Causes of infertility in view of Iranian traditional medicine: a review

Infertility is one of the most important reproductive health concerns in the conventional medicine. Iranian traditional medicine presents different viewpoints in this regard which they could be of benefit and a good guide for the society of medicine. This study sought to provide the comprehensive investigation on the causes of infertility according to Iranian traditional medicine for understanding of old sages' ideas and categorizing of the causes of infertility. In this narrative review, we searched causes of infertility in traditional medicine books and available articles in this field. Iranian traditional physicians have investigated the causes of infertility in couples and attributed them to male and female causes. They have divided the main causes of infertility in both sexes into structural and functional abnormalities, that both traditional medicine and conventional medicine have a lot of participations, but the traditional medicine believes holistic approach in the treatment of diseases and the involvement of all parts of the body particularly specialty board members [heart, liver, brain, ovary, and testicles] in the proper conduct activities in different parts of the body such as reproduction system. There is also special attention to temperament Mizaj disorders. Given the numerous commonalities existing between traditional and conventional medicine in categorizing the causes of infertility, Iranian traditional medicine methods can be applied as a complementary solution in infertility. It could be also subject to further research and investigation due to its opposition to modern medicine in some regards

Effect of laparoscopic ovarian drilling on outcomes of in vitro fertilization in clomiphene-resistant women with polycystic ovary syndrome

Background: Recently the laparoscopic ovarian drilling [LOD] has been used as a surgical treatment for ovulation in women with polycystic ovarian syndrome [PCOS], although its mechanism and outcomes are still unclear. This study was undertaken to evaluate the in vitro fertilization [IVF]/intracytoplasmic sperm injection [ICSI] outcomes in clomiphene-resistant women with PCOS who were treated with LOD

Materials and Methods: In this retrospective study, we reviewed the medical records of 300 women between 20 to 35 years old with clomiphene-resistant PCOS who had an ovulatory infertility and who were nominated for IVF/ICSI. Based on their treatment history, they were located into the following two groups: group I [n=150] including PCOS women who had history of LOD at least 6 months to 3 years before IVF/ICSI, and group II [n=150] including PCOS patients without history of drilling. Both groups were treated with antagonist protocol in the assisted reproductive technology [ART] process. The duration of treatment cycles, number of oocytes and embryos obtained, chemical and clinical pregnancy rate, the number of embryos transferred, and presence of ovarian hyper stimulation syndrome [OHSS] were measured. To compare means and frequencies, Student's t test, Mann-whitney and chi-square tests were used

Results: Our results showed that ovarian cauterization before IVF/ICSI in patients with PCOS reduced the risk of OHSS [P=0.025]. Despite the same pregnancy rate in both groups [P=0.604], more obtained oocytes and embryos were seen on women without ovarian drilling than women with LOD [P<0.001 and P=0.033, respectively]

Conclusion: There is no difference between the pregnancy rate in both groups. Due to significant reduction in OHSS in women undergoing LOD, this surgical treatment may be considered as a useful technique in the management of patients who have previously developed OHSS. However, there are ongoing concerns about long-term effects of LOD on ovarian function

Prevalence of primary open angle glaucoma in obstructive sleep apnea syndrome

Obstructive sleep apnea [OSA] is partial or complete recurrent upper airway obstructions during sleep. Reduction in blood flow of the optic nerve head is an important causative factor in glaucoma. The objective of this study is to determine the prevalence of primary open angle glaucoma [POAG] in OSA patients. From September 2009 to January 2010 in this descriptive-analytic cross sectional study, 90 cases of patients with OSA referred to Yazd Shahid Sadoughi hospital were collected and studied by polysomnography, blood gas analysis and ocular examination including measurement of intra ocular pressure, gonioscopy, fondoscopy and automated perimetry. Statistical analysis was performed by SPSS software. Thirty-one patients had mild OSA, 30 patients had moderate OSA and 29 patients had severe OSA. The prevalence of POAG in this group of patients was 10% [95% CI: 4-16]. It is higher than the general population in the same age group [p=0.017]. There was no significant correlation between the presence of glaucoma and apnea hypopnea index [AHI], mean saturation arterial O[2] [MSaO[2]], body mass index [BMI], sex and age. A significant correlation between AHI with IOP and cup/disc ratio was not documented. According to our founding, the prevalence of POAG in OSA patients was higher than the general population in the same age group. Thus we recommend screening of glaucoma in OSA patients. This Study suggests that AHI, MSaO[2], BMI, sex or age are not important risk factors for glaucoma in OSA patients

Microdose GnRH agonist flare-up versus ultrashort GnRH agonist combined with fixed GnRH antagonist in poor responders of assisted reproductive techniques cycles

This study compares the microdose flare-up protocol to the ultrashort gonadotropinreleasing hormone [GnRH] agonist flare combined with the fixed multidose GnRH antagonist protocol in poor responders undergoing ovarian stimulation. In this randomized clinical trial, 120 women who were candidates for assisted reproductive techniques [ART] and had histories of one or more failed in vitro fertilization [IVF] cycles with three or fewer retrieved oocytes were prospectively randomized into two groups. Group I [60 patients] received the microdose flare-up regimen and group II [60 patients] received the ultrashort GnRH agonist combined with fixed GnRH antagonist. There were no significant differences between the groups in the number of used gonadotropin ampoules [p=0.591], duration of stimulation [p=0.610], number of retrieved oocytes [p=0.802], fertilization rate [p=0.456], and the number of transferred embryos [p=0.954]. The clinical pregnancy rates were statistically similar in group I [10%] compared with group II [13.3%, p=0.389]. According to our results, there is no significant difference between these protocols for improving the ART outcome in poor responders. Additional prospective, randomized studies with more patients is necessary to determine the best protocol [Registration Number: IRCT201105096420N1]

Effect of calcium ionophore on unfertilized oocytes after ICSI cycles

Fertilization failure is one of the most problems in assisted reproduction technology [ART]. The aim of this study was the evaluation of oocytes activation by addition of calcium ionophore in unfertilized oocytes in ICSI cycles. This study was done on 15 ICSI cycles [stimulated with standard long protocol]. Mature retrieved oocytes with normal morphology that had no evidence of fertilization 24 hours after ICSI were included in the study. The oocytes with fertilization and unfertilized oocytes with degeneration were excluded from the study. The unfertilized oocytes were washed with GIVF medium and were transferred to GIVF medium that contained 5 micro mol of calcium ionophore and were incubated for 10 minutes. Then again oocytes were washed with GIVF medium and consequently were transferred to GIVF medium and were incubated at 37°C in 6% CO[2]. After 18 hours, the oocytes were examined and activated oocytes were defined with observation of at least one pronucleus or cleaved oocytes. After ovarian stimulation and oocytes retrieval, 175 mature oocytes were obtained and injection of sperm was done for all of them. 114 of 175 oocytes [66%] showed evidence of fertilization after 24 hours. A total of 61 oocytes [34%] showed no evidence of fertilization and 10 oocytes were degenerated and were excluded from the study. Only 51 unfertilized oocytes with normal morphology were selected and were exposed to calcium ionophore. 37 [72.5%] of treated oocytes were fertilized [2PN] and 32 [62.7%] of them showed evidence of cleavage. 6 [11.8%] embryos had good quality. According to our results, oocytes activation with calcium ionophore had an acceptable fertilization rate, however high quality embryos remained low. We propose future studies to evaluate embryo quality

survey on effect of health education on health volunteer performance and knowledge in prevention of cutaneous leishmaniasis in Yazd

Cutaneous leishmaniasis [CL], is one of the health priorities in many of the tropical areas of the world, and is also very common in Iran, especially in urban areas of the country. The best way of prevention of the disease is to increase knowledge in terms of prevention and early referral of suspected cases to physician, as well as suitable treatment for patients. To define the influence of education on health volunteer performance and knowledge about CL in Yazd. In this semiempirical survey, knowledge and performance of 74 randomly selected health volunteers in Yazd were assessed via questionnaire before and after the education. The resulting data were processed and analyzed by SPSS software and with ANOVA and paired t test exams. This survey showed that knowledge and performance of health volunteers after the training course increased by 44% and 56%, with mean of 7.53 before education to 10.84 after the course, and from 1.12 to 1.75 respectively. The effect of the training course in terms of level of literacy and age group were assessed resulted in meaningful differences, as well. It seems that the education has a significant influence on increase of knowledge and performance of health volunteer, and as these personnel have essential role in people's knowledge and health situation in community, so continuous use of these educational courses may result in a decline in prevalence of the disease