooperatively. To evaluate knowledge and attitude of infertile couples about assisted reproductive technology we designed a descriptive cross-sectional study. 400 infertile patients were investigated by a self- administered structured questionnaire about demographic data, infertility history, and several relevant variables in an outpatient infertility clinic of a university hospital. The main outcome measurements included scoring the answers in the questionnaire regarding knowledge, and grouping the answers regarding attitude. Resulted data were analyzed in relation to patient's gender and treatment history, and educational, ethnic and religious groups. Of 400 cases [251 women and 149 men] 167 patients [41.7%] were scaled to have good knowledge and 223 patients [55.7%] had a poor knowledge about ART. 74.6% of patients with advanced education and 30.3% of patients without advanced education were scaled to be good in knowledge. 45.6% of men, 43.4% of women and 64.8% of patients with a history of passing previous ART cycles had a good knowledge. The source of information was mentioned to be the ART centers in 73% of cases. 95% of patients disagreed to have sperm or ovum donation or to undergo surrogacy. 22% of all patients [27.5% of women versus 12.1% of men] agreed with embryo reduction. 94.5% of patients mentioned the ART expenses not to be affordable readily. Less than half of patients presented to be knowledgeable about ART. Not a great portion of the patients agreed with sperm donation. ART expense is mentioned to be burdensome by nearly all of the patients

Chylous ascites and gut malrotation

Chylous ascites was diagnosed in a female neonate. Following the administration of a gastrografin enema, which showed the presence of gut malrotation, she was operated. This led to a complete recovery and optimal weight gain. For evaluation of chylous ascites in neonates, gut malrotation should be considered in order to prevent volvolus and further complications

randomized trial of metformin-letrozole versus metformin-clomiphene citrate in patients with polycysytic ovary syndrome resistant to clomiphene

To compare the effects of the combination of aromatase inhibitor Letrozole [2.5 mg] and metformin vs. clomiphene citrate [CC: 100 mg] and metformin in clomiphene resistant PCO women. In a prospective randomized trial, a total of 120 cycles in 60 women with clomiphene resistant polycystic ovary syndrome were studied. Patients were randomized into treatment with 2.5 mg of Letrozole daily [29 patients, 53 cycles] or 100 mg of CC daily [30 patients, 67 cycles]. Number of mature follicles, endometrial thickness, estradiol level, pregnancy rate, and miscarriage rate were measured. The mean age, BMI, infertility duration, ovulation rate and the number of mature follicles [>18 mm] in both groups of patients were similar. Total and per follicle estradiol concentrations were significantly lower in the Letrozole group than in the CC group on the day of HCG administration [1664.63 +/- 1350 vs. 981.35 +/- 648 and 783.38 +/- 251 vs. 447.60 +/- 133.36 picomol/L], and the endometrial thickness was significantly higher [0.82 +/- 0.1 vs. 0.55 +/- 0.28 cm]. No difference was found in metformin side effects between both groups. There was no significant difference in pregnancy rate between Letrozole and CC groups [10 cases or 34.5% vs. 5 pregnancies or 16.67% respectively]. Two miscarriages of the 5 pregnancies [40.0%] occurred in the CC group with no abortion in Letrozole group. In comparison to the CC group term pregnancies were also significantly higher in the Letrozole group [10 cases or 34.5% vs. 3 pregnancies or 10.00% respectively]. In women with clomiphene resistant polycysytic ovary syndrome, the combination of Letrozole and metformin is associated with higher pregnancy, and lower miscarriage rates in comparison to CC and metformin