effect of vitamin E and aspirin on the uterine artery blood flow in women with recurrent abortion: a single-blind randomized controlled trial

Background: Recurrent spontaneous abortion has high incidence rate. The etiology is unknown in 30-40%. However high uterine artery resistance is accounted as one of the recurrent abortion reasons

Objective: The objective of the current study was to determine the impacts of vitamin E and aspirin on the uterine artery blood flow in women having recurrent abortions due to impaired uterine blood flow

Materials and Methods: This randomized clinical trial was conducted on 99 women having uterine pulsatility index [PI] more than 2.5 and the history of more than two times abortions. The candidates were categorized into three groups; receiving aspirin, only vitamin E, and aspirin+vitamin E. After 2 months, uterine PIs were compared with each other

Results: All drug regimens caused an enhancement in uterine perfusion with a significant decline in uterine artery PI value. The women receiving vitamin E in accompanied with aspirin had the least mean PI of the uterine artery [p<0.001]. The total average PI score of the right and left uterine arteries in groups receiving vitamin E in accompanied with aspirin was lower than the two counterparts significantly [p<0.001]

Conclusion: Vitamin E, aspirin and especially their combination are effective in improving uterine artery blood flow in women with recurrent abortion due to impaired uterine blood flow. More well-designed studies are needed to find out whether the enhancement of uterine perfusion may lead to a better pregnancy outcome

Cervical length versus vaginal PH in the second trimester as preterm birth predictor

To evaluate diagnostic value of vaginal pH and cervical length measurement in the second trimester of pregnancy as a preterm labor [PTL] predictor. During a prospective cohort study 438 uncomplicated singleton pregnant women between 18 and 24 weeks of gestation were assessed regarding vaginal PH and cervical length. Vaginal pH was measured using Ph-indicator strips and cervical length was determined using transvaginal ultrasound. The cut-off values for vaginal PH and cervical length were defined as 5 and <30 mm respectively. Vaginal pH of 5 and above was found in 162/438 women [37%] while cervical length <30 mm was found in 38/438 [8.7%]. The incidence of PTL < 37 weeks was 87/438 [19.9%] while the incidence of early [PTL <34 weeks] was 51/438 [11.6%]. Predictive value of higher vaginal PH was significantly more [31%] than vaginal PH<5 [13%] in predicting PTL. As a result, alkaline vaginal PH significantly increases the odds of preterm labor [OR=3.06]. Shortened cervical length is better predictor of PTL than higher vaginal PH with positive predictive value of 71% and negative predictive value of 85%. Cervical length less than 30 mm nearly 14-fold increases odds of preterm birth [OR=13.9]. Compared to alkaline vaginal PH, shortened cervical length has better value to predict PTL overall. However, regarding early or late PTL, vaginal PH is more accurate to predict late PTL, while cervical length measurement is more appropriate to predict early PTL [<34 weeks]

Pregnancy rate following luteal phase support in Iranian women with polycystic ovarian syndrome

To assess the efficacy of luteal phase support [LPS] using intravaginal progesterone [P] on pregnancy rate in Iranian women with polycystic ovarian syndrome [PCOS] who used a combination for ovulation induction consisting of letrozole or clomiphene citrate [CC] and human menopausal gonadotropin [HMG]. This was a randomized clinical trial undertaken in a fertility clinic in Kashan, Isfahan Province, Iran. A total of 198 patients completed treatment and follow up. Base on chosen ovulation induction programs, they were divided into two following groups: i. CC group [n=98] used a combination consisting of CC [100 mg x 5 day] and HMG [150 IU x 5 day] and ii. letrozole group [n=100] used a combination consisting of letrozole [5 mg x 5 day] and HMG [150 IU × 5 day]. After human chorionic gonadotropin [hCG] administration [5000 IU], the patients [n=122] who randomly received intravaginal P [Cyclogest, 400 mg daily] were included in LPS group, while the rest [n=123] were included in non-P cycles group. The outcome was the comparison of chemical pregnancy rate between the groups. Our findings showed that LPS was associated with a 10% higher pregnancy rate than in non-P cycles, although this difference did not reach statistical significant [p=0.08]. LPS improved pregnancy rate in both CC [4%] and letrozole [6%] groups. In addition, patients who used letrozole for ovulation induction along with intravaginal P showed higher pregnancy rates than CC group. Administration of vaginal P for LPS may improve the pregnancy rate in women with PCOS using letrozole or CC in combination with HMG for ovulation induction [Registration Number: IRCT201206072967N4]

Sexual functioning among married Iranian women with polycystic ovary syndrome

This study aimed to assess sexual functioning among women with polycystic ovary syndrome [PCOS] in Iran. A cross-sectional study was conducted to ascertain factors related to sexual functioning in 300 PCOS patients attending to the private practice centers in Kashan, Isfahan Province, Iran, from May to October 2012. The Female Sexual Function Index [FSFI] was used to measure sexual functioning. Moreover, the socio-demographic details and clinical information of PCOS including obesity, hirsutism, acne, menstrual cycle disturbances, infertility and endocrine profile were recorded for each patient. Overall the prevalence of female sexual dysfunction [FSD] was 16.6%. In particular patients indicated poorer sexual functioning for the desire [48.3%] and the arousal [44.7%] subscales. Multiple logistic regression analysis suggested patients with lower educational level [OR: 2.94; 95% CI: 1.46-5.92] and irregular menstrual status [OR: 4.61; 95% CI: 1.93-11] were more likely to report sexual dysfunction. The findings suggest that desire and arousal were the most prevalent sexual disorders reported in this patient population. In addition, findings suggested that women with limited or no formal education and a history of menstrual irregularities were the most likely to report female sexual dysfunction. Further investigations are needed to examine female sexual functioning among women with PCOS, to educate their health care providers, and to develop therapeutic interventions

Health-related quality of life and its relationship with clinical symptoms among Iranian patients with polycystic ovarian syndrome

Polycystic ovarian syndrome [PCOS] has been shown to cause a reduction in Health-related quality of life [HRQOL]. This study examines the extent of different clinical symptoms in PCOS patients on HRQOL. A cross-sectional study was undertaken to ascertain the factors related to HRQOL in 200 PCOS patients in Kashan, Iran. Main outcome measures were modified polycystic ovarian syndrome questionnaire [MPCOSQ] and clinical information of PCOS. Major clinical PCOS features including obesity [BMI], excessive body hair [hirsutism score], acne, menstrual cycle disturbances and infertility. Findings showed that the most common HRQOL concern was menstrual irregularities and infertility, followed in descending order by hirsutism, weight, emotion, and acne. Multivariate analysis revealed the menstrual irregularities as a significant predictor of menstruation [p=0.005], emotion [p=0.02] and infertility [p=0.02] subscales of the MPCOSQ. Having of infertility, predicted scores on the infertility subscale [p<0.0001]. Hirsutism score was a significant predictor of hirsutism [p<0.0001] and emotion [p<0.0001] subscales. Weight subscale concerns was predicted by BMI [p<0.0001], also, acne was found to be predicted score of acne subscale [p<0.0001]. Worsened HRQOL in women with PCOS was related to more menstrual irregularities and infertility than to obesity. The finding suggests a potential for poorer compliance with weight management protocols among affected PCOS patients.

Evaluation of female youth educational needs about reproductive health in non-medical students in the city of Qom

To evaluate reproductive health education which is essential to the prevention of sexual risk behavior and its associated adverse outcomes of unwanted pregnancy, AIDS and other sexually transmitted disease in adolescents. Little is known about youth educational needs about reproductive health in Iran. The aim of this study is evaluation of female youth educational needs about reproductive health in non-medical universities in the city of Qom, north central of Iran. The study was descriptive-analytical type conducted in nine non-medical universities [400 students]. A questionnaire was constructed to meet the purpose of the study based on similar studies of knowledge and attitude in different countries, yet it was modified according to Iranian culture and social norms. The findings showed that a majority of participants have moderate knowledge about all components of reproductive health. Approximately, one-third of the participants reported difficulties to discuss about sexual health with mothers. The most of the participants believed insufficient female youth reproductive health services and low knowledge about reproductive health were the main barriers for female youth reproductive health aims. The participants in this study are representatives of an important subgroup in Iran in order to evaluate female youth reproductive health educational needs. The study identified many misconception and negative attitude that need to be addressed. A health education program through parents, peers, mass media campaign and more comprehensive family planning curriculum in universities are recommended to overcome misconception and spread awareness

Iranian version of modified polycystic ovary syndrome health-related quality of Life questionnaire: Discriminant and convergent validity

A preliminary report indicated that the Iranian version of modified polycystic ovary syndrome health-related quality of life questionnaire [MPCOSQ] is a valid measure of health-related quality of life [HRQOL] in PCOS patients. Accordingly, the Iranian version of MPCOSQ was subjected to further psychometric analyses among a different sample of patients with PCOS. To examine discriminant and convergent validity of the Iranian version of MPCOSQ. This was a cross sectional study of 200 women with PCOS that was carried out in two private gynecology clinics in Kashan, Iran. Discriminant validity was assessed using the known groups comparison. Convergent validity was evaluated by assessing the correlation between similar content on the MPCOSQ and the SF-36. The mean scores for the MPCOSQ showed that women rated lowest on the infertility and menstrual subscales indicating worst health in these dimensions. The results from the SF-36 questionnaire indicated that emotional and vitality domains were the areas of poorest health. Known groups comparison showed that the MPCOSQ differentiated well between sub-groups of women who differed in PCOS specific symptoms, lending support to its discriminant validity. Convergent validity was assessed and as expected a good positive correlation was found between related subscales of the two instruments. The MPCOSQ has now been extensively tested in Iran and can be considered for using as an outcome measure in future outcome studies in this population

Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome

Most previous research has focused on polycystic ovary syndrome [PCOS] characteristics and their association with psychological disorders, such as anxiety and depression. In the present study, our aim was to study whether PCOS characteristics are associated with several aspects of psychological well-being namely self-esteem and body satisfaction. This was a cross-sectional study of 300 women with PCOS that was carried out in Kashan, Iran. Main outcome measures were the Body Image Concern Inventory [BICI] and the Rosenberg's Self-Esteem Scale and clinical information of PCOS. Major clinical PCOS features including obesity [BMI], excessive body hair [hirsutism score], acne, menstrual cycle disturbances and infertility. The findings of regression analysis indicated that infertile women had lower levels of self-esteem [beta=-0.11, p=0.049] and poorer body satisfaction [=0.121, p=0.036] compared with PCOS women without infertility. Furthermore, hirsute women experienced poorer self-esteem than women without hirsutism [beta=-0.124, p=0.032]. Women with menstrual irregularities had higher body dissatisfaction [beta=0.159, p=0.005]. Moreover, women with higher body mass index scores had poorer body satisfaction [beta =0.151, p=0.009] but were not associated with self-esteem. The emotional well-being of the patients presenting with the syndrome needs to be recognized more fully, particularly in relation to the low self-esteem, poor body image, and struggles with weight, menstrual irregularities, hirsutism and infertility. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of women with PCOS

Comparison of oral folic acid and folinic acid on blood homocysteine level of patients on hemodialysis

Hyperhomocysteinemia is common in patients with chronic kidney disease. There is a direct relationship between cardiovascular mortality and increase of blood homocysteine. Folic acid is used as common treatment in such patients. Folinic acid, a shortened form of folic acid, is not affected by inhibitors of dihydrofolate reductase enzyme such as methoterxate. This study was performed to evaluate the effect of oral folinic acid on the blood homocysteine level of hemodialysis patients, in comparison with folic acid. This clinical trial was performed on 60 hemodialysis patients. The participants were divided into 2 groups to receive either 15 mg of oral folic acid or 15 mg of oral folinic acid, daily. Blood homocysteine levels were measured before dialysis and after the study period. Folic acid and folinic acid decreased the blood homocysteine levels by 33.0% and 28.7%, respectively [P < .001]. However, only 3 patients [6.5%] enjoyed a normalized homocysteine level. Our study showed that both folic and folinic acid decreased the blood homocysteine level and no meaningful difference was observed between them; therefore, we suggest they can be used interchangeably

Use of letrozole versus clomiphene citrate combined with gonadotropins in patients with clomiphene resistant polycystic ovarian syndrome: a comparative study

To compare the clinical outcomes between letrozole and clomiphene citrate [cc] combined with gonadotropins in Clomiphene - resistant polycystic ovary syndrome [PCOS] patients. One hundred and twenty PCOS women after clomiphene response failure were randomly divided into two equal groups to receive clomiphene [100 mg/day] or letrozole [5mg/ day] on days 3-7 of menstrual cycle, combined with human menopausal gonadotropin at a dose 150 IU on days 5-8. The number of dominant follicles, consumed gonadotropin ampoules, endometrial thickness, and clinical pregnancy rates were compared. No significant difference was found regarding the number of dominant follicles, endometrial thickness and consumed gonadotropin ampoules between letrozole and CC groups. Although, the pregnancy rate in letrozole group was higher than that of the CC, the difference was not significant [36.7% vs. 33.3%, p=0.702]. In clomiphene - resistant PCOS patients, similar to Clomiphene, letrozole in combined regimens with gonadotropin can be effective for the induction of ovulation

Prognostic value of B-type natriuretic peptide for assessment of left ventricular function in patients with chronic kidney disease

Since the level of B-type natriuretic peptide [BNP] increases in heart failure, elevated plasma BNP concentration is used as a predictor in the diagnosis and management of heart failure. Due to the diminished renal clearance of BNP, its level is above normal in kidney failure. This study evaluated the BNP prognostic value for assessing ventricular function in patients with chronic kidney disease. All the participants were diagnosed with chronic kidney disease. Echocardiography was employed to assess ejection fraction. Body mass index, serum creatinine, and BNP were measured for all the patients. Prognostic value of BNP was assessed for ventricular function measured by ejection fraction. Forty-four patients, including 34 men and 10 women, participated in the study. Level of BNP had a significant correlation with body mass index, ejection fraction, age, and gender. The sensitivity and specificity of BNP levels of 150 pg/mL and 705 pg/mL were 93.3% and 28.6% and 50.0% and 85.7%, respectively, for the diagnosis of ventricular dysfunction in the patients with chronic kidney disease. These findings suggest that a level of BNP of 705 pg/mL is a rather acceptable predictive factor for heart failure in patients with chronic kidney disease. The participants' height and weight, which were associated with BNP as body mass index, contributed to this level