[Diagnostic value of prolactin and B-HCG levels of vaginal fluid in diagnosis of premature rupture of membranes]

The aim of this study was diagnosis of premature rupture of membranes in suspected patients by measurement of prolactin and B-hCG levels in vaginal washing in order to reduce perinatal mortality and morbidity. The study included 211 pregnant women who were referred to the emergency of Imam Hossein Hospital at 28-38 weeks of pregnancy for leakage or prenatal care from April, 2007 to April 2008. The expulsion of fluid from the cervix was evaluated and fern and nitrazin tests were done. B-hCG and prolactin levels of vaginal washing fluid were measured. The presence of 2 of 3 parameters of fern test, nitrazin and cervical fluid was defined as absolutely premature rupture of membranes. Man-Withney U-test was used for analysis. The Roc curve was calculated. There were 132 patients in PROM group and 79 patient in the control group. The average age in the PROM and control groups was 26.9 +/- 6.08 and 26.2 +/- 4.84 years, respectively [P=0.074]. Both groups were matched for parity and gravidity. Prolactin levels in PROM group were 2930 +/- 3737 mIU/l versus 23.18 +/- 120mIU/l in the control group [P=0.000]. B-hCG was 439.78 +/- 1867mIU/l in PROM and 17.72 +/- 30mIU/l in control group [p=0.000]. Sensitivity and specificity of prolactin according to cut-off of 16.0mIU/l was 79.41% and 96%, respectively. Sensitivity and specificity for B-hCG with cut-off point of 12.5 was 69.85% and 69.33%, respectively. The measurement of prolactin and B-hCG levels in patients with suspected premature rupture of membranes can help in decision-making and treatment

[Effect of estradiol prescribed during luteal phase of art cycles and pregnancy outcome]

Implantation is one of the most important steps in ART cycles and it depends upon embryo and endometrial reception. Different protocols have been suggested for getting better endometrium. It seems estrogen increases the endometrial reception and pregnancy rate by inducing changes in the hormonal status. The aim of this study was to evaluate the effect of estradiol[E2] on luteal phase support and pregnancy rate in ART cycles. This prospective randomized study was done in Yazd at the IVF center from March until December, 2002. 68 patients who had undergone IVF or ICSI were enrolled in the study. Exclusion criteria was age>40, endometriosis and ovarian hyper stimulation syndrome. Induction ovulation protocol was long suppression with GnRH analogues.After embryo transfer, patients were divided in two groups randomly. Both groups received 100mg progesterone IM daily from the transfer day. Estradiol valerate 2 mg/day was added from the 7th transfer day to progesterone in Group I and continued if the BhCG became positive. Abortion and malformations were measured in all patients. Data analyzed with SPSS 11.0 and P value <0.05 considered statistically significant. Pregnancy rate in the 34 patients of estradiol group [group I] was 26.5%which was significantly higher than 11.8 %[ 4 cases] in the other group [Pvalue=0.034]. Abortion rate was higher in estradiol group [3 cases], but there was no abortion in the progesterone group[P=0.119]. 2 cases of major fetal malformations were observed in E2 supplementation group [P=0.246]. E2 suplementation to progesterone in the luteal phase of ART cycles, especially in the long GnRH analogues causes higher endometrial receptivity and pregnancy rate

[Infections in recurrent miscarriage]

Abortion is one of the prevalent complication in pregnancy and this definition is cerifined to the termination of pregnancy for many reason before 20 week's gestation based upon the data of the first day of the last noromal mens if this processes happenes three or more it will be reffered to recurrent miscarriege one of the machanisms responsible for abortion is infection and this problem is more important in spontaneous abortion. In this situation, many infections factors are interfering. Most of them are effective only spontaneous abortion but their role on recurrent abortion aren't demonstrated one of the most infection disease during pregnancy is Torch Syndrome that leads Pregnancy to Spontaneous abortion. Despite unrepeatedly syndrome but in many cases unfortunately doing Torch lab exam is the first request Now adays many studies that support the role of Mycoplasma hominis, Ureaplasma Urealyticum, chlamydia trachematis and Syplise with less Importance have affection on spontaneous abortion also many studies have been showed that CMV is left in body and can be isolated from urine, Saliva, and the other liquid. Because there is no treatment in subsequent pregnancy with it's tratogenic affect can Resulting Recurrent abortion. There are many different diagnostic Methods including microorganism culture, Serological lab with ELISA, PCR etc that it seems PCR is more accurat. So after diagnose the cause of infection patient should be treated completely before Renewed pregnancy. It should be noticed that with the exception of viruses most of microorganisms reply to medical treatment

[ Study of Complications in 1120 Cases of Transvaginal Ultrasound - guided Oocyte Pick-up in IVF Centre of Yazd]

To determine the prevalence of oocyte pick up complications in 1120 cycles of IVF. In this prospective study 1120 pationts that were reffered to infertility clinics for IVF were enrolled. The patients with the infertility following COH by regimens of CC + hMG/hCG, hMG/hCG, hMG + GnRH-a/hCG were punctured by transvaginal sonography, preformed after injection of sedatives. The follicular aspiration was performed only by vaginal preparation with sterile distilled water .The patients were discharged in an hour. Vaginal bleeding was observed in 190 cases [17%], who were not severe and treated with vaginal pack and discharged after 2 hours after exit the vaginal pack. 15 patients [1.3%] with severe abdominal pain were hospitalized for 24 hours, one with hypovolemic signs was operated by laparoscopy and ruptured ovary was cauterized. 3 cases [0.35%] with fever, chills and abdominal pain managed with diagnosis of PID. One patient with history of 2 previous laparatomy before IVF cycle, didn't respond to medical treatment and after further investigation pararectal abscess diagnosed which was managed surgically. Considering the number of patients, transvaginal follicular puncture is a safe procedure in oocyte retrieval.In patients with history of PID, previous surgery and endometrioma prophylactic antibiotic was given at the time of oocyte puncture

[ assessment of sonohysterography as a diagnostic tool for uterine cavity defects and tubal patency]

In a prospective blind study, we evaluated Sonohysterography [SHG] as a diagnostic tool for uterine cavity and tubal patency and compare SHG with laparoscopy in tubal patency and hysterosalpyngography for Uterine anomaly as gold standard methods. 76 infertile patients undergone SHG and HSG and laparoscopy and comparison between the different diagnostic techniques for the evaluation of the uterine cavity and tubes was carried out. In comparison between SHG and HSG in the evaluation of uterine cavity, the sensivity of SHG for uterine anomalies was 50% and its specificity was 86.95%. In comparison between SHG and laparoscopy in evaluating tubal patency, specificity of SHG was 81.29% and its sensivity was 28.57%. Sonohysterography can be considered as a reliable and accurate method in the first line of evaluation of uterine cavity and tubal patency in infertile patients before HSG, Hysteroscopy, laparoscopy and the all of patients with history of failed IVF

[Does intracytoplasmic sperm injection overcome the reduce of fertilization rate by increasing maternal age?]

The aim of this study was to determine the effects of maternal age in fertilization rate of intracytoplasmic sperm injection comparison with IVF. In this prospective clinical trial study, 200 couples with male subinfertility that referred to infertility clinic were enrolled. Couples were selected on the basis of semen parameters and divided randomly into two groups of IVF and ICSI. Couples were divided into different subgroups based on age of females .The fertilization rate of every subgroups were assessed and compared together. Results were analyzed by Chi-square method. After induction ovulation with standard protocols, 525 oocytes were retrieved during egg collection in ICSI groups versus 474 in IVF. After selection of good quality oocytes, IVF and ICSI was done as routine .The fertilization rate of every age group was measured and compared with age increased. In IVF group, the fertilization rate was 41.3% in patients <35 years versus 26.7% in older than 35 years old .The mean fertilization rate was 89.3% in patients <35 comparison with 75.2% in women >35 years old by ICSI .On the other hand, the mean cleavage rate of IVF cycles was significantly lower in patients >35 years in IVF [49.5%] versus younger patients [P value<0.001] but this finding was not observed by ICSI [85.17% VS 85.15%].Reduction of fertilization rate with increase of female age was statistically meaningful [P value <0.001] in IVF and ICSI. These findings suggest that fertilization of oocyte reduce consequently with maternal age increased, therefore, ICSI can not overcome this problem their cause is not clear and may refer to chromosomal or structural abnormality in oocytes