Comparative effectiveness of antidepressant medication versus psychological intervention on depression symptoms in women with infertility and sexual dysfunction

Background: Fertility loss is considered as a challenging experience. This study was conducted to compare the effectiveness of antidepressant medication and psychological intervention on depression symptoms in women with infertility and sexual dysfunctions [SD]

Materials and Methods: This randomized, controlled clinical trial study was completed from December 2014 to June 2015 in Babol, Iran. Of the 485 participants, 93 were randomly assigned in a 1: 1: 1 ratio to psychosexual therapy [PST], bupropion extended-release [BUP ER] at a dose of 150 mg/d, and control [no intervention] groups. The Beck Depression Inventory [BDI] was completed at the beginning and end of the study. Duration of study was eight weeks. Statistical analyses were performed by using paired-test and analysis of covariance

Results: The mean depression score on the BDI was 22.35 +/- 8.70 in all participants. Mean BDI score decreased significantly in both treatment groups [PST: P<0.0001, BUP: P<0.002] from baseline to end of the study, whereas intra-individual changes in BDI score were not significant in the control group. The decrease in mean BDI score was greater with PST compared to BUP treatment [P<0.005] and the control group [P<0.0001]. The PST group showed greater improvement in depression levels [severe to moderate, moderate to mild] in comparison with the two other groups [P<0.001]. Drug treatment was well tolerated by the participants in the BUP group

Conclusion: PST can be a reliable alternative to BUP ER for relieving depression symptoms in an Iranian population of women with infertility and SD

Comparison of pregnancy rate between fresh embryo transfers and frozen-thawed embryo transfers following ICSI treatment

Background: The use of assisted reproductive technology [ART] is increasing in the world. The rate, efficacy and safety of ART are very different among countries. There is an increase in the use of intra cytoplasmic sperm injection [ICSI], single fresh embryo transfer [ET] and frozen-thawed embryo transfer [FET]

Objective: The objective of this study was to compare pregnancy rate in fresh ET and FET

Materials and Methods: In this retrospective cross-sectional study 1014 ICSI-ET cycles [426 fresh ET and 588 FET] from 753 women undergoing ICSI treatment referred to Fatemezahra Infertility and Reproductive Health Research Center in Babol, Iran from 2008 to 2013 were reviewed

Results: There were no significant differences between biochemical pregnancy rate [23% versus 18.8%, OR 1.301; 95% CI .95-1.774], gestational sac [95.6% versus 100% in FET, OR 0.60; 95% CI 0.54-0.67], and fetal heart activity [87.2% versus 93.6% OR .46; 95% CI .16-1.32] in fresh ET and FET cycles, respectively. P< 0.05 was considered statistically significant for all measures

Conclusion: Although, the result showed no significantly difference between the fresh ET and the FET cycles, however the embryos are able to be stored for subsequent ART. Therefore, we recommend FET cycles as an option alongside the fresh ET

Sexual dysfunction in women undergoing fertility treatment in Iran: prevalence and associated risk factors

Background: Sexual dysfunctions are one of the most fundamental difficulties for infertile women, which can be as the cause of infertility. This study investigated the prevalence of this disorder and associated factors in order to improve infertility treatment process and the quality of life of women referring to infertility center

Methods: A cross sectional study was performed on 236 women who referred to Fatima Zahra infertility center of Babol, Iran. Data collection tool was a questionnaire contained two parts; demographic characteristics and infertility information. Also, data for sexual dysfunction was obtained through diagnostic interview based on the international classification DSM-IV. For data analysis, logistic and linear regression analysis were used. The p<0.05 was considered significant

Results: Most of women [84.9%] suffered from primary infertility and the mean duration of infertility was 60.2 +/- 8.4 months. The prevalence of sexual dysfunction was 55.5% [n=131]; including dyspareunia in 28% [n=66], impaired sexual desire and lack of orgasm in 26.3% [n=62 patients], vaginismus in 15.2% [n=36] and lack of sexual stimulation in 13.6% [n=32]. Binary logistic regression analysis showed that age, sexual satisfaction and history of mental illness had a significant effect on the probability of experiencing the sexual dysfunction

Conclusion: There is a high prevalence of sexual dysfunction among infertile women. Considering the interaction between sexual dysfunction and infertility, professional health care centers should be sensitive to this effect. Also, more attention must be paid on marital relationships, economic and social situation and infertility characteristics in order to prevent sexual dysfunction development through early screening and psychological interference

Association between endometriosis and hyperprolactinemia in infertile women

The association of endometriosis with hyperprolactinemia is controversial. The present study aimed to determine the frequency of endometriosis and association of prolactin with endometriosis in infertile women. 256 infertile women who underwent diagnostic laparoscopy for the evaluation of infertility, referred to Fatemezahra Infertility and Reproductive Health Research Center were included in a cross-sectional study. The presence of endometriosis was evaluated. To investigate the association of endometriosis with hyperprolactinemia, the patients whose infertility was not caused by endometriosis were included as control group. Serum prolactin [PRL] level was measured in both groups. The comparison of basal serum PRL levels between the two groups was performed, using independent t-test. One way ANOVA was used to determine PRL association with endometriosis stages. The frequency of endometriosis was found to be 29%. PRL levels were significantly higher in endometriosis group compared to control group [23.02 +/- 1.25 vs. 17.22 +/- 1.22 respectively, p=0.004]. Statistically significant associations were found between staging of endometriosis and prolactin levels [p=0.01]. Hyperprolactinemia may be associated with endometriosis and its progression

Enhanced ovarian folliclular development by metformin does not correlate with pregnancy rate: a randomized trial

Polycystic ovary syndrome [PCOS] is a common, complex endocrine disorder for women of productive age. A high incidence of ovulation failure in women with PCOS is related to insulin resistance. Some studies have assessed the effects of hyperinsulinemia and insulin resistance in relationship with insulin sensitizing agents such as Metformin [Met]. These medicines have been suggested new scope for ovulation stimulation enhancement with Clomiphene Citrate [CC] in PCOs women. The aim of this study is to compare the effectiveness of adding Met to CC in women with PCOS. This multicenter, single-blind, randomized controlled trial study was performed on 334 PCOS patients from 2007 to 2009. Patients were randomly divided into two groups and ovulation induction was performed with either CC alone or CC + Met. The treatment was continued for three cycles, then the mature follicle and pregnancy rates were evaluated. In the CC + Met group, 68% had at least one dominant follicle in the first cycle that was significant [p<0.001], and 31.7% had one in the second cycle. In the CC group 54.5% in the first cycle, 31.7% second cycle, and 6.9% ovulated in the third cycle. The pregnancy rate was 28.7% in CC + Met group and 24.6% in the CC group, with no significant differences between the two groups. Adding Met to CC is significant for ovulation, but it does not enhance the pregnancy rate

Does adding dexamethasone to clomiphene citrate improve ovulation in PCOS patients? a triple - blind randomized clinical trial study

A common cause of anovulation is polycystic ovarian syndrome [PCOS]. Clomiphene citrate [CC] is the first line of treatment in PCOS patients however approximately 25% of patients may be CC-resistant. This study aimed to evaluate the efficacy of adding dexamethasone [dex] to CC in CC-resistant PCOS patients with the intent to improve ovulation. This randomized controlled trial study was performed on 60 infertile PCOS patients referred to our infertility research center from 2007 to 2009. Patients were randomly divided in two groups and stimulation performed with dex+CC or CC+placebo. Rates of ovulation, pregnancy and number of mature follicles were evaluated. Ovulation rate in the dex+CC group was 21 out of 30 [70%] and in the CC+placebo group it was 17 out of 30 [56.7%]. The pregnancy rate was 5 [16.7%] in the dex+CC group and 3 [10%] in the CC+placebo group. There was no significant difference between rates of ovulation and pregnancy in both groups, but the number of follicles >/= 18 mm were significant in the dex+CC group [p<0.05]. Our results showed that addition of dex to CC significantly increased the number of matured follicles, however the ovulation and pregnancy rates were comparable between the two groups

[Correlation between abnormal glucose challenge test and pregnancy outcomes]

Gestational diabetes is the most common metabolic disorder in pregnancy. Glucose Challenge Test [GCT] is done for all pregnant women during the 24th to 28th weeks of gestation. If the GCT value is more than 130 mg/dl a Glucose Tolerance Test [GTT] is asked and if GTT is impaired, gestational diabetes mellitus [GDM] is diagnosed and she will receive treatment accordingly. Some studies have illustrated that impaired GCT can cause unfavorable pregnancy outcomes. Therefore, the goal of this study was to determine the pregnancy outcome in pregnant women with abnormal GCTs. This study was done on all pregnant women attending Babol Shahid Yahyanezhad Hospital for prenatal care during 1999 to 2009. GCT was done for all the participants during the 24th to 28th weeks of gestation. Pregnancy outcomes of 225 pregnant women with abnormal GCTs and normal GTTs were compared with those of 225 pregnant women with normal GCTs as the controls. The individuals were compared for pregnancy outcomes such as macrosomia, premature rupture of membranes [PROM] and the need for a cesarean section [C/S]. The average birth weight of the neonates were 3.5 +/- 0.5 kg and 3.3 +/- 0.4 kg [p<0.001] in the cases and controls, respectively. Twenty-five neonates in the case group [12.1%] and eight neonates in the control group [3.6%] had macrosomia [p=0.003]. Frequency of PROM was 17.85% [40] in the cases and 8.9% [20] in the controls [p=0.008]. The cases had a higher frequency for preeclampsia 4.4% [10] than the controls 1.8% [4], [p=0.17]. and pregnancy in the cases lead to a greater number of Cesarean sections, 42.2% [95] in comparison to the controls, 28% [63], [p<0.001]. Prevalence of macrosomia, PROM and C/S were higher in pregnant women with abnormal GCTs. Due to the aforementioned unfavorable conditions that bear the risk of a poor perinatal outcome, early diagnosis and proper follow up of women with GDM is suggested during the prenatal period

[Comparison of sperm parameters in swim up method with single and double washing]

There are different methods to improve sperm parameters including swim up. Sperm washing is a basic step in this method during 2007. It seems that two times washing cause better result especially in high viscosity sample and sample it is not liqufy. The aim of this study is to compare the single and double washing swim up method on sperm parameters. This study was carried out on 50 semen samples referred to Fatemeh-Alzahra infertility center of Babol University of Medical Sciences during 2007. Semen samples had the following characteristics: volume 2-5ml, count > 20 million/ml, motility > 50% and normal morphology > 14%. Sampling condition were completely considered. Sperm parameter analysis carried out after two times washing. Data entered to SPSS-10 and analyzed by repeated measurement and paired T-Test and p-value < 0.05 considered statistically significant. Semen volume mean was 4.050 +/- 1.006. Mean sperm motility is one and two times washings increased [P<0.05], but there was not statistically significant differences between one and two times washing. In grading analysis, by increasing the washing, grade III, IV increase and grade I decrease [P< 0.05]. Sperm morphology mean increased with washing but it is not statistically different between one and two times washing. This study showed that swim up method is effective method for sperm preparation and two times washing cause recuperation of sperm parameters

[Comparison of pregnancy and hyperstimulation syndrome rate with GnRH agonist and HCG in ovation induction of PCOS]

Infertile women with induction ovulation that have appropriate follicules, need LH surge to release eggs, this is done routinely by HCG. This study designed to compare the pregnancy rate and hyper stimulation syndrome in PCOS patients with GnRH agonist instead of HCG. This descriptive study performed from 2003 to 2004 on 130 infertile patients with PCOS at Babol Infertility Center, Babol, Iran. This study was approved by the local committee of medical ethics. After induction ovulation if patients had 2 Follicules more than 16 mm or 3 folliculs more than 14 mm, we randomly used HCG or GnRH agonist for LH surge. The pregnancy rate and hyperstimulation syndrome evaluated. Data analyzed by SPSS. There were79 patients in HCG group and 44 patients in GnRH agonist group. There was no significante difference between HCG and GnRH agonist group, with regard to the mean age, infertility duration, number of HCG injection, body mass index and type of infertility [p>0.05]. Over all 7[8.9%] patients in HCG group and 3[6.8%] in GnRH agonist group had ovarian hyperstimulation syndrome [p= 0.49]. There was pregnancy in 35 [44.3%] patients of HCG group and in 20 [45.5%] patients of GnRH agonist group [p= 0.526]. There was no significant difference in the rate of pregnancy and ovarian hyperstimulation in patients with polycystic ovary, having induction ovulation with HCG and GnRH agonist. So it can be concluded we can say that: GnRH can be used instead of HCG for doing LH surge in PCO patients

Serum beta human chorionic gonadotropin levels and preeclampsia

Preeclampsia is one of the most common complications of pregnancy. It is a trophoblastic disorder. Since human chorionic gonadotropin [hCG] is secreted by trophoblast, the purpose of the study was to determine the levels of beta [hCG] in preeclampsia and normal cases. This study was conducted on 40 term pregnant women with preeclampsia [case group] and 40 normal pregnant cases [control group] in the Department of Obstetrics and Gynecology, Medical University, Babol, Iran, from 2004 to 2005. Serum beta-hCG in all cases were measured by radioimmunoassay. The mean beta-hCG level in preeclampsia [mild and severe] was compared with normal cases. The maternal serum, beta-hCG level in patients with preeclampsia [39840 +/- 24630 IU/L] was higher than in the control group [27460 +/- 25862 IU/L] [p=0.031]. In mild preeclampsia [34 cases], the mean serum beta-hCG level was 31991 +/- 16758 IU/L while in severe preeclampsia [6 cases] 84312 +/- 9257 IU/L [p<0.0001]. The mean serum beta-hCG level in mild and severe preeclampsia was higher compared to the normal cases. The results of this study show that the levels of beta-hCG in severe form of preeclampsia is higher compared to the milder ones