Comparison of pre-treatment with OCPs or estradiol valerate vs. no pre-treatment prior to GnRH antagonist used for IVF cycles: an RCT

Background: both oral contraceptive pills [OCPs] and estradiol valerate [E2] have been used to schedule a gonadotropin-releasing hormone antagonist in vitro fertilization [IVF] cycles. Since the suppression of follicle-stimulating hormone by OCPs can stay 5-7 days after stopping the pills, it seems that starting the gonadotropin-releasing hormone [GnRH] after 6 days of pre-treatment discontinuation may be important in IVF outcomes

Objective: the aim of the present study was to determine the number of mature oocyte and pregnancy rate of three pretreatment methods for fresh embryo transfer cycles

Materials and Methods: in this randomized controlled trial, two-hundred ten women [18-35 yr and less than 2 previous IVF attempts] undergoing IVF with the GnRH antagonist protocol were randomized to the OCP, E2, and no pretreatment arms. OCP group [n=53] received OCP [ethinyl estradiol30 micro g and levonorgestrel150 micro g], E2 group [n=63] received 4 mg/day oral E2 [17beta?E2] for 10 days from day 20 of the previous cycle and GnRH antagonist stimulation was started 6 days after the interruption of OCP and E2. The control group [n =70] did not receive any pretreatment

Results: no significant difference was observed in the mean number of the mature oocyte, endometrial thickness, and embryo quality. The pregnancy rate in E2 group was higher than the two other groups [42.9% vs 39.6% and 34.3% in OCP and control group, respectively], but the difference was not statistically significant [p=0.59]

Conclusion: it seems OCP or E2 pretreatment could not improve the fresh IVF-embryo transfer outcomes

Prevalence and Risk Factors of Domestic Violence against Iranian Women: A Cross-Sectional Study / 가정의학회지

BACKGROUND: Violence against women in families is the most common form of violence against them. The purpose of this study was to determine the prevalence of domestic violence and its effects on married women of Ilam. METHODS: In this descriptive-sectional research, 334 married women referred to medical health centers in Ilam were selected to participate using a random sampling method. After obtaining their consent to participate in the study, participants responded to a 46 items questionnaire and responses were analyzed using IBM SPSS for Windows ver. 20.0 (IBM Co., Armonk, NY, USA). RESULTS: The majority of the participants reported experiencing domestic violence and emotional violence was more prevalent than other kinds of violence. Logistic regression analysis showed that lower education level, marriage at a younger age, shorter duration of marriage, fewer children, being a housewife, and husband's unemployment had a significant relationship with domestic violence against women. CONCLUSION: The high prevalence of wife abuse in Ilam especially emotional violence due to lower education levels and marriage at younger age could be a serious threat for women's health as well as for other members of the family. This could be a grounding factor for other social harms such as suicide and this issue must be studied from legal, religious, and cultural standpoints.

Analysis of clonal relationships among shigella spp. isolated from children with shigellosis in ahvaz, iran

Shigellosis is one of the important gastrointestinal bacterial infections, particularly among children of developing countries such as Iran. Antibiotic susceptibility pattern and genetic typing for epidemiological purposes are of significant issues in Shigella infectious control

The aim of this study was to investigate the antibiotic susceptibility and genetic relationship among Shigella strains isolated from children with shigellosis at paediatric hospital in Ahvaz, south west of Iran. This study included all Shigella strains isolated from paediatric patients with diarrhea admitted to Abuzar pediatric hospitals in Ahvaz, during January-June 2015. Shigella isolates were identified using standard microbiological and serological methods. Shigella spp strains also were studied by antimicrobial susceptibility testing and Enterobacterial Repetitive Intergenic Consensus [ERIC] - PCR analysis. Total of 50 Shigella strains were isolated from children with dysentery diarrhea. In total, 31 [62%] were identified as Shigella flexneri, 16[32%] and 3 [6%] were Shigella sonnei and Shigella boydii respectively. High level resistance were detected against ampicillin, trimethoprim-sulfamethoxazole and cephalotine. All isolates were sensitive to ceftriaxone, imipenem gentamicin and amikacin

The results of ERIC-PCR data analysis showed 11 different types of Shigella with four closely-related patterns. S. flexneri was the predominant serogroup of Shigella spp. in children in the referral pediatric hospital in Ahvaz

Ampicillin and trimethoprim-sulfamethoxazole is no longer recommended for shigellosis empirical treatment and should be replaced by other antibiotics such as ceftriaxone or ciprofloxcacin. Diverse but genetically close strains of shigella were responsible for shigellosis in paediatric patients in Ahvaz, south west of Iran?

comparative study of the impact of antenatal training care infants to fathers and couple on the fathers' participations after birth

Increasing number of working mothers and changes in viewpoints on fathers' roles in families has increased fathers' participations. Fathers' participation is his broad, positive and active participation in different stages of children's life. Women possess the main role in enhancing and limiting father's participation. Fathers and couples require training to define father's role in infant care and the significance of his role in infant's health and foundation of family. Therefore, the present study is done to determine the impact of training couples and fathers how to take care of infants on the rate of father's participation to take care of infants after birth. The study was done as a clinical trial in three groups, on 150 people who refered to health clinical centers of Medical University of Mashhad. Fathers of training group and couples of training group took part in two training sessions of infant care in weeks 35 to 37 of pregnancy. The questionnaires of role of father's training in infant care were filled by mothers in three groups and were analyzed by SPSS18 software and ANOVA with repeated measure, Bonferroni tests. Role of fathers' participation in infants care in father's training group and couple training group than control group increased significantly [P=0.003]. Training fathers and couples before birth will enhance rate of their participation in infant care

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

GnRH antagonist versus agonist in normoresponders undergoing ICSI: a randomized clinical trial in Iran

General concern is that the pregnancy rate is higher with GnRH-agonist as a protocol of pituitary suppression. GnRH-antagonist protocol provides a shorter period of administration and an easy flexible protocol. In this study, the outcomes of GnRH agonist and antagonist in ICSI cycles are compared in normo responder patients. In this randomized clinical trial, 300 normoresponders undergoing ICSI were randomly divided to GnRh agonist [n=150] and GnRh antagonist [n=150] groups. The main outcome measurements were chemical, clinical and ongoing pregnancy rates [PR]. The mean duration of stimulation were 9.6 +/- 1.6 and 8.2 +/- 1.6 days in agonist and antagonist groups respectively [p=0.001]. The mean number of MII oocyte retrieved in agonist and antagonist groups were 7.7 +/- 4.0 and 6.9 +/- 4.3 respectively [p=0.03]. There was no significant difference between two groups regarding mean number of gonadotrophin ampoules, follicles, occytes, total embryos and good quality embryos, OHSS incidence, and abortion rate. Chemical pregnancy rate was 35.3% in agonist and 39.3% in antagonist group. Clinical pregnancy rate was 35.3% in agonist and 34% in antagonist group. Ongoing pregnancy rate was 45 [31.3%] in agonist and 44 [29.3%] in antagonist group. There was no significant difference between two groups in pregnancy rates. In this study antagonist protocol was shown to be an easy, safe and friendly protocol in Iranian normoresponder patients, having similar outcomes with standard agonist protocol but shorter period of stimulation

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

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