Successful pregnancy outcome with IUI in patients with unexplained recurrent miscarriage, whose male partners have low score hypo-osmotic swelling test

In order to determine outcome of pregnancy with IUI in patients with unexplained recurrent miscarriage whose husbands have low hypo-osmotic swelling test scores, a prospective clinical intervention was performed at a university referral clinic of recurrent abortion. Out of 56 patients whose husbands had abnormal hypo-osmotic swelling tests, 43 patients underwent IUI, from which only 14 patients became pregnant [treatment group] and 13 patients became spontaneously pregnant without IUI as control group. Our main outcome measure was successful pregnancy [continuation of pregnancy after 20 weeks]. Among the 14 patients who became pregnant, 3 patients aborted below 20 weeks [21.4%], and 11 patients continued pregnancy after 20 weeks of gestation [78.6%]. In the control group among the 13 patients with spontaneous pregnancy, 8 patients aborted below 20 weeks [61.5%] and 5 patients continued pregnancy over 20 weeks [36.4%], success rate ratio was 2.04% and the difference was statistically significant [c[2]=4.49, p<0.05]. Treating the unexplained recurrent aborter whose male partner has a low hypo-osmotic swelling test score with IUI could be effective. This is the first study to present an ideal way for selection of recurrent aborters who benefit from IUI. The probable mechanism for this effect may be selection of the best quality sperms which will be discussed in detail

comparative, double-blind, randomized, placebo-controlled trial of intraperitoneal administration of bupivacaine and lidocaine for pain control after diagnostic laparoscopy

The purpose of this study was to compare the effect of intraperitoneal bupivacaine and lidocaine administration on pain reduction after diagnostic laparoscopy. In this randomized, double blind, placebo controlled study, diagnostic laparoscopy was done for one-hundred and ninety-six infertile women with unexplained infertility. Patients were randomized to 4 groups [A, B,C, and D]. At the end of the procedure, 30 mL of 0.125% bupivacaine, 30 mL of 5% lidocaine and 30 mL of normal saline was instilled in the pelvic cavity and 15 mL of the same solution over the diaphragmatic vault in group A, B and C, respectively. Group D received no intraperitoneal substance. The verbal pain scale questionnaire was used for assessment of postoperative pain. In conclusion, when instilled intraperitoneally after diagnostic laparoscopy, bupivacaine significantly decreases postoperative pain for a long period. It also reduces the rate of analgesic needed, increases the rate at which patients were discharged 2 hours after surgery, and decreases hospital stay. It is highly effective compared to lidocaine and placebo

prospective, double-blind, randomized, placebo-controlled clinical trial of dexamethasone during the follicular phase in clomiphene resistant patients with polycystic ovary syndrome and normal DHEAS

In order to evaluate the effects of short course administration of dexamethasone [DEX] combined with clomiphene citrate [CC] in CC-resistant patients with polycystic ovary syndrome [PCOS] and normal DHEAS, a prospective, double blind, placebo controlled, randomized study was undertaken at referral university hospitals. Two-hundred and thirty women with PCOS and normal DHEAS who failed to ovulate with a routine protocol of CC received 200 mg of CC from day 5 to 9 and 2 mg of DEX from day 5 to 14 of the menstrual cycle. The control group received the same protocol of CC combined with placebo. Follicular development, hormonal status, ovulation rate, and pregnancy rate were evaluated. Mean follicular diameters were 18.4124 +/- 2.4314 mm and 13.8585 +/- 2.0722 mm [p<0.001] for treatment and placebo group respectively. Eighty-eight% of treatment and 20% of the control group had evidence of ovulation. The difference of cumulative pregnancy rate in treatment and control groups was statistically significant [p<0.0001]. Hormonal levels, follicular development and cumulative pregnancy rate improved with the addition of DEX to CC in CC-resistant patients with PCOS and normal DHEAS. This regimen is recommended before any gonadotropin therapy or surgical intervention

Congenital adrenal hyperplasia in north-east of Iran: a review of 47 patients and the role parental consanguinity in the occurrence of disease.

In this study the clinical and epidemiological characteristics of congenital adrenal hyperplasia were evaluated prospectively in 47 patients admitted in Imam Reza Hospital in Mashhad during a 4 year period. 21-hydroxylase deficiency was present in 42 patients [89.3%], the simple virilizing form in 6 and the salt-losing form in 36 of them. 11b-hydroxylase deficiency was present in 5 patients [10.7%]. The median chronological age at diagnosis in the salt-losing form was 68 and 47 days in boys and girls respectively. 7 girls were considered to be male before the diagnosis was established. Parental consanguinity rate among families of patients was higher than the general population in Mashhad [82% vs. 35%]. In 16.2% of patients the history of disease was positive in siblings. This study showed that the incidence of congenital adrenal hyperplasia is expected to be high due to a high rate of consanguinity in our population, hence genetic counseling before marriage would definitely be beneficial in our population

value of dipstick analysis of urinary protein in pregnancy induced hypertension

In order to determine the value of dipstick analysis of urinary protein in pregnancy induced hypertension, a prospective study analyzing pregnant patients with a diagnosis of hypertensive disorder was conducted to compare the result of urinary protein dipstick analysis with 24hr. urine protein collection in obstetrical clinics affiliated to Shiraz University of Medical Sciences. All patients fulfilling the criteria of the American College of Obstetricians and Gynecologists' definitions for establishing a diagnosis of hypertensive disorder on the basis of urinary dipstick measurements were included in the study. During the study, 102 hypertensive pregnant patients aged from 16-42 years were included in the study. Obtained results showed that the presence of negative value on urinary dipstick with a sensitivity of 100% is a useful method for ruling out significant proteinuria [> 300 mg/24hr]. But values of >2+ are not adequate to confirm a diagnosis of severe hypertensive disorder because its positive predictive value is only 22% and values of > trace-although highly suggestive of significant proteinuria [positive predictive value: 78%]-have a false positive rate of 23%; a timed collection of urine for determination of 24-hr protein excretion becomes mandatory in such cases. The urinary dipstick determination of protein excretion therefore has significant limitations for determination of the presence or severity of proteinuria

Hysteroscopic metroplasty: report of 76 cases

Congenital Mullerian abnormalities, particularly the septate uterus, may result in recurrent abortion, premature labor and infertility. The purpose of this study is to report the surgical and reproductive outcome in two groups of patients who underwent hysteroscopic metroplasty [HMP]. Between Aug. 1993 and March 1998, 76 women underwent HMP in Shiraz University of Medical Sciences' affiliated hospitals. They were divided into two groups. Group one received no postoperative [post-op] additional therapy. Group two received post-op estrogen, and an IUD was also placed to prevent post-op endometrial adhesion. They were analyzed with respect to post-op complications and reproductive outcome. Seven of these patients had a complete uterine septum which extended through the cervix and to the vagina. All of the seven cervical septums were incised with good obstetrical outcome. There were a total of 45 pregnancies during 6 months or more post-op in the two groups. Differences between the reproductive outcome of the two groups was not statistically significant [p=0.90066] and the.general results were as follows: term delivery rate was 35 [72.7%], 23 [51%] delivered vaginally, and 12 [26.5%] delivered by cesarean section [C/S] for obstetric indications, 4 [8.8%] were spontaneous abortions and one immature delivery at 16 wks due to premature rupture of membranes [PROM]. Intraoperative and post-op morbidity was negligible. We concluded that with HMP, septa can be incised successfully, post-op hormonal therapy and IUD placement are not needed, the cervical septum can be incised without any post-op complication,' and a good reproductive outcome can be expected

comparison of intraperitoneal insemination and intrauterine insemination in infertility treatment

This prospective study was undertaken to evaluate the relative efficacy of two out-patient methods of assisted fertilization in 156 infertile women with patent fallopian tubes. Direct intraperitoneal insemination [DIPI] and intrauterine insemination [IUI], both with controlled ovarian hyperstimulation [COH] were performed. The procedures were used randomly in the treatment of male subfertility, cervical factor, and unexplained infertility over 548 cycles. Of these, 39 had unexplained infertility, 33 male infertility and 84 cervical-mucus hostility. Twenty three pregnancies occurred over 267 cycles of IUI and 19 pregnancies over 281 cycles of DIPI, giving an overall PR/couple ratio of 26.92% and PR/cycle of 7.66. There was no significant difference in the PRs between the IUI and DIPI [a 6.76% PR/cycle in DIPI and 8.61% in IUI group] p = 0.971. It is concluded that both IUI and DIPI combined with COH are valuable methods in treating infertility

Laparoscopic ovarian cauterization in patients with polycystic ovaries; clinical outcome and endocrine changes

Fifty-two women with polycystic ovarian syndrome, and a 5.2 years mean duration of infertility, underwent laparoscopic ovarian cautery. Regular ovulatory cycles were established in 75% of the patients. In 26 responders there was a significant fall in mean luteinizing hormone from 20.3 +/- 2.3 [SEM] to 14.7 +/- 2.1 mIU/ml [p<0.05], prolactin from 319.3 +/- 38.5 to 271.0 +/- 35.3 mlU/L [p<0.01], and testosterone from 0.84 +/- 0.07 to 0.72 +/- 0.07 ng/ml [p< 0.025] ten days postoperatively. There was no significant change in the level of follicle stimulating hormone. Pregnancy occurred in 30.4% of clomiphene citrate failure cases, and 80% of patients in whom medical treatment was not complete, with an overall conception rate of 45.5%. Laparoscopic ovarian cautery should be considered in the management of patients with polycystic ovarian syndrome