Pregnancy outcome in delayed start antagonist versus microdose flare GnRH agonist protocol in poor responders undergoing IVF/ICSI: an RCT

Background: Over the years, many article on different aspects of pathogenesis and management of poor ovarian responders have been published but there is no clear guideline for treating themyet

Objective: This study was designated to compare the effectiveness of a delayed start protocol with gonadotropin-releasing hormone [GnRH] antagonist and microdose flare-up GnRH agonist protocol in poor ovarian responders

Materials and Methods: This randomized clinical trial consisted of 100 poor ovarian responder women in assisted reproductive technologies cycles. They were divided randomly in delayed-start antagonist protocol [with estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation] and microdose flare-up GnRH agonist protocol. The main outcome was clinical pregnancy rate and second outcome was the number of retrieved oocytes, mature oocytes, 2PN number, fertilization rate, and implantation rate

Results: Fertilization rate, clinical pregnancy rate, and ongoing pregnancy rates were not significantly different between the two studied protocols. Number of retrieved oocytes [5.10+/-3.41 vs. 3.08+/-2.51] with p=0.002, mature oocytes [4.32+/-2.69 vs. 2.34+/-1.80] with p=0.003, number of 2PN [3.94+/-1.80 vs. 2.20+/-1.01] with p=0.001 and implantation rate [19.40% vs. 10.30%] with p=0.022 were significantly higher in delayed antagonist group

Conclusion: The delayed-start protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle development

effect of 24 hours delay in oocyte maturation triggering in IVF/ICSI cycles with antagonist protocol and not-elevated progesterone: a randomized control trial

Background: The best time of final oocyte maturation triggering in assisted reproduction technology protocols is unknown. This time always estimated by combined follicular size and blood progesterone level

Objective: The aim of this study was evaluation of the effect of delaying oocyte maturation triggering by 24 hr on the number of mature oocytes [MII] and other in vitro fertilization cycle characteristics in antagonist protocols with not-elevated progesterone [p

Materials and Methods: All patients' candidate for assisted reproduction technology underwent controlled ovarian hyperstimulation by antagonist protocol. When at least 3 follicles with >/=18 mm diameters were seen by vaginal ultrasonography; blood progesterone level was measured. The patients who had progesterone level

Results: Number of retrieved oocytes, mature oocytes [MII], fertilized oocytes [2PN], embryos formation, number of transferred embryos and embryos quality has not significant differences between two groups. Also, fertilization and implantation rate, chemical and clinical pregnancy did not differ between groups

Conclusion: Delaying of triggering oocyte maturation by 24 hr in antagonist protocol with not-elevated progesterone [progesterone

Efficacy of Intrauterine infusion of granulocyte colony stimulating factor on patients with history of implantation failure: a randomized control trial

Background: Although pregnancy rate in in vitro fertilization-embryo transfer [IVF-ET] cycles has been increased over the preceding years, but the majority of IVF-ET cycles still fail. Granulocyte colony stimulating factor [GCSF] is a glycoprotein that stimulates cytokine growth factor and induces immune system which may improve pregnancy rate in women with history of implantation failure

Objective; The aim of this study was to evaluate GCSF ability to improve pregnancy rate in women with history of implantation failure

Materials and Methods: 0.5 ml [300 microg/ml[ GCSF was infused intrauterine in intervention group. Pregnancy outcomes were assessed based on clinical pregnancy

Results: The mean age of participants was 31.9S+/-4.71 years old. There were no significant differences between demographic characteristics in two groups [p>0.05]. The pregnancy outcome in GCSF group was improved significantly [p=0.043]

Conclusion: GCSF can improve pregnancy outcome in patients with history of implantation failure

Therapeutic effect of vitex agnus castus in patients with premenstrual syndrome

Medical therapies have been widely used for premenstrual syndrome [PMS], but in all of them side effects are predominant. Herbal remedies rarely have side effects and people have more tendencies toward them than chemical therapies. In this study the therapeutic effect of Vitex agnus castus on women who had the PMS, in comparison with placebo, were investigated. In this randomized, placebo-controlled, double-blind study, from134 selected patients 128 women suffered from PMS were evaluated [active 62, placebo 66]. All patients answered to a self assessment questionnaire about their headache, anger, irritability, depression, breast fullness and bloating and tympani during the premenstrual period before the study. Forty drops of Vitex agnus extract or matching placebo, administrated for 6 days before menses for 6 consecutive cycles. Patients answered the self-assessment questionnaires after 6 menstrual cycles, again. Each item rated using a visual analogue scale [VAS]. The mean age was 30.77 [SD=4.37] years in the active group and 30.89 [SD=4.02] years in the placebo group. Rank of variables had significantly difference in active and placebo group before and after the study [P<0.0001] also we noticed significant differences on the use of Vitex agnus in comparison with placebo [P<0.0001]. Vitex agnus can be considered as an effective and well tolerated treatment for the relief of symptoms of mild and moderate PMS

Primary bilateral intrapelvic hydatid cyst presenting with adnexal cystic mass: a case report

Hydatid disease, caused by Echinococcusgranulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur with the rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis. But primary hydatid cyst in the pelvis is rare. We report a case of bilateral hydatid cyst of the pelvis in a 53years old woman presented with adnexal cystic mass

Hydrosalpinx with adnexal torsion in a virgin patient

We present a case of 28-years-old female, presenting with acute right lower abdominal pain. She wasn't sexually active and in the absence of infection and hormonal treatment, with right side adnexal torsion due to hydrosalpinx

Is reducing ovarian volume in polycystic ovarian syndrome patients after administration of metformin associated with improving cardiovascular risk factors?

Women with polycystic ovary syndrome [PCOS] are at increased risk for cardiovascular [CV] and metabolic disorders. There is a close relationship between elevated androgen plasma levels and the ultrasound findings of stromal hypertrophy. In randomized trials, the administration of metformin has been shown to be followed by an improvement in insulin sensitivity and decrease in androgen levels in most women. In the present study, we investigate the association between reduced ovarian volume in PCOS patients after administration of metformin with improvement in CV risk factors. This was a randomized clinical trial study. A total of 28 women diagnosed with PCOS who referred to the infertility clinic were selected. Anthropometric characteristics of the patients, mean ovarian volume and plasma levels of fasting blood sugar [FBS], lipid profile, luteinizing hormone [LH], follicle stimulating hormone [FSH], estradiol, testosterone, 17-alpha-OH progesterone [17OHP], dehydroepiandrosterone sulfate [DHEAS], C-reactive protein [CRP] and homocysteine [Hcy] were evaluated before and after treatment with 500 mg metformin, three times daily for three months. Statistics were calculated with the aid of SPSS 16.0 with student's paired t-and Pearson's correlation coefficient tests. Significance was set at p<0.05. There were significant reductions in mean ovarian volume and body mass index [BMI], in addition to CRP, Hcy, testosterone, FBS, HDL and LDL levels. There was a positive correlation between mean ovarian volume and waist-to-hip ratio [WHR]. After treatment, there correlation noted with reduction in mean ovarian volume and decreased BMI, in addition to reductions in CRP, LDL, Hcy and testosterone levels. A positive correlation may exist between reduced mean ovarian volume and improvement in CV risk factors after administration of metformin [Registeration Number: IRCT138903244176N1]

Umbilical endometriosis associated with umbilical hernia

Abdominal wall endometriosis is defined as endometrial tissue superficial to the peritoneum. Cutaneous endometriosis is a well known but rare phenomenon. We present a case of spontaneous umbilical endometriosis

Metformin therapy decreases hyperandrogenism and ovarian volume in women with polycystic ovary syndrome

It is well known that there is a close relationship between elevated androgen plasma levels and the ultrasound findings of stromal hypertrophy in polycystic ovary syndrome [PCOS]. The objective of this study was to investigate the effects metformin on the hyperandrogenism and ovarian volume in PCOS. The study is an unrandomized clinical trial with before-after design. Twenty eight patients with infertility [male or female factor] meeting the Rotterdam ESHRE/ASRM criteria for PCOS were studied during the 2008-2009. The anthropometric characteristics of the patients, mean bilateral ovarian volume, and morphology by trans vaginal sonography as well as the plasma levels of leutinizing hormone, follicle stimulating hormone, estradiol, testosterone, 17- alpha -hydroxyprogesterone, and dehydroepianderosterone sulfate were obtained before and after treatment with metformin [500 mg three times a day] for three months. Paired t, Pearson's Correlation Coefficient, or Partial Correlation test was used to analyze the findings. The patients had a mean age of 25.67 years. A significant reduction in mean ovarian volume [11.70 +/- 4.31 ml vs 8.27 +/- 3.71 ml P=0.001], body mass index [BMI, 28.11 +/- 4.55 kg/m[2] vs 26.84 +/- 4.55 kg/m[2] P=0.000] and serum androgen levels was seen after three months of treatment with metformin. There was positive correlations between the ovarian volume and serum testosterone level [r=0.589, P=0.001] or BMI [r=0.663, P=0.000]. Metformin therapy may lead to a reduction in ovarian volume. It is likely that the reduction of ovarian volume reflect a decrease in the mass of androgen producing tissues

Effect of low-dose folic acid supplementation versus HRT and combination of folic acid and HRT on plasma level of homocysteine in postmenopausal women

This study was designed to evaluate the effect of hormone replacement therapy [HRT] and folic acid supplementation on Homocysteine [Hcy] level in postmenopausal women. This is a randomized clinical trial conducted on 66 postmenopausal women [menopause at least for 2 years] attending Hamedan outpatient Fatemieh teaching hospital. Since March 2006 till April 2007. The patients were randomly divided into four groups. Before studying plasma level of Albumin, total protein, folate, fasting level of plasma Hcy was measured. The patients of first group received folic acid 5mg daily. In the second group of patients took oral conjugated estrogen 0/625mg and medroxy progesterone acetate 2/5 mg daily. In third group the patients received combination of folic acid and HRT and placebo in fourth group. Fasting plasma level of Hcy was measured four weeks later. Plasma level of Hcy was significantly decreased in group1, 2 and 3 [P<0/05] after treatment. There was significant difference between group 1, 3 [p=0/026] and 1, 4 [P=0/005] for plasma level of Hcy. HRT and folic acid therapy can reduce plasma Hcy. Combination of both HRT and folic acid supplementation is more effective than HRT or folic acid alone in reduction of hyperhomocysteinemia