Metabolic syndrome in patients with Polycystic Ovary Syndrome in Iran

Background: The prevalence of metabolic syndrome [MetS] in polycystic ovary syn-drome [PCOS] has been studied in different populations, but their results were so con-troversial regarding Iranian women. These controversial data indicated the need for more investigation of MetS characteristics in PCOS patients in our population. So this study aimed to evaluate the clinical and laboratory characteristics and metabolic features of patients with PCOS in Rasht

Materials and Methods: This prospective cross sectional study was conducted on 215 PCOS women who lived in Rasht, north of Iran, from March 2010 to July 2012. The participants were then divided into two groups of women with MetS [n=62] and women without MetS [n=153]. The diagnosis of PCOS and MetS were based on the Rotterdam 2003 criteria and the Adult Treatment Panel III [ATP III] criteria, respectively. Demographic characteristics, fertility characteristics, family history and laboratory findings were assessed

Results: The prevalence of MetS in women with PCOS was 28.8%. In PCOS women of both groups, the waist circumference [WC] exceeded 88cm in 72.6%, hypertension [systolic blood pressure [SBP] and/or diastolic blood pressure [DBP] >/= 130/85mm Hg] was prevalent in 9.3%, fasting blood sugar [FBS] level was >/= 110 mg/dl in 6%, triglycerides [Tg] level were >/= 150 mg/dl in 47%, and high-density lipoprotein [HDL] level was <50 mg/dl in 86%. The values of WC, SBP, DBP, body mass index [BMI], ovarian size, Tg, cholesterol, FBS, 2-hour blood sugar, aspartate aminotransferase [AST], and alanine aminotransferase [ALT] were significantly greater in PCOS women with MetS than women without MetS. Also HDL and luteinizing hormone [LH] levels in women with MetS were significantly lower than women without MetS

Conclusion: Prevalence of MetS in PCOS women was 28.8%, indicating that this value is higher than other studies conducted on PCOS women in Iran and other studies conducted on general population in Iran. PCOS women are considered as a high-risk population for MetS. The special strategies are required to prevent MetS and its associated complications in PCOS women

Effect of vaginal misoprostol on pregnancy rate after intrauterine insemination: a randomized controlled trial

Intrauterine insemination [IUI] is one of the most appropriate and cost-effective methods in infertility treatment. We aimed to investigate effect of vaginal misoprostol on pregnancy rate after IUI. Two hundred and ten infertile women who were referred to Infertility Clinic of Alzahra Hospital by an indication of IUI during 2012-2013 were randomly assigned to receive 200 microg vaginal misoprostol [n=105] or vaginal placebo [n=105] after IUI. For detecting pregnancy, past 2 weeks, beta human chorionic gonadotropin evaluation was made and if positive, transvaginal sonography was done for evaluation of pregnancy 2-3 weeks later and clinical pregnancy was recorded. Pregnancy had been noted in 24 patients in misoprotol [22.9%] and 27 patients in placebo [25.7%] groups that this difference was not significant [p=0.748]. In misoprostol group, 3 case of nausea and vomiting [2.9%] had been observed. According to the results, administering 200 microg vaginal misoprostol after IUI doesn't have significant effect on the success rate of IUI

Comparison between unilateral and bilateral ovarian drilling in clomiphene citrate resistance polycystic ovary syndrome patients: a randomized clinical trial of efficacy

Laparoscopic ovarian drilling [LOD] is an alternative method to induce ovulation in polycystic ovary syndrome [PCOS] patients with clomiphene citrate [CC] resistant instead of gonadotropins. This study aimed to compare the efficacy of unilateral LOD [ULOD] versus bilateral LOD [BLOD] in CC resistance PCOS patients in terms of ovulation and pregnancy rates. In a prospective randomized clinical trial study, we included 100 PCOS patients with CC resistance attending to Al-Zahra Hospital in Rasht, Guilan Province, Iran, from June 2011 to July 2012. Patients were randomly divided into two ULOD and BLOD groups with equal numbers. The clinical and biochemical responses on ovulation and pregnancy rates were assessed over a 6-month follow-up period. Differences in baseline characteristics of patients between two groups prior to laparoscopy were not significant [p>0.05]. There were no significant differences between the two groups in terms of clinical and biochemical responses, spontaneous menstruation [66.1 vs. 71.1%], spontaneous ovulation rate [60 vs. 64.4%], and pregnancy rate [33.1 vs. 40%] [p>0.05]. Following drilling, there was a significant decrease in mean serum concentrations of luteinizing hormone [LH] [p=0.001] and testosterone [p=0.001] in both the groups. Mean decrease in serum LH [p=0.322] and testosterone concentrations [p=0.079] were not statistically significant between two groups. Mean serum level of follicle stimulating hormone [FSH] did not change significantly in two groups after LOD [p>0.05]. Based on results of this study, ULOD seems to be equally efficacious as BLOD in terms of ovulation and pregnancy rates

relationship between vaginal bleeding in the first and second trimester of pregnancy and preterm labor

Vaginal bleeding is a common complication during pregnancy, which is observed in about 1/4 of pregnancies and in half of cases can lead to abortion. If vaginal bleeding happens during pregnancy some adverse pregnancy outcomes, including perinatal mortality and morbidity, low birth weight and preterm delivery will be increased. The aim of this study was to determine the relationship between vaginal bleeding and its characteristics in the first and second trimester of pregnancy and preterm labor. This is a case-control study conducted on 440 pregnant women referred to Al-Zahra Hospital in Rasht, Iran. Data were collected by a form. The form included demographic characteristics and confounding factors, the occurrence of bleeding during pregnancy and its features. Data were analyzed by T test, chi square and logistic regression in SPSS 16. Findings showed that vaginal bleeding was associated with 3 times increased risk of preterm delivery [OR: 3, 1.84-4.89]. Also, findings showed that bleeding characteristics including bleeding time, frequency, severity and intensity was significantly associated with preterm labor. According to significant association between vaginal bleeding and preterm delivery, it seems that performing some interventions to prevent preterm labor could be appropriate.

impact of different time intervals between hCG priming and oocyte retrieval on ART outcomes

Abnormal oocyte morphology has been associated with the hormonal environment to which the gametes are exposed. In this study, we evaluated the oocytes morphology, fertilization rate, embryos quality, and implantation rate resulted of retrieved oocytes in different times after human chorionic gonadotrophin [HCG] administration. A total of 985 metaphase II oocytes were retrieved 35, 36, 37 and 38 h after the injection of HCG as groups 1, 2, 3, and 4 respectively. Oocyte morphology was divided into [I] normal morphology, [II] extracytoplasmic abnormalities, [III] cytoplasmic abnormalities and [IV] intracytoplasmic vacuoles and in each group, oocytes were evaluated according to this classification. Extracytoplasmic abnormalities were encountered in 17.76% and 31.1% of these oocytes [groups 3 and 4 respectively, p=0.007] in comparison with 12.23% group 2. Cytoplasmic abnormalities in group 4 were higher than other groups. 23.88% [p=0.039] and 43.25% [p=0.089] of resulted 2PN [two pronucleus] from groups 3 and 4 showed grade Z3 respectively in comparison to group 2 [16.44%]. Normal and various categories of abnormal oocytes did not differ regarding fertilization and cleavage rates [p=0.061]. However, group 4 showed significant difference in the rate of embryos fragmentation [grade III and IV embryo] in comparison with group 2 [40.96% vs. 24.93%, p=0.078]. The pregnancy rate was higher in G2 and G3 groups [28.5 and 24.13% respectively]. Oocyte retrieval time following HCG priming affected on oocyte morphology, 2PN pattern and embryos qualities subsequently. Both good quality embryo formation and pregnancy outcomes were noticeably higher when oocytes were retrieved 36 h after HCG priming in ART program

Role of dyslipidemia in preeclamptic overweight pregnant women

Obesity is an independent risk factor of preeclampsia with unknown mechanism and hyperlipidemia might be a probable case of it. The objective of this study was to determine the role of hyper-triglyceridemi in association with high prepregnancy body mass index and the risk of preeclampsia. The authors conducted this case-control study of 42 preeclamptic and 41 normotensive overweight pregnant women. The two groups were comparable with respect to age, gestational age, and body mass index. Blood samples were collected at the time of diagnosis of preeclampsia, after 14 hour fasting to determine plasma lipid concentrations. Enzymatic photometric tests were used to determine lipid profile. Data was analyzed with independent "t-test", Chi-square and one-way ANOVA and post HOC Tukey HSD test. The statistical significance was set at 0.05 levels. In the subjects with preeclampsia, serum triglyceride and total cholesterol levels were significantly increased and plasma HDL-cholesterol concentrations were decreased compared with the controls, [p<0.05], but plasma LDL cholesterol levels didn't differ between the two groups. Women who developed severe preeclampsia had higher concentrations of TG and cholesterol and lower levels of HDL compared to noromotensive group. Mean TG: 375.16 vs. 202.85, p<0.001, Mean cholesterol: 245.64 vs. 214.32, p=0.04, Mean HDL: 40.80 vs. 48.95, p=0.03]. We noted that dyslipidemia, particularly hypertriglyceridemia was highly correlated with prepregnancy high BMI in preeclamptic women. These findings continue to support a role for dyslipidemia in BMI related preeclampsia

[ relationship between soluble serum HLA-G and ICSI success rates]

Pregnancy is a successful transplantation. Factors evading rejection of the fetus by the mother's immune system are poorly understood and success rate and maintenance of embryos in assisted reproductive technologies [ART] may also depend on the same factors. The molecules of HLA-G are non-classical major histocompatibility complex class I antigens that have recently attracted attention in regards to pregnancy. The aim of the present study was to determine the concentration of HLA-G and its correlation with success or failure rates of ICSI. Serum samples of 107 women who were undergoing ICSI [the case group] were collected before and 14 days after embryo transfer, as were serum samples of 24 women with normal pregnancy [the control group] in the first trimester of pregnancy. Soluble HLA-G1 and G5 isoforms and the total sHLA-G were assayed by sandwich ELISA. Nonparametric Kolmogorov-Smirnov [K-S], Mann Whitney U and Wilcoxon tests were used for statistical analysis. No significant differences were observed in clinical variables including age, infertility duration and treatment regimen between the control and the case groups. Levels of sHLA-G1 and sHLA-G5 and the total sHLA-G prior and after ICSI in the control group, respectively, were 47.4 +/- 62.8 U/ml, OD: 1.47 +/- 0.58 prior and 59.6 +/- 69.5 U/ml, OD: 1.38 +/- 0.57 after ICSI. In the non-pregnant group, the values respectively were 35.7 +/- 55.2 U/ml, OD: 1.37 +/- 0.45 prior and 39.7 +/- 57.2 U/ml, OD: 1.31 +/- 0.46 after ICSI, corresponding to the control group; 53.16 +/- 47.92 U/ml and OD: 1.29 +/- 0.49. No significant statistical differences were found between the pregnant, nonpregnant and the control groups. No significant changes in the serum levels of sHLAG1 and sHLA-G5 isoforms and the total sHLA-G were observed following embryo transfer. No significant correlation was found between sHLA-G and the success of pregnancy in women undergoing ART. It seems that serum HLA-G has no prognostic value in the prediction of ICSI failure

In vitro fertilized embryos do not secrete detectable HLA-G on day two

Pregnancy is a successful transplantation. The factors evading rejection of the fetus are poorly understood. Recently an interest has grown, in HLA-G molecules as one of these factors. Since these antigens are mainly expressed on the surface of cytotrophoblasts that are in direct contact with maternal tissues, it has been suggested that these molecules may have a role in induction of immune tolerance in mothers. To find the association of soluble HLA-G [sHLA-G] and the success of pregnancy with intracytoplasmic sperm injection [ICSI] procedure. In this study, the supernatant of 287 individually cultured embryos corresponding to 96 women under ICSI procedure were assayed for soluble HLA-G1 and G5 by a sandwich ELISA. Clinical pregnancy successfully occurred in 30 of candidates. No differences in clinical parameters [age, infertility duration, stimulation regimen] were observed between pregnant and nonpregnant women under ICSI procedure. None of the embryo supernatants in either group showed any detect-able sHLA-G molecules. Our results showed that detectable level of sHLA-G is not produced by day 2 embryos and such a measurement may not provide reliable information for embryo selection and estimation of pregnancy success

Seasonal variation of the onset of preeclampsia and eclampsia

Preeclampsia is one of the three leading causes of maternal mortality. Studies have suggested that the incidence of preeclampsia may be partially dependent on the month or season of delivery. This study was conducted to evaluate whether seasonal variation has any effect on the incidence of eclampsia or preeclampsia. From 1999 to 2001, a cross-sectional study in Alzahra Hospital was performed using all deliveries with gestational age more than 20 weeks. Variables of maternal age, parity, occurrence of preeclampsia and eclampsia, and season were evaluated and analyzed by chi-square test in SPSS 10. During the period of the study, there were 12,142 deliveries at Alzahra Hospital in Rasht. There were 2,579 [21.3%] deliveries in spring, 2,696 [22.2%] in summer, 3,645 [30%] in autumn, and 3,222 [26.5%] in winter. There was no statistically significant relationship between the age, parity and season. Hypertensive disorder was reported in 609 pregnancies [5%], with 11,533 [95%] having no hypertensive disorder. Data showed that 397 patients [3.3%] had preeclampsia and eclampsia. The highest rate of preeclampsia was in spring [3.6%], and the lowest rate was in summer [3%], but it revealed no statistical difference in the incidence of preeclampsia with season. We found no correlation between preeclampsia or eclampsia and season. It may be due to relative similarities between seasons in North of Iran. For example, there are relative similarities between spring and summer, and between autumn and winter

comparison between suppository diclofenac and pethidine in post-cesarean section pain relief: a randomized controlled clinical trial

Narcotic drugs are usually used for postoperative pain control which could cause several complications such as respiratory depression and apnea. Therefore, replacement of these drugs with safer analgesics is recommended. The aim of this study was to compare the analgesic effects of suppository diclofenac and pethidine in post-cesarean section [C/S] patients. In this clinical trial, pregnant women who were admitted to Alzahrah Hospital, Isfahan, Iran, between August and February 2004 and met the inclusion criteria were recruited. After obtaining informed consent, the patients were randomly assigned [block randomization] to two groups. In group A, 100 mg rectal suppository diclofenac was used after operation at four time points: at the end of operation and 8, 16 and 24 hours after the operation. Group B received pethidine 1 mg/kg intramuscularly at similar time points. The pain scores were assessed at 2, 10, 18 and 26 hours after C/S using the Visual Analogue Scale [VAS]. Age, gestational age, parity, history of previous abortion, C/S and abdominal surgery, level of education, pain score, side effects and satisfaction level were assessed. Analysis was carried out with ANCOVA model and X[2] Mantel Haenszel tests by SPSS.10 software. P<0.05 was considered significant. Two hundred forty patients met inclusion criteria. Age, parity, history of previous abortion, history of previous C/S and abdominal surgery, level of education and satisfaction level were similar in the two groups [P>0.05]. There was no significant difference between side effects in the two groups except for dizziness in 11 cases in group B. There were significant statistical difference between pain intensity in 10, 18 and 26 hours after C/S in group A and group B [2.05 +/- 2.07, 1.4 +/- 1.6 and 0.5 +/- 1.1 vs. 2.6 +/- 2.2, 2.3 +/- 2.2 and 1.3 +/- 1.9] respectively. The results of the present study showed that the use of suppository diclofenac is an appropriate replacement therapy for pain relief after C/S