Controlled ovarian stimulation with r-FSH plus r-LH vs. HMG plus r-FSH in patients candidate for IVF/ICSI cycles: an RCT

Background: Different combination of gonadotropin preparation has been introduced with no definite superiority of one over others in vitro fertilization [IVF], but individualized regimens for each patient are needed

Objective: The aim of the present study was to investigate the effect of controlled ovarian stimulation with recombinant- follicle stimulating hormone [r-FSH] plus recombinant-luteinizing hormone [rLH] versus human menopausal gonadotropin [HMG] plus r-FSH on fertility outcomes in IVF patients

Materials and Methods: This is a randomized clinical trial study that was performed from October 2014-April 2016 on 140 infertile patients with a set of inclusion criteria that referred to infertility clinics in Vali- asr and Gandhi Hospital in Tehran. The women were randomly divided into two treatment groups. The first group [n=70] received rFSH from the second day of cycle and was added HMG in 6[th] day and the 2[nd] group [n=70], received rFSH from the second day of cycle and was added recombinant-LH in 6[th] day. Then ovum Pick-Up and embryo transfer were performed. In this study, we assessed the outcomes such as; chemical and clinical pregnancy rate, live birth and abortion rate

Results: Number of follicles in ovaries, total number of oocytes or M[2] oocytes and quality of fetuses has no significant differences between two groups [p>0.05]. Total number of fetuses were significantly higher in patients who received rFSH + HMG [p=0.02]. Fertility outcomes consisted of: live birth rate, chemical pregnancy and clinical pregnancy rate were higher in rFSH + HMG group in comparison to rFSH +r-LH group [p<0.05]

Conclusion: It seems that in IVF patients, HMG + rFSH used for controlled ovarian hyperstimulation have better effects on fertility outcomes, but in order to verify the results, it is recommended to implement studies on more patients

Comparison of clinical performance of antigen basedenzyme immunoassay [EIA] and major outer membrane protein [MOMP]-PCR for detection of genital Chlamydia trachomatis infection

Background: Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen worldwide. Early detection and treatment of C.trachomatis genital infection prevent serious reproductive complications

Objective: Performances of enzyme immunoassay [EIA] and major outer membrane protein [MOMP]-polymerase chain reaction [PCR] for diagnosis of genital C.trachomatis infection in women were compared

Materials and Methods: In this cross sectional study a total of 518 women volunteers were included [33.67 +/- 8.3 yrs] who had been referred to Gynecology clinics of Qom province, Iran, were included. Endocervical swab specimens were collected to detect lipopolysaccharide [LPS] antigen in EIA and to amplify MOMP gene of C.trachomatis in PCR. Results were confirmed using ompI nested-PCR. Sensitivity, specificity, positive [PPV] and negative predictive values [NPV] were calculated for performance of the tests. Odds ratios were determined using binary logistic regression analysis

Results: In total, 37 [7.14%] cases were positive by EIA and/or MOMP-PCR. All discrepant results were confirmed by nested-PCR. Sensitivity, specificity, PPV and NPV values of EIA were 59.46%, 100%, 100% and 96.98%, and those of MOMP-PCR were 97.30%, 100%, 100%, 99.79%, respectively. Reproductive complications including 2.7% ectopic pregnancy, 5.4% stillbirth, 5.4% infertility, and 10.8% PROM were recorded. The risk of developing chlamydiosis was increased 4.8-fold in volunteers with cervicitis [p<0.05; OR 4.80; 95% CI 1.25-18.48]

Conclusion: C.trachomatis infection should be regarded in women of reproductive ages especially those with cervicitis. Primary screening of women by using the low cost antigen-EIA is recommended; however, due to the low sensitivity of Ag-EIA, verification of the negative results by a DNA amplification method is needed

Luteal phase support in the intrauterine insemination [IUI] cycles: a randomized double blind, placebo controlled study

To evaluate the impact of luteal phase support with vaginal progesterone on pregnancy rates in the intrauterine insemination [IUI] cycles, stimulated with clomiphene citrate and human menopausal gonadotropin [hMG], in sub fertile couples. This prospective, randomized, double blind study was performed in a tertiary infertility center from March 2011 to January 2012. It consisted of 253 sub fertile couples undergoing ovarian stimulation for IUI cycles. They underwent ovarian stimulation with clomiphene citrate [100 mg] and hMG [75 IU] in preparation for the IUI cycle. Study group [n = 127] received luteal phase support in the form of vaginal progesterone [400 mg twice a day], and control group [n = 126] received placebo. Clinical pregnancy and abortion rates were assessed and compared between the two groups. The clinical pregnancy rate was not significantly higher for supported cycles than that for the unsupported ones [15.75% vs. 12.69%, p = 0.3]. The abortion rate in the patients with progesterone luteal support compared to placebo group was not statistically different [10% vs. 18.75%, p = 0.45]. It seems that luteal phase support with vaginal progesterone was not enhanced the success of IUI cycles outcomes, when clomiphene citrate and hMG were used for ovulation stimulation

Effects of Chlamydia trachomatis infection on fertility; a case-control study

Nowadays, Chlamydia trachomatis is known as a causative agent of infertility. Because of, asymptomatic nature of infection, many may suffer from its lasting complications such as infertility. This study was performed in Tehran during April 2007 to April 2008 to compare the prevalence of Chlamydia trachomatis infection in fertile and infertile women using ELISA and PCR methods. Overall, 234 infertile and 223 pregnant women, as the fertile group, participated in this hospital-based case-control study. After completing an informed consent form and the questionnaire, first catch urine and blood sample were obtained for PCR and ELISA [IgG, IgM] tests, respectively. Logistic regression analysis was used to control possible confounding factors, and determine adjusted odds ratio of infertility due to the infection. PCR results revealed that 29 [12.4%] of the infertile and 19 [8.5%] of the fertile women were positive for C. trachomatis infection [p=0.440]. IgG was positive in 21 [9.0%] of the infertile and 11 [5.0%] in the fertile group [p=0.093]. IgM assays identified that 2 [0.9%] of the infertile and 4 [1.8%] of the fertile women were positive for the micro-organism [p=0.375]. We found no significant differences among fertile and infertile women for Chlamydia trachomatis infection. Nevertheless, molecular techniques which are more sensitive, more specific and non-invasive can be used to detect C. trachomatis infection

Appropriateness of cesarean sections using the RAND appropriateness method criteria

The aim of this study was to identify the appropriateness of cesarean sections, performed in Tehran hospitals using standardized Rand Appropriateness Method [RAM] criteria. In this study we used the RAM criteria. In order to prepare the list of cesarean scenarios, clinical guidelines were selected, and the Appraisal of Guidelines for Research and Evaluation was used to choose the most appropriate. Two panels were held with the participation of related specialists. The scenarios derived through this method were compared with data existing in the medical records of 250 women who underwent cesarean sections in selected hospitals affiliated with Tehran University of Medical Sciences. The appropriateness rate of the cesarean sections was calculated. Out of 250 cases of cesarean sections performed, 91 [36.4%] were inappropriate, 41 [16.4%] were equivocal and 118 [47.2%] were considered to be appropriate. Appropriateness differed between public and private hospitals, which were statistically significant. This study shows that as with many other health services, cesarean section has many scenarios that there are different opinions about them and no decision about presenting these scenarios as yet. Moreover the result of study showed the rate of inappropriate cesarean sections in this study is one of the highest reported rates from different communities

Comparing serum basal and follicular fluid levels of anti-Mullerian hormone as a predictor of in vitro fertilization outcomes in patients with and without polycystic ovary syndrome

The prediction of in vitro fertilization [IVF] outcomes by anti-Mllerian hormone [AMH] measurement is getting increasing attention from clinicians. This study compares the relationship between serum or intrafollicular AMH levels and IVF outcomes in women with and without polycystic ovary syndrome [PCOS]. This prospective study was carried out in two university-based fertility clinics. Serum samples were collected on cycle day 3 and follicular fluid [FF] was collected on the day of oocyte retrieval from 26 women with PCOS and 42 normo-ovulatory controls. AMH levels were measured in the samples using immunoenzymatic assay. The relationship between serum or FF AMH levels and IVF outcomes, including number of oocytes retrieved, oocyte maturation rate, fertilization rate, implantation rate, high quality grade embryo rate, and bio-chemical and clinical pregnancy rates were further assessed. Median serum basal AMH and FF AMH levels were significantly higher in the PCOS group as compared to controls, the values being 14.2 ng/mL vs. 3.2 ng/mL [P<0.001] and 8.2 ng/g protein vs. 4.7 ng/g protein [P,.01], respectively. In both groups, serum basal AMH levels showed a positive correlation with number of positive relationship between serum basal AMH levels and percentage of matured oocytes [r=0.331; P=0.32] and implantation rate [r=0.305; P=.05]. Serum basal, and not intrafollicular, AMH levels may be a good predictive factor for quantitative and qualitative IVF outcomes in normo-ovulatory, but not in PCOS patients