ABSTRACT
Background: both oral contraceptive pills [OCPs] and estradiol valerate [E2] have been used to schedule a gonadotropin-releasing hormone antagonist in vitro fertilization [IVF] cycles. Since the suppression of follicle-stimulating hormone by OCPs can stay 5-7 days after stopping the pills, it seems that starting the gonadotropin-releasing hormone [GnRH] after 6 days of pre-treatment discontinuation may be important in IVF outcomes
Objective: the aim of the present study was to determine the number of mature oocyte and pregnancy rate of three pretreatment methods for fresh embryo transfer cycles
Materials and Methods: in this randomized controlled trial, two-hundred ten women [18-35 yr and less than 2 previous IVF attempts] undergoing IVF with the GnRH antagonist protocol were randomized to the OCP, E2, and no pretreatment arms. OCP group [n=53] received OCP [ethinyl estradiol30 micro g and levonorgestrel150 micro g], E2 group [n=63] received 4 mg/day oral E2 [17beta?E2] for 10 days from day 20 of the previous cycle and GnRH antagonist stimulation was started 6 days after the interruption of OCP and E2. The control group [n =70] did not receive any pretreatment
Results: no significant difference was observed in the mean number of the mature oocyte, endometrial thickness, and embryo quality. The pregnancy rate in E2 group was higher than the two other groups [42.9% vs 39.6% and 34.3% in OCP and control group, respectively], but the difference was not statistically significant [p=0.59]
Conclusion: it seems OCP or E2 pretreatment could not improve the fresh IVF-embryo transfer outcomes
ABSTRACT
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
Subject(s)
Humans , Female , Adult , Follicle Stimulating Hormone, Human , Luteinizing Hormone , Menotropins , Sperm Injections, Intracytoplasmic , Fertilization in Vitro , FertilityABSTRACT
One of the most important factors affecting success rates in assisted reproductive techniques [ART] besides the number of oocytes retrieved and high quality embryos derived from them is the technical aspects of embryo transfer. It seems that pretreatement with uterine relaxants can be helpful in preventing unpleasant cramps which can have an adverse effect on ART outcome. In this respect, some drugs such as prostaglandin inhibitors or sedatives have been evaluated but not confirmed yet remain controversial. This study was performed in order to assess the effect of administrating Piroxicam prior to embryo transfer on pregnancy rates in ART cycles. This pilot study was performed from August 2010 through December 2011 on 50 infertile women in ART cycles. Recombinant follicle stimulating hormone [rFSH] with a long gonadotropin releasing hormone [GnRH] analogue protocol were used for controlled ovarian hyperstimulation. The subjects were randomly allocated into two groups of 25 patients after obtaining written consent. Group A received a 10 mg Piroxicam capsule 30 minutes before embryo transfer and group B was the control group with no treatment. Data were analyzed by Chi-square and analysis of variance [ANOVA]. Pregnancy rate was 34% [n=17] totally, with 32% [n=8] in group A and 36% [n=9] in group B [p=0.75]. Uterine cramps were experienced by 4 women [16%] in group B, while none were reported by women in group A [p=0.037]. It seems that Piroxicam administration 30 minutes prior to embryo transfer cannot increase pregnancy rates, but can prevent or reduce uterine cramps after the procedure
Subject(s)
Humans , Male , Female , Reproductive Techniques, Assisted , Embryo Transfer , Pregnancy RateABSTRACT
Female sexual dysfunction is a common problem among general population, especially in urogynecological patient, and can lead to a decrease in quality of life and affect martial relationship. This study was compared the effect of surgical methods versus physiotherapy on sexual function in pelvic floor disorder. This randomized controlled trial was performed in Urogynecology clinic since August 2007 to December 2009 on 90 patients aged from 25-55 years with previous delivery, positive history of sexual dysfunction with stage <3 of pelvic organ prolapsed and divided in two groups. Group A [n=45] received standard rectocele repair and prineorrhaphy, group B [n=45] received physiotherapy for eight weeks twice a week [electrical stimulation, Kegel exercises]. The female sexual function index [FSFI] used to evaluate the sexual function in cases before and after intervention. Frequency of variable scores [libido, orgasm, dysparunia] included without disorder, frequently good, sometimes good, very much and extreme were compared between two groups. Libido and arousal were improved in both groups [p=0.007, p=0.001 respectively]. Orgasm and dyspareunia were improved in group B [p=0.001]. Dysparunia was more painful in group A. There was significant difference between two groups [improvement of orgasm and dysparunia in group B] [p=0.001]. It seems that physiotherapy is an appropriate method for treatment of sexual disorder in pelvic floor disorder.
ABSTRACT
Objective: This study was conducted with the aim to investigate and compare Iranian produced and foreign oxytocin for use in induction of labor
Materials and methods: This random clinical trial was conducted on a population of 198 pregnant women with live fetus and cephalic presentation and conditions conducive to induction of labor, monitored by obstetricians and gynecologists. They were randomly divided into group A [n = 99] received 10 units of Syntocinon [Novartis Pharma Canada] in 500 cc Ringer lactate, and group B [n = 99] received 10 units of Oxytip [Caspian Tamin Company Iran] in 500 cc serum, who entered the study to commence induction, by signing written consent. Study variables such as induction indications [post-term, ruptured membranes, diabetes, and..], induction duration, duration of the 1[st] and the 2[nd] stages of labor, and delivery method; as well as labor outcomes like hyper-stimulation of uterine, postpartum bleeding, 5-minute Apgar score, and infant's birth weight; and neonatal outcomes [admission to NICU, oxygen and intubation] were assessed for the two groups by a trained midwife and registered in the patient's questionnaire. Data were analyzed in SPSS software using statistical tests: t-test, Chi-square, and Mann-Whitney
Results: Two groups were similar in demographic variables such as; age, BMI, parity, education. There was no significant difference regarding to obstetric and gynecologic characteristics such as: gestational age, dilatation, effacement, and fetal positioning, as well as the indication for labor induction when the study began. After intervention, variables including: induction duration, duration of the 1[st] and the 2[nd] stages of labor, delivery method; and labor outcomes such as: hyper-stimulation of uterine, postpartum bleeding, 5-minute Apgar score, and infant's birth weight; and neonatal outcomes [admission to NICU, oxygen and intubation], in the two groups, were found to be the same [P < 0.05]. Mean oxytip dosage needed was less than that of oxytocin to reach for appropriate pain [P = 0.042]
Conclusion: The two drugs in terms of labor induction and neonatal complications had similar outcomes and the locally made drug with a lower dosage appears to produce the desired outcome
ABSTRACT
Objective: To evaluate the efficacy and side effects of Oxybutinin in comparison to tolterodine in treatment of overactive bladder [OAB] with detrussor overactivity [DOA] in Iranian women
Materials and Methods: One hundred Iranian old women with clinical symptoms of OAB who show IDO in the filling cystometry participated in this randomized double-blinded parallel-group by using two kinds of the drugs for 4- week course [2 mg tolterodine twice-daily, or oxybutinin 5 mg, three times a day] in alike packages. We collected data from 3-day FVC before and after the treatment course. The effectiveness of each drug was studied using the paired t-test and improvement after treatment between two groups was compared by independent T-test
Results: Positive changes in urinary urgency, Frequency and Urge incontinence after treatment in both groups were seen but mean improvements in the all were larger in the patients who treated by oxybutinin especially in terms of urgency and Urge incontinence. Dry mouth was the most common side-effect in two groups. Unlike other studies it was higher in the tolterodine group but the difference was not significant
Conclusion: Four week treatment with oxybutinin was better than tolterodine in improving urgency and urge incontinence but there were not statistically significance between them
ABSTRACT
Background: Polycystic Ovary Syndrome [PCOS] is presented with characteristic complications such as chronic an ovulation, obesity, and hyperandrogenism which can affect sexual function in women of reproductive age
Objective: Herein we evaluated the frequency and predisposing factors of sexual dysfunction in infertile PCOS patients
Materials and Methods: In this cross-sectional study, 130 married women with a definite diagnosis of PCOS who were referred due to infertility were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index [FSFI] questionnaire
Results: The frequency of sexual dysfunction was verified 57.7% in PCOS patients with the domains of desire and arousal being commonly affected in 99.2% and 98.5%of cases respectively. BMI had a significant effect on sexual desire and arousal [p=0.02] while the effect of hirsutism was significant on all domains [p<0.001 for total FSFI score] except for dyspareunia
Conclusion: PCOS patients markedly suffer from sexual dysfunction as comorbidity. It seems appropriate to screen all PCOS patients for sexual function with a simple short questionnaire such as FSFI. Targeted interventions could be considered to help improve their quality of life along with other treatments
ABSTRACT
The aims of this study were to determine the frequency of urinary and fecal incontinence and their determinants in pre-menopausal and menopausal women in Iran. This one-year cross-sectional study was performed on 304 women aged 40-55 who were admitted to women's clinic at Imam Khomeini Hospital. Symptoms of urinary, gas, and fecal incontinence and pelvic organs prolapse were diagnosed by a specialist through examination and a questionnaire. Patients were divided into two groups of with and without [urinary, gas, and fecal] incontinence symptoms. The probable risk factors of these disorders were studied and registered in the questionnaire and compared using t-test, chi-squared test, and regression of quantitative and qualitative variables. Generally, 129 [42%] out of 304 women had pelvic floor dysfunction [urinary and fecal incontinence, and pelvic organs prolapse]. Risk factors including menopause, hormone therapy, history of hysterectomy, inactivity, age, BMI, and first child's birth weight were compared between the two groups using chi-squared and t tests. There was a statistically significant difference between the two groups [P=0.000] as risk factors were more frequently observed in women with incontinence symptoms. Some risk factors of pelvic floor dysfunction are menopause, hormone therapy, history of hysterectomy, inactivity, age, BMI, and first child's birth weight. Therefore, some strategies should be included in women's health education programs to prevent the above-mentioned risk factors
Subject(s)
Humans , Female , Risk Factors , Premenopause , Menopause , Fecal Incontinence , Urinary Incontinence, Stress , Cross-Sectional StudiesABSTRACT
Zinc is the second main element in the body after iron. Its importance in pregnancy is related to role in DNA and protein synthesis and consequently the necessity of its availability for the appropriate growth and development of the fetus and neonate. The purpose of this study was to assess the effect of zinc supplement on fetal outcomes [height, weight, head and chest circumference of the fetus, low birth weight, and pre-term birth] in pregnant women with lower-than-median serum zinc. Participants of this experimental double-blind clinical trial study were 263 healthy singleton pregnant women with a mean age of 26.46 [+/- 4.52] years and gestational age of 14.52 [+/- 4.51] weeks whose [non-fasting] serum zinc levels were lower than median of the study population. All eligible individuals were randomly divided into two groups of zinc supplement and placebo. Individuals in the zinc supplement group [128 participants] took one zinc supplement capsule including 25 mg elemental zinc and participants in the placebo group [135 people] took one placebo capsule per day until the end of pregnancy. All women were under control and supervision until the end of the pregnancy and their information about labor, delivery, and neonate measures were collected through their obstetric records and then compared. Findings of this study showed no significant difference in fetal measures at birth [weight, height, head and chest circumference], pre-term delivery, and low birth weight between zinc supplement and placebo groups. According to our findings, administration of 25mg elemental zinc per day does not improve fetal measures in pregnant women with lower-than-median serum zinc concentration; however, more in-depth studies with larger sample sizes are recommended to achieve more reliable results
Subject(s)
Humans , Female , Pregnancy Outcome , Fetus , Pregnant Women , Pregnancy , Double-Blind MethodABSTRACT
PCOS is a multifaceted disorder with multiple potential risk factors [e.g. infertility, diabetes, cardiovascular disease and metabolic syndrome]. PCOS affects quality of life and can worsen anxiety and depression either due to the features of PCOS or due to the diagnosis of a chronic disease. This study aimed to determine the risk factors of PCOS in a group of patients. In this descriptive-analytic study, 81 patients with PCOS were studied in Vali-e-Asr Reproductive Health Research Center, Tehran, Iran. A questionnaire with items related to stress information was used for data collection. Stress symptoms were assessed using the Understanding Yourself standard questionnaire. Statistical analyses were performed using SPSS 13.0 [SPSS Inc., Chicago, ILL, USA]. Data are presented as mean +/- SD or as frequency with percentages. P-value less than 0.05 were considered as statistically significant. The evaluation of psychological signs in 81 PCO patients and descriptive results showed that 8 [9.9%] had not any stress problem, 32 [39.5%] had neurotic stress, 29 [35.8%] had high level and 12 [14.8%] had extremely high level of stress. The age range of 26 years and more [P=0.023], touchy personality [P = 0.028] and acne [P = 0.015] related with high stress level. The odds of high level of anxiety in women with hirsutism was 3.1 [95%CI 1.00 to 9.59]. The odds of high level of obsession in overweight patients was 3.2 [95%CI 1.12 to 9.234]. The odds of high level of worrisome in patients with touchy personality was 3.4 [95%CI 1.10 to 11.19]. Obsession score had a correlation with illness duration [r = -0.268, P = 0.038]. These data showed that clinical signs of PCOS are the most closely associated with psychological distress and this has important implications for the diagnosis and treatment of disorders
Subject(s)
Humans , Female , Psychology , Risk Factors , Surveys and Questionnaires , Anxiety , Obsessive Behavior , HysteriaABSTRACT
Polycystic ovary syndrome [PCOS] is a common cause of ovulatory disorders and infertility with high LH to FSH ratio. In order to prevent further increase of LH and follicle atresia, different regimens for ovulation induction have been recommended using FSH alone. This study was performed in PCOS patients to compare ART outcomes in cycles induced by FSH alone, using either recombinant or urinary products. In a randomized trial, from 623 patients who underwent down regulation with GnRH analogue in a long protocol, 160 PCOS patients were randomly divided into two groups of 80. Group A received 150 IU/d recombinant FSH [Gonal-F] and group B 150 IU/d urinary FSH [Fostimon]. 33 cases [41.2%] in group A and 36 [45%] in group B achieved clinical pregnancy, which was not significantly different [p=0.67]. Total number of oocytes retrieved [13.03 +/- 5.56 vs. 14.17 +/- 4.89, p=0.17], quality and number of embryos [7.42 +/- 3.35 vs. 7.63 +/- 3.28, p=0.68] and OHSS rate were similar in group A compared to group B. Endometrial thickness which was 9.66 +/- 1.67 mm in group A and 10.36 +/- 1.35 mm in group B, showed a significant difference [p=0.004]. It seems that in PCOS patients, both pure FSH products used for controlled ovarian hyperstimulation have similar effects on ART outcome and can be used according to availability and patient acceptance without significant difference
Subject(s)
Humans , Female , Young Adult , Adult , Follicle Stimulating Hormone/chemical synthesis , Follicle Stimulating Hormone , Polycystic Ovary Syndrome/drug therapy , Treatment Outcome , Randomized Controlled Trials as Topic , Prospective Studies , Pregnancy RateABSTRACT
Polycystic ovary syndrome [PCOS] is a complex, multifaceted, het-erogeneous disorder, affecting 4%?18% of reproductive-aged women and it is asso-ciated with reproductive, metabolic and psychological dysfunctions. PCOS affects quality of life and can worsen anxiety and depression either due to the features of PCOS or due to the diagnosis of a chronic disease. In this descriptive-analytical study, 81 patients with PCOS were recruited from Vali-e-Asr Reproductive Health Research Center. A questionnaire with items related to pieces of information about stress was used for data collection. Stress symptoms were assessed using the Understanding Yourself questionnaire. Statistical analyses were performed using SPSS Ver. 13.0 [SPSS Inc., Chicago, ILL, USA]. The data are presented as mean +/- SD or as frequency with percentages. A p-value less than 0.05 was considered as statistically significant. The descriptive results showed that 8 [9.9%] participants did not have any signs of stress, 32 [39.5%] had neurotic stress, 29 [35.8%] had high and 12 [14.8%] had extremely high levels of stress. The odds of high levels of anxiety in women with hirsutism was 3.1 [95% CI, 1.00?9.59]. The odds of high levels of obsession in overweight patients was 3.2 [95% CI, 1.12?9.234]. The odds of high levels of worries in patients with touchy personality was 3.4 [95% CI, 1.10?11.19] obsession score. The present study showed that clinical signs of PCOS were most close-ly associated with psychological distress which has important implications in the diagnosis and treatment of disorders
ABSTRACT
General concern is that the pregnancy rate is higher with GnRH-agonist as a protocol of pituitary suppression. GnRH-antagonist protocol provides a shorter period of administration and an easy flexible protocol. In this study, the outcomes of GnRH agonist and antagonist in ICSI cycles are compared in normo responder patients. In this randomized clinical trial, 300 normoresponders undergoing ICSI were randomly divided to GnRh agonist [n=150] and GnRh antagonist [n=150] groups. The main outcome measurements were chemical, clinical and ongoing pregnancy rates [PR]. The mean duration of stimulation were 9.6 +/- 1.6 and 8.2 +/- 1.6 days in agonist and antagonist groups respectively [p=0.001]. The mean number of MII oocyte retrieved in agonist and antagonist groups were 7.7 +/- 4.0 and 6.9 +/- 4.3 respectively [p=0.03]. There was no significant difference between two groups regarding mean number of gonadotrophin ampoules, follicles, occytes, total embryos and good quality embryos, OHSS incidence, and abortion rate. Chemical pregnancy rate was 35.3% in agonist and 39.3% in antagonist group. Clinical pregnancy rate was 35.3% in agonist and 34% in antagonist group. Ongoing pregnancy rate was 45 [31.3%] in agonist and 44 [29.3%] in antagonist group. There was no significant difference between two groups in pregnancy rates. In this study antagonist protocol was shown to be an easy, safe and friendly protocol in Iranian normoresponder patients, having similar outcomes with standard agonist protocol but shorter period of stimulation
ABSTRACT
To survey emotional intelligence in promoting of the citizenship behavior [manner gesture] of physicians. In a descriptive study, co relational and statistical community approach of research were used. Cases were doctors having subspecialty of the infertility in Islamic Republic of Iran. Using simple random sampling method 212 cases were selected. Questionnaire was used for data collection. After summarization, structural equation modeling techniques were used for analyses and interpretation of research data. Findings confirmed that three of the five aspects of EI have had significant positive impact on the citizenship manner of physicians that these factors in order to their priority impact are: 1] Empathy, 2] Self motivation and 3] Self control. EI interpersonal elements have greater influence on the citizenship behavior of physicians
ABSTRACT
Aplasia of the uterus and upper two-thirds of the vagina due to Mayer-Rokitansky-Kuster-Hauser syndrome prevents normal coitus which may lead to anxiety and other psychiatric problems in these women. Vaginal reconstruction improves the patients' quality of life. This study intends to compare sexual function in normal women and women having undergone vaginoplasty for Mayer-Rokitansky-Kuster-Hauser syndrome. This descriptive and analytical study was carried out in the gynecologic clinic of Imam Khomeini Hospital in 2004 to 2008. Nineteen female patients with Mayer-Rokitansky-Kuster-Hauser syndrome and a history of vaginoplasty were compared to 30 women without any anatomical malformations in their genitalia. The female sexual function index [FSFI] was used to evaluate the problem in the two groups. The calculated scores of the two groups were compared and statistically analyzed. The mean age of the patients was 29.57 [SD = 6.11] years. The mean score for sexual desire in individuals with a history of vaginoplasty was 22.84 [SD = 2.5] compared to 24.63 [SD = 2.94] in the healthy women [p = 0.033] and the mean score for sexual arousal in women having undergone vaginoplasty was 13.89 [SD = 2.47] compared to 15.27 [SD = 3.41] in the healthy individuals. Sexual arousal, orgasm and pain were not different between the two groups. Sexual arousal and satisfaction were not different in women having undergone vaginoplasty and women with normal sexual function. It seems that the surgery offers a better quality of life and is acceptable to women with Mayer-Rokitansky-Kuster-Hauser syndrome