[ comparative study comparing low-dose step-up versus step-down in polycystic ovary syndrome resistant to clomiphene]

Polycystic ovary syndrome [PCOS] is one of the most common cause of infertility in women. Clomiphene is the first line of treatment, however 20% of patients are resistant to clomiphene. Because of follicular hypersensitivity to gonadotropins in pcod, multiple follicular growth and development occurs which is cause of OHSS and multiple pregnancy. Our aim of this random and clinical study was comparation between step-down and low dose step-up methods for induction ovulation in clomiphene resistant. 60 cases were included 30 women in low-dose step-up group and 30 women in step-down group. In low-dose step-up HMG 75u/d and in step-down HMG 225 u/d was started on 3[rd] days of cycle, monitoring with vaginal sonography was done on 8[th] days of cycle. When follicle with>14mm in diameter was seen HMG dose was continued in low-dose step-up and was decreased in step-down group. When follicle reached to 18mm in diameter, amp HCG 10000 unit was injected and IUI was performed 36 hours later. Number of HMG ampules, number of follicles>14mm on the day of HCG injection and level of serum estradiol was greater in low dose step up protocol than step down protocol [p<0/0001]. Ovulation rate and pregnancy rate was greater in low dose step up group than step down group with significant difference [p<0/0001]. Our study showed that low-dose step-up regimen with HMG is effective for stimulating ovulation and clinical pregnancy but in view of monofollicular growth, the step down method was more effective and safe. In our study multifolliular growth in step-up method was higher than step-down method. We can predict possibility of Ovarian Hyperstimulation Syndrome in highly sensitive PCOS patients

[Relationship of serum ceruloplasmin and pre-eclampsia]

Pre-eclampsia is a pregnancy disorder which increases maternal and pre-natal morbidity and mortality. The incidence is about 5% and is influenced by pariety, genetic background, and environmental factors. At present, the sole treatment is termination. It is suitable to use antioxidants for pre-eclampsia prevention. The aim of this study is to measure the maternal serum ceruloplasmin and evaluation of changes presented in pre-eclamptic women VS. Non pre-eclamptic ones. This study is executed in a case-control method. 100 cases were selected through pregnant women bedridden from obstetrics-gynecologic and maternity ward of Imam Khomeini Hospital in Sari. After examination of exclusion criteria in each case and receiving consent, information was entered in the questionnaire. Venous blood samples were sent to laboratory to measure ceruloplasmin. Data was analyzed by independent t-test. The gestational age means in case and control groups were serially 36.01 +/- 2.90 and 37.86 +/- 2.82 weeks. The mean for systolic blood pressure for these two groups were serially 153.40 +/- 12.22 and 112.5 +/- 8.90 mm Hg. The average amount of serum ceruloplasmin in case group was significantly more than control group. 63.3% of women in the case group were in early pre-eclamptic phase and 36.7% of them were in late phase. 22% of women in this group had a history of pre-eclampsia in previous pregnancies and 16% additionally had a history of hypertension before pregnancy. 92% of women in the case group had an extra normal serum ceruloplasmin, while in the control group the number was 42%. The variables of Body mass Index, Systolic and Diastolic blood pressure and ceruloplasmin showed a significant difference between case and control groups. The history of pre- eclampsia and hypertension were effective on the appearance of pre-eclampsia and increased in serum ceruloplasmin, can be considered as an early sign, while having a correlation with pre-eclampsia severity

[Peritoneal benign cystic mesothelioma in a patient with presentation of ascites, a case reprot]

Cystic mesotheloma is an uncommon lesion of the peritoneum occurring predominantly in women of reproductive age. The case was a 21 years girl presented with 4 years history of mild abdominal distension and periodic pain. The results of the clinical examinations were normal. Sonography and CT scan confirmed gross ascites. The results of paraclinical tests were normal without any positive findings for etiology of acites. During laparoscopy multiple transparent cysts were found in pelvic and culdesac. All cysts were removed by laparoscopy. Histology confirmed benign cystic mesotheloma. Reviewing the records revealed that this case is the second case of mesothelial cysts that presented with ascites

[Effect of varicocelectomy on semen analysis parameters in patients with abnormal semen parameters]

Varicocele represents the most common corrigible surgery in infertile men. The aim of present study was to evaluation the effect of varicocelectomy on heptads semen parameters in patients with abnormal semen parameters. This study was conducted on infertile patients who have abnormal semen analysis according to WHO parameters and to an urologist diagnosis, they have varicocele size with grade II, III, they came to infertility clinic of Imam Khomeini Hospital, Sari, Iran, 2004. The Inguinal varicocelectomy was performed over these patients by a urologist. They follow up on the basis of varicocele, post surgery complication, and semen analysis for three months. 67 patients participated in this study with the mean age of 33/6 +/- 7/3 and a range of 20-50 years. The patients's infertility range was 2-20 years, and with the mean 6/5 +/- 4/02.%58 has varicocele with grade two and%42 with grade three. In this study, the significant change in total sperm count, sperm motility, sperm morphology [P<0.05], was observed in patients before and after varicocelectomy. It hasn't also observed any significant association between heptads semen analysis parameters and varicocele grade. Performing varicocelectomy could be useful improvement of semen analysis parameters and in the possible treatment of infertility in men as well