Trans dermal estrogen [oestrogel] for endometrial preparation in freeze embryo transfer cycle: an RCT

Background: Estrogen and progesterone are two crucial factors for endometrial preparation in frozen embryo transfer [FET] cycles. Studies assessing different forms of estradiol in FET have published already but literature lacks enough surveys on transdermal estrogen application in reproductive medicine

Objective: To investigate the effects of trans dermal estrogen [Oestrogel] on pregnancy rates in patients that candidate for FET cycle

Materials and Methods: In this randomized clinical trial, 100 women undergoing FET cycles referred to Imam Khomeeini Hospital were enrolled in two groups, randomly. Group I received 8 mg/day estradiol valerate [E2 tablet] orally and group II were treated with 6 mg/day transdermal oestrogel gel after suppression with gonadotropin releasing hormone agonist. In both groups medication were started in the first day of menstruation cycle and continued until endometrial thickness reached 8 mm. Pregnancy rates [chemical, clinical, and ongoing], abortion rate, live birth rate, and frequency of complications were compared between two groups

Results: Chemical and clinical pregnancy rates were not significantly different between two groups [p=0.384]. The abortion rate was significantly lower in group II than group I [p=0.035]. Ongoing pregnancy and the live birth rates were significantly higher in group II [p=0.035]. The rate of complication was not different in two groups

Conclusion: Oestrogel seems to enhance ongoing pregnancy and live birth rates in comparison to estradiol valerate tablet

Morphological, ultrastructural, and molecular aspects of in vitro mouse embryo implantation on human endometrial mesenchymal stromal cells in the presence of steroid hormones as an implantation model

Objective: This experimental study aimed to evaluate the effects of 17beta-estradiol [E2] and progesterone [P4] on the interaction between mouse embryo and human endometrial mesenchymal stromal cells, and gene expressions related to implantation [alphaV and beta3 integrins, interleukin-1 receptor [IL-1R], and leukemia inhibitory factor receptor [LIFR]] using an in vitro twodimensional model

Materials and Methods: In this experimental study, the endometrial stromal cells were isolated enzymatically and mechanically, and cultured to the fourth passage. Next, their immunophenotype was confirmed by flow cytometric analysis as mesenchymal stromal cells. The cells were cultured as either the experimental group in the presence of E2 [0.3 nmol] and P4 [63.5 nmol] or control group without any hormone treatment. Mouse blastocysts were co-cultured with endometrial mesenchymal stromal cells in both groups for 48 hours. Their interaction was assessed under an inverted microscope and scanning electron microscopy [SEM]. Expressions of alphaV and beta3 integrins, LIFR, and IL-1R genes were analyzed by real-time reverse transcription-polymerase chain reaction [RT-PCR]

Results: Similar observations were seen in both groups by light microscopy and SEM. We observed the presence of pinopode-like structures and cell secretions on the apical surfaces of endometrial mesenchymal stromal cells in both groups. The trophoblastic cells expanded and interacted with the mesenchymal monolayer cells. At the molecular level, expression of IL-1R significantly increased in the hormonal treated group compared to the control [P

Conclusion: This study has shown that co-culture of endometrial mesenchymal stromal cells with mouse embryo in media that contained E2 [0.3 nmol] and P4 [63.5 nmol] could effectively increase the expression of IL-1R, which is involved in embryo implantation. However, there were no significant effects on expressions of alphaV and beta3 integrins, LIFR, and on the morphology and ultrastructure of endometrial mesenchymal stromal cells

Short term culture of vitrified human ovarian cortical tissue to assess the cryopreservation outcome: molecular and morphological analysis

Background: The aim of the present study was to evaluate the effectiveness of human ovarian vitrification protocol followed with in vitro culture at the morphological and molecular levels

Methods: Ovarian tissues were obtained from 10 normal transsexual women and cut into small pieces and were divided into non-vitrified and vitrified groups and some of the tissues fragments in both groups were randomly cultured for two weeks. The morphological study using hematoxylin and eosin and Masson's trichrome staining was done. The analysis of mean follicular density, 17-beta estradiol [E2] and anti mullerian hormone [AMH], and real-time RT-PCR was down for the evaluation of expression of genes related to folliculogenesis. Data were compared by paired-samples and independent-samples T test. Values of p<0.05 were considered statistically significant

Results: The proportion of normal follicles did not show significant difference between vitrified and non-vitrified groups before and after culture but these rates and the mean follicle density significantly decreased in both cultured tissues [p<0.05]. The expression of genes was similar in vitrified and non-vitrified groups but in cultured tissues the expression of GDF9 and FSHR genes increased and the expression of FIGLA and KIT-L genes decreased [p<0.05]. An increase in E2 and AMH concentration was observed after 14 days of culture in both groups

Conclusion: In conclusion, the present study indicated that the follicular development and gene expression in vitrified ovarian tissue was not altered before and after in vitro culture, thus this method could be useful for fertility preservation; however, additional studies are needed to improve the culture condition

Evaluation of two endometriosis models by transplantation of human endometrial tissue fragments and human endometrial mesenchymal cells

Background: The animal models of endometriosis could be a valuable alternative tool for clarifying the etiology of endometriosis

Objective: In this study two endometriosis models at the morphological and molecular levels was evaluated and compared

Materials and Methods: The human endometrial tissues were cut into small fragments then they were randomly considered for transplantation into gamma irradiated mice as model A; or they were isolated and cultured up to fourth passages. 2×106 cultured stromal cells were transplanted into ? irradiated mice subcutaneously as model B. twenty days later the ectopic tissues in both models were studied morphologically by Periodic acid-Schiff and hematoxylin and eosin staining. The expression of osteopontin [OPN] and matrix metalloproteinase 2 [MMP2] genes were also assessed using real time RT-PCR. 17-beta estradiol levels of mice sera were compared before and after transplantation

Results: The endometrial like glands and stromal cells were formed in the implanted subcutaneous tissue of both endometriosis models. The gland sections per cubic millimeter, the expression of OPN and MMP2 genes and the level of 17-beta estradiol were higher in model B than model A [p=0.03]

Conclusion: Our observation demonstrated that endometrial mesenchymal stromal cells showed more efficiency to establish endometriosis model than human endometrial tissue fragments

Effect of human ovarian tissue vitrification/warming on the expression of genes related to folliculogenesis

Ovarian tissue cryopreservation is an alternative strategy to preserve the fertility of women predicted to undergo premature ovarian failure. This study was designed to evaluate the expression of folliculogenesis-related genes, including factor in the germline alpha [FIGLA], growth differentiation factor-9 [GDF-9], follicle-stimulating hormone receptor [FSHR], and KIT LIGAND after vitrification/warming of human ovarian tissue. Human ovarian tissue samples were collected from five transsexual women. In the laboratory, the ovarian medullary part was removed by a surgical blade, and the cortical tissue was cut into small pieces. Some pieces were vitrified and warmed and the others were considered as non-vitrified group [control]. Follicular normality was assessed with morphological observation by a light microscope, and the expression of FIGLA, KIT LIGAND, GDF- 9, and FSHR genes was examined using real-time RT-PCR in both the vitrified and non-vitrified groups. Overall, 85% of the follicles preserved their normal morphologic feature after warming. The percentage of normal follicles and the expression of FIGLA, KIT LIGAND, GDF-9, and FSHR genes were similar in both vitrified and non-vitrified groups [P > 0.05]. Vitrification/warming of human ovarian tissue had no remarkable effect on the expression of folliculogenesis-related genes

[ comparison of two mouse endometriosis models using endometrial tissue fragments and endometrial isolated cells]

Objective: Endometriosis is a common disease in which the endometrial stroma and glands grow abnormally outside the uterine cavity. The establishment of animal models can be effective for determining the etiology of endometriosis. In this study we compare two endometriosis models using endometrial fragments and isolated cultured endometrial cells

Methods: We obtained endometrial tissues that were in the proliferative or secretory phases from women who underwent hysteroscopies for benign reasons at Imam Khomeini Hospital [Tehran]. Following confirmation of the tissue's normality, we cut the tissues into 2 mm cube pieces. The remainder of endometrial tissues were used for isolation and cultured to the fourth passage. In the first model of endometriosis, the endometrial tissue fragments and in the second model, 2×106 isolated endometrial cells were subcutaneously transplanted into gamma irradiated mice. The mice were kept under controlled, sterile conditions for 20 days. The mice sera were collected before and after transplantation for assessment of 17beta estradiol. The ectopic tissues in both models were assessed for morphological staining using hematoxylin and eosin, as well as periodic acid Schiff [PAS] for gland secretion. The gland sections per mm2 were analyzed

Results: At 20 days after tissue transplantation, we observed endometrial-like glands in the subcutaneous tissue of both endometriosis models. The number of gland sections was 57.55 +/- 17.18/mm2 for the first model and 271.57 +/- 77.98/mm2 for the second model. This result was significantly higher in the second model when compared to the first model. Gland secretion was positive for PAS. The level of 17beta estradiol was higher in both models compared to the control group. This level was significantly higher in the second model compared to the first [P

Conclusion: The endometriosis model that used cultured endometrial cells showed more efficiency in morphology, gland formation and level of17beta estradiol

[ comparison of the effect of vitrification on the morphology of stimulated and non-stimulated human ovaries]

Objective: This study aimed to evaluate the effect of vitrification on the morphology of human ovarian tissue in a stimulated group compared to a non-stimulated group

Methods: Ovarian cortex biopsies collected from stimulated and non-stimulated groups were transported to the laboratory in L-15 medium. Biopsies were cut into small pieces and divided randomly into the vitrified and non-vitrified subgroups. The vitrified-warmed and fresh samples were fixed using Bouin's solution, then passaged, sectioned and stained with hematoxylin and eosin and Masson's trichrome. The follicles at different developmental stages were counted and evaluated

Results: Morphological observations showed that the follicles and stromal tissue had well preserved normal structures after vitrification and warming. The percentage of normal follicles in the non-stimulated non-vitrified group was 89.22%; for the non-stimulated vitrified group, it was 84.60%. In previous groups the proportion of primordial follicles were 68.7 +/- 1.60% and 67.80 +/- 3.71%, primary follicles were 28.60 +/- 1.72% and 29.40 +/- 3.51%, and secondary follicles were 3.60 +/- 0.66% and 2.70 +/- 1.20%, respectively. The percentage of normal follicles in the stimulated non-vitrified group was 88.18%; for the stimulated vitrified group, it was 84.19%. In stimulated non-vitrified and stimulated vitrified groups the proportion of primordial follicles were 49.70 +/- 4.13% and 49.34 +/- 2.86%, primary follicles were 44.50 +/- 3.83% and 44.72 +/- 2.68%, and secondary follicles were 5.60 +/- 0.72% and 5.91 +/- 0.77%, respectively. There was no significant difference between the vitrified and non-vitrified and stimulated and non-stimulated groups

Conclusion: Vitrification had no harmful effect on the morphology of stimulated human ovarian tissue and stroma and ovarain tissue structure was similar to the non-stimulated group. This method could be a good alternative for fertility preservation

Evaluation of association between labor dystocia and birth spacing in Iranian women

In view of the effect of hard labor on pregnancy outcomes and to determine risk factors, in this study, the effect of spacing between pregnancies was evaluated for probable effect on the incidence of dystocia in labor. This is a cross - sectional study used the records of 210 pregnant women referred to Azad University hospitals between January 2000 and December 2012. Dystocia was diagnosed according to ICD-9-CM. Data were analyzed using statistical software Spss[17]. It was found that in pregnancies with 2-4 years spacing between births normal delivery was more prevalent while in the group with 8-10 years spacing labor dystocia was more prevalent. Based on the findings of this study the interval between pregnancies has a significant effect on labor dystocia. Increasing the spacing between pregnancies more than 8 years is a risk factor for dystocia

randomized controlled trial of foley catheter, extra-amniotic saline infusion and prostaglandin E2 suppository for labor induction

The aim of this study is to further compare the efficacy of PGE2 suppository, the intracervical foley catheter and extra-amniotic saline infusion in nulliparous women referred for labor induction. Totally 368 nulliparous women with a Bishop score

Maternal and perinatal outcomes in pregnant women with first trimester vaginal bleeding

To study the pregnancy outcomes in first trimester vaginal bleeding. This cross sectional study was done on 60 pregnant women with first trimester vaginal bleeding referring to university hospitals affiliated to Islamic Azad University, Tehran, Iran. All women were evaluated for the outcomes including abortion, preterm rapture of membranes, preterm labor, second and third trimester vaginal bleeding, low birth weight and intra uterine growth retardation and the mode of delivery. Data were analyzed using SPSS-11. Placenta accreta, second trimester bleeding and preterm labor were significantly more prevalent in pregnant women with first trimester bleeding [P

Psychological distress in women with polycystic ovary syndrome from Imam Khomeini Hospital, Tehran

Polycystic ovary syndrome [PCOS] is a complex, multifaceted, het-erogeneous disorder, affecting 4%?18% of reproductive-aged women and it is asso-ciated with reproductive, metabolic and psychological dysfunctions. PCOS affects quality of life and can worsen anxiety and depression either due to the features of PCOS or due to the diagnosis of a chronic disease. In this descriptive-analytical study, 81 patients with PCOS were recruited from Vali-e-Asr Reproductive Health Research Center. A questionnaire with items related to pieces of information about stress was used for data collection. Stress symptoms were assessed using the Understanding Yourself questionnaire. Statistical analyses were performed using SPSS Ver. 13.0 [SPSS Inc., Chicago, ILL, USA]. The data are presented as mean +/- SD or as frequency with percentages. A p-value less than 0.05 was considered as statistically significant. The descriptive results showed that 8 [9.9%] participants did not have any signs of stress, 32 [39.5%] had neurotic stress, 29 [35.8%] had high and 12 [14.8%] had extremely high levels of stress. The odds of high levels of anxiety in women with hirsutism was 3.1 [95% CI, 1.00?9.59]. The odds of high levels of obsession in overweight patients was 3.2 [95% CI, 1.12?9.234]. The odds of high levels of worries in patients with touchy personality was 3.4 [95% CI, 1.10?11.19] obsession score. The present study showed that clinical signs of PCOS were most close-ly associated with psychological distress which has important implications in the diagnosis and treatment of disorders

Relation between fluoxetine and menstrual cycle disorders

To investigate the effect of fluoxetine as an SSRI on menstrual disorders. In this cross-sectional study 200 women referring to the Islamic Azad University affiliated hospitals during March 2011- March 2010 were divided into 4 groups. All included patients in this study had the chief complaint of mood disorders in peri- menstrual period. All patients received daily vitamin B6 tablets as primitive treatment. In groups A, B and C patients also received daily doses of 10 mg, 20 mg and 40 mg of fluoxetine respectively for 6 months and in group D as the control group fluoxetine was not given. Data were analyzed by spss18 statistical software. Significant difference was set at p<0.05. In the groups receiving fluoxetine [groups A - C] 34 patients and in control group 5 patients showed irregular menstruation started during fluoxetine administration and following 3 months. Significant difference with p<0.05 was found regarding the incidence of menstrual irregularity between groups with and without fluoxetine prescription. Fluoxetine consumption leads to increased incidence of menstrual irregularity compared to the control group. The incidence increases with increasing dosage of the drug

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

Biological side effects and reproductive hazards in laboratories of plasma physics and nuclear fusion research school of Iran

Reporting some biological side effects with special attention to reproductive points which were seen after different experiments in laboratories of the Plasma Physics and Nuclear Fusion in atomic energy organization of Iran. Dosimeter analysis and interpretation of biological side effects of research studies in nuclear fusion laboratories. In the last 3 decades, neglecting the principles of the radiation protection has been confirmed in laboratories of the plasma physics and nuclear fusion research school of Iran, especially on DAMAVAND and ALVAND Tokamaks and DENA Plasma Focus. Also a series of biological side effects such as alopecia and thyroid function disorders, oligospermia and stomach cancer have been seen in personnel working in related laboratories. As in our laboratories transportation of the peripheral components such to further distances from the main devices seems not to be cost effective. The level of the absorbed dose of the personnel must be decreased in other ways such as: lowering the number of attended shots for each person and proper shielding

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