Exploration of infertile couples' support requirements: a qualitative study

Due to high prevalence of infertility, increasing demand for infertility treatment, and provision of high quality of fertility care, it is necessary for healthcare professionals to explore infertile couples' expectations and needs. Identification of these needs can be a prerequisite to plan the effective supportive interventions. The current study was, therefore, conducted in an attempt to explore and to understand infertile couples' experiences and needs. This is a qualitative study based on a content analysis approach. The participants included 26 infertile couples [17 men and 26 women] and 7 members of medical personnel [3 gynecologists and 4 midwives] as the key informants. The infertile couples were selected from patients attending public and private infertility treatment centers and private offices of infertility specialists in Isfahan and Rasht, Iran, during 2012-2013. They were selected through purposive sampling method with maximum variation. In-depth unstructured interviews and field notes were used for data gathering among infertile couples. The data from medical personnel was collected through semi-structured interviews. The interview data were analyzed using conventional content analysis method. Data analysis revealed four main categories of infertile couples' needs, including: i. Infertility and social support, ii. Infertility and financial support, iii. Infertility and spiritual support and iv. Infertility and informational support. The main theme of all these categories was assistance and support. The study showed that in addition to treatment and medical needs, infertile couples encounter various challenges in different emotional, psychosocial, communicative, cognitive, spiritual, and economic aspects that can affect various areas of their life and lead to new concerns, problems, and demands. Thus, addressing infertile couples' needs and expectations alongside their medical treatments as well as provision of psychosocial services by development of patient-centered approaches and couple-based interventions can improve their quality of life and treatment results and also relieve their negative psychosocial consequences

Altered Th17/Treg ratio in recurrent miscarriage after treatment with paternal lymphocytes and vitamin D3: a double-blind placebo-controlled study

Background: Recurrent miscarriage [RM] affects 2-5% of pregnant women. Paternal lymphocyte immunotherapy is a common treatment for RM patients but the outcome has not been consistent. Therefore, combined therapy with other immunosuppressive drugs such as 1a, 25-dihydroxy-vitamin-D3 [vitamin D3] may improve the outcome

Objectives: To investigate the effect of vitamin D3 on the balance of two essential T cells subsets, T helper [Th] 17 and T regulatory [Treg] cells, which regulate tolerance

Methods: The expression levels of CD4 and forkhead box protein 3 [FOXP3] in Treg cells, and the expression levels of CD4 and IL-17 in Th17 cells, were evaluated pre- and 3 months post-immunotherapy in RM patients treated with a combination of paternal lymphocytes and vitamin D3 compared with RM patients receiving lymphocyte immunotherapy alone

Results: Vitamin D3 therapy decreased the frequency of Th17 cells in addition to reducing the Th17/Treg ratio in peripheral blood of RM patients compared with the control group [p<0.05]

Conclusion: Considering that RM patients have a higher Th17/Treg ratio in peripheral blood, vitamin D3 may be a candidate therapeutic approach in this disease

comparative cohort study for detecting the incidence of trisomy 21 in ART and non-ART neonates

One of the most important points concerning the patients who undergo assisted reproductive techniques [ART] for getting pregnant can be the possible neonatal chromosomal abnormalities as a result of these methods. This study was conducted to help answering a part of this question. This is a historical cohort study from April 2006 to April 2007. Data were collected from women admitted in Mehregan Hospital and Esfahan Infertility Center. 225 of 2000 infertile women who had taken ART methods and 225 of 1800 women undergoing no ART treatment were included in our study. All of the cases were aged 35 or more. Data were obtained from patient files from 2 infertility centers of Isfahan, Iran. Chromosomal analysis was successfully performed for all clinically suspicious infants for trisobmy 21. As a result, 4 cases of trisomy 21 in ART group and 7 in non-ART group were found. Two cases from IUI, 1 case of IVF and 1 of ICSI were found to have trisomy 21 in infants. There was no statistically difference in occurring trisomy 21 in our two groups of study and this was also the same for women undergoing IVF and ICSI. ART methods did not increase the rate of Trisomy 21 according to our study although we found less in ART group, it was not statistically significant

Variations in T-helper 17 and regulatory T cells during the menstrual cycle in peripheral blood of women with recurrent spontaneous abortion

Disorders in immune system regulation may result in pregnancy abnormalities such as recurrent spontaneous abortion [RSA]. This study aims to determine the ratio of regulatory T [Treg] and T helper [Th] 17 cells in unexplained RSA [URSA] women during proliferative and secretory phases of their menstrual cycles compared to healthy non-pregnant women. In this case control study, 25 women with URSA and 35 healthy, non-pregnant women were enrolled. The percentage of Th17 and Treg cells in participants peripheral blood were determined by flow cytometry. The percentage of Th17 cells and their related cytokines in serum [IL-17A] were higher in the proliferative and secretory phases of the menstrual cycles of URSA women compared to the control women. However, a lower percentage of Treg cells and their related cytokines in serum, transforming growth factor [TGF] beta1 and interleukin [IL]-10 were detected in the proliferative but not the secretory phase of the URSA group. The ratio of Th17/CD4+ Treg was higher in the URSA group than the control group. We observed an increased ratio of Th17/CD4+ Treg during the proliferative and secretory phases in URSA women. The imbalance between Th17 and Treg cells during the proliferative phase of menstrual cycles in the URSA group may be considered a cause for spontaneous abortion

Comparison study on effectiveness of pentoxifyllin with LD to prevent recurrent endometriosis

About 75% of the symptomatic patients who involved with endometriosis have pelvic pain and dysmenorrhea. Pentoxifyllin is one of the drugs that according to its mechanism could be effective for pain relief of endometriosis which has been used for endometriosis treatment recently. We conducted a comparative study for detecting the effect of pentoxifylin [as an immonomodelator] in preventing recurrence endometriotic pain with pentoxifylin plus a combined contraceptive pill with low dose estrogen [LD] and also the LD pill alone. This was a comparative clinical trial on 83 patients with the chief complaint [CC] of pain [dysmenorrheal /or pelvic pain] and with the end diagnosis of endometriosis, in an operative laparoscopy. Patients, dividing to 3 groups, were treated with pentoxifylin, pentoxifylin+LD and LD alone for 10 months. The severity of pain [dismenorhea and/or pelvic pain] was detected by visual analogue scale [VAS] before and after the treatment. The severity of endometriosis in the patients was: I in class I and II in class II and III in class III. The groups were matched for the pain. The number of the patients in group 1, 2 and 3 were 28, 28 and 27 respectively. The pain was reduced in the groups of pentoxifylin+LD [p<0.001] and LD alone [p=0.00]. The pain relief was not significant in the group of pentoxifylin alone [p=0.136]. After treatment, the severity of pain was not significantly different between the LD group and the LD+penthoxyfillin group, but there was difference between these two groups and the group of penthoxyfillin alone. This study showed that penthoxyfillin actually could not have any effect on the pain relief of endometriosis. It also made it clear that penthoxyfillin could not increase the efficacy of LD when used with this medication