ABSTRACT
Background: understanding the prevalence of menstrual disorders has important implications for both health service planning and risk factor epidemiology
Objective: the aim of this review is to identify and collate studies describing the prevalence of menstrual disorders in Iran
Materials and Methods: studies with original data related to the prevalence of menstrual disorders were identified via searching six electronic databases and reviewing citations. All abstracts or titles found by the electronic searches were independently scrutinized by two reviewers. The Meta-analysis was performed with a random effects model, considering the remarkable heterogeneity among studies. A total of 35 eligible epidemiological studies were included in this review
Results: overall, the pooled prevalence of primary dysmenorrhea was 73.27% [95% CI=65.12-81.42]. The mean proportion of women with oligomenorrhea was 13.11% [95.5%, 95% CI: 10.04-16.19]. We identified 16 studies that reported polymenorrhoea with a random effect of pooled prevalence estimate of 9.94% [95% CI 7.33%-12.56%]. The prevalence estimate of hypermenorrhea was 12.94% [95% CI 9.31%-16.57%]. Overall prevalence of hypomenorrhea was 5.25% [95% CI 3.20%-7.30%], ranging from 0.9- 12.90%. Pooling six studies that reported estimates for menorrhagia, the overall prevalence was 19.24% [95% CI 12.78-25.69]. Overall, 6.04% [95% CI: 1.99-10.08] of the women were shown to have metrorrhagia
Conclusion: this systematic review suggests that the average prevalence of menstrual disorders in Iran is substantial. It has been neglected as a fundamental problem of women's reproductive health. Diagnosis and treatment of these disorders should be included in the primary health care system of reproductive health
ABSTRACT
Background: Women undergoing in vitro fertilization [IVF] cycles should successfully go through multiple points during the procedure [i.e., implantation, clinical pregnancy, no spontaneous abortion and delivery] to achieve live births. In this study, data from multiple cycles and multiple points during the IVF cycle are collected for each individual to model the effects of factors associated with success at different stages of IVF cycles in Iranian infertile women
Materials and Methods: This historical cohort study includes 996 assisted reproductive technology [ART] cycles of 511 infertile women. Covariates considered in this study were women's age, type of cycle [fresh or frozen embryo transfer], number of embryos transferred and having polycystic ovarian syndrome during IVF cycles. Generalized estimating equations were used for calculation of odds ratio [OR] and 95% confidence intervals [95% CI] of success at different stages during IVF cycles. Cluster-weighted generalized estimating equations [CWGEE] was also fitted to handle informative cluster size
Results: After adjusting for potential confounders, it was seen that receiving frozen embryo transfer was associated with higher odds of success compared to receiving fresh embryo transfer [adj OR: 2.26, 95% CI: 1.66-3.07]; however, cycles with fresh embryo transfer exhibited better results in clinical pregnancy compared to those receiving frozen embryo. Being in the age category of 38 to 40 was associated with lower odds of success compared to the reference category [<35] in CWGEE model [adj OR: 0.67, 95% CI: 0.45-1.00]. The number of embryos transferred was positively associated with the odds of success in CWGEE [adj OR: 1.21, 95% CI: 1.03-1.42] as well as the GEE model
Conclusion: Receiving frozen embryo was positively associated with odds of success compared to cycles with fresh embryo. The number of embryos transferred and women's age were significantly associated with odds of success
ABSTRACT
Background: premenstrual syndrome [PMS] is a common disorder characterized by physical, mental and behavioral changes in the luteal phase of the menstrual cycle in the reproductive age women
Objective: the present study aimed to determine the overall prevalence of PMS in Iran by a systematic review and meta-analysis study
Materials and Methods: in this systematic review and meta-analysis, we searched international databases included ISI Web of Knowledge, PubMed/Medline, Scopus, Google Scholar, and also local databases including Iranmedex, Scientific Information Database, and Magiran for articles in English and Persian language published up to September 2016. We carried out data analysis with Stata version 11. We examined heterogeneity in the results of studies through I[2] statistics and chi- square based Q test. Also, we investigated the effects of potential heterogeneity factors in the prevalence of PMS by meta-regression
Results: we studied a total of 9147 reproductive-age women from 24 articles which entered to meta-analysis. Based on the result of random effect model, we estimated the overall prevalence of PMS 70.8% [95% CI: 63.8-77.7]. The results of subgroup analysis revealed that prevalence of PMS was 80.4% [95% CI; 66.9-93.9] among high school students, 68.9% [95% CI; 59.2-78.6] among university students, and 54.9% [95% CI; 51.6-58.2] in general population. Univariate meta-regression model showed that prevalence of PMS was decreased by increasing the age of subjects but this was not statistically significant [p=0.155]
Conclusion: our finding showed that PMS was prevalent in Iranian reproductive age women especially among high school students. More epidemiological research for determining factors that affect PMS prevalence seems essential
ABSTRACT
Background: The hospital anxiety and depression scale [HADS] is a common screening tool designed to measure the level of anxiety and depression in different factor structures and has been extensively used in non-psychiatric populations and individuals experiencing fertility problems
Objective: The aims of this study were to evaluate the factor structure, item analyses, and internal consistency of HADS in Iranian infertile patients
Materials and Methods: This cross-sectional study included 651 infertile patients [248 men and 403 women] referred to a referral infertility Center in Tehran, Iran between January 2014 and January 2015. Confirmatory factor analysis was used to determine the underlying factor structure of the HADS among one, two, and three factor models. Several goodness of fit indices were utilized such as comparative, normed and goodness of fit indices, Akaike information criterion, and the root mean squared error of approximation. In addition to HADS, the Satisfaction with Life Scale questionnaires as well as demographic and clinical information were administered to all patients
Results: The goodness of fit indices through CFAs exposed that three and one factor model provided the best and worst fit to the total, male and female datasets compared to the other factor structure models for the infertile patients. The Cronbach's alpha for anxiety and depression subscales were 0.866 and 0.753 respectively. The HADS subscales significantly correlated with SWLS, indicating an acceptable convergent validity
Conclusion: The HADS was found to be a three-factor structure screening instrument in the field of infertility
ABSTRACT
Background: Multiple pregnancies are an important complication of assisted reproductive technology [ART]. The present study aims to indentify the risk factors for multiple pregnancies independent of the number of transferred embryos
Materials and Methods: This retrospective study reviewed the medical records of patients who underwent intracy topi asm ic sperm injection [ICSI] cycles in Royan Institute between October 2011 and January 2012. We entered 12 factors that affected the number of gestational sacs into the poisson regression [PR] model. Factors were obtained from two study populations-cycles with double embryo transfer [DET] and cycles that transferred three embryos [TET]. We sought to determine the factors that influenced the number of gestational sacs. These factors were entered into multivariable logistic regression [MLR] to identify risk factors for multiple pregnancies
Results: A total of 1000 patients referred to Royan Institute for ART during the study period. We included 606 eligible patients in this study. PR analysis demonstrated that the quality of transferred embryos and woman's age had a significant effect on the number of observed sacs in patients who underwent ICSI with DET. There was no significant predictive variable for multiple pregnancies according to MLR analysis. Our findings demonstrated that both regression models [PR and MLR] had the same outputs. A significant relation existed between age and fertilization rate with multiple pregnancies in patients who underwent ICSI with TET
Conclusion: Single embryo transfer [SET] should be considered with the remaining embryos cryopreserved to prevent multiple pregnancies in women younger than 35 years of age who undergo ICSI cycles with high fertilization rates and good or excellent quality embryos. However, further prospective studies are necessary to evaluate whether SET in women with these risk factors can significantly decrease multiple pregnancies and improve cycle outcomes
ABSTRACT
Background: This study compared common psychological symptoms and life satisfaction in husbands and wives according to infertility diagnosis
Materials and Methods: We conducted this cross-sectional study on 248 infertile couples between November 1, 2014 and February 28, 2015 at Royan Institute, Tehran, Iran. Participants answered three questionnaires. First, they completed a demographic questionnaire followed by the Hospital Anxiety and Depression Scale [HADS, 14-item self-report instrument] composed of two sub-scales: anxiety [HADS-A] and depression [HADS-D]. Participants also completed the Satisfaction with Life Scale [SLWS] comprised of 5 items. Both our questionnaires were validated for the Iranian population
Results: In couples with male factor infertility, wives had a significantly higher mean score for anxiety compared to their husbands [P<0.001]. When the cause of infertility was female factor, the wives appeared significantly more anxious [P<0.001] and depressed [P=0.004] than their husbands. Male patients, those with unknown and female factors, expressed greater satisfaction with life compared to other male patients [P=0.022]. Significantly greater depression existed among the couples in which the wives' educational levels was above their husbands [P=0.045]
Conclusion: Our findings showed that when the infertility etiology was male factor, female factors or unexplained, wives showed significantly higher anxiety than their husbands. In couples diagnosed with female factor infertility, wives showed significantly more depression than their husbands
ABSTRACT
Background: The multiple pregnancy incidence is increasing worldwide. This increased incidence is concerning to the health care system. This study aims to determine the frequency of multiple pregnancy and identify factors that affect this frequency in Tehran, Iran
Materials and Methods: This cross-sectional study included 5170 mothers in labor between July 6-21, 2015 from 103 hospitals with Obstetrics and Gynecology Wards. The questionnaire used in this study consisted of five parts: demographic characteristics; information related to pregnancy; information related to the infant; information regarding the multiple pregnancy; and information associated with infertility. We recruited 103 trained midwives to collect data related to the questionnaire from eligible participants through an interview and medical records review. Frequencies and odds ratios [OR] for the association between multiple pregnancy and the selected characteristics [maternal age, economic status, history of multiple pregnancy in first-degree relatives, and repro-ductive history] were computed by multiple logistic regression. Stata software, version 13 [Stata Corp, College Station, TX, USA] was used for all statistical analyses
Results: Multiple pregnancy had a prevalence of 1.48% [95% confidence interval [CI]: 1.19-1.85]. After controlling for confounding variables, we observed a significant association between frequency of multiple pregnancy and mother's age [OR=1.04, 95% CI: 1.001-1.09, P=0.044], assisted reproductive technique [ART, OR=6.11, 95% CI: 1.7-21.97, P=0.006], and history of multiple pregnancy in the mother's family [OR=5.49, 95% CI: 3.55-9.93, P=0.001]
Conclusion: The frequency of multiple pregnancy approximated results reported in previous studies in Iran. Based on the results, we observed significantly greater frequency of multiple pregnancy in older women, those with a history of ART, and a history of multiple pregnancy in the mother's family compared to the other variables
ABSTRACT
Objective: In assisted reproductive technology, it is important to choose high quality embryos for embryo transfer. The aim of the present study was to determine the grade A embryo count and factors related to it in infertile women
Materials and Methods: This historical cohort study included 996 infertile women. The main outcome was the number of grade A embryos. Zero-Inflated Poisson [ZIP] regression and Zero-Inflated Negative Binomial [ZINB] regression were used to model the count data as it contained excessive zeros. Stata software, version 13 [Stata Corp, College Station, TX, USA] was used for all statistical analyses
Results: After adjusting for potential confounders, results from the ZINB model show that for each unit increase in the number 2 pronuclear [2PN] zygotes, we get an increase of 1.45 times as incidence rate ratio [95% confidence interval [CI]: 1.23-1.69, P=0.001] in the expected grade A embryo count number, and for each increase in the cleavage day we get a decrease 0.35 times [95% CI: 0.20-0.61, P=0.001] in expected grade A embryo count
Conclusion: There is a significant association between both the number of 2PN zygotes and cleavage day with the number of grade A embryos in both ZINB and ZIP regression models. The estimated coefficients are more plausible than values found in earlier studies using less relevant models
ABSTRACT
Background: Infertility and its treatment can have a considerable effect on a person's quality of life [QoL]. The Fertility QoL [FertiQoL] questionnaire is currently the most frequently used instrument to measure QoL in people with fertility problems. This study aims to examine the reliability and validity of the FertiQoL in infertile Iranian women
Materials and Methods: This cross-sectional study included 155 women with fertility problems in a referral fertility clinic in Tehran, Iran from January to March 2014. A battery of instruments was used: FertiQoL, Satisfaction with Life Scale [SWLS], Hospital Anxiety and Depression Scale [HADS], and a demographic questionnaire. Construct validity of the scale was evaluated using confirmatory factor analysis [CFA]. We assessed internal consistency with Cronbach's alpha and convergent validity was examined by correlating the FertiQoL with SWLS and HADS
Results: The results of the CFA generally supported the four-factor model of Core FertiQoL and two-factor model of Treatment FertiQoL. Both FertiQoL modules and their subscales revealed acceptable internal consistency that ranged from 0.643 to 0.911. However, the FertiQoL might be improved if Q15 and T2 items were removed from the scale. These items had low loadings on the Relational and Environment factors which decreased their internal consistency. The FertiQoL and their subscales significantly correlated with both SWLS and HADS, which confirmed convergent validity
Conclusion: The Persian version of the FertiQoL is a valid, reliable instrument to measure QoL in infertile women and seems to perform as well as the original English Version
Subject(s)
Adult , Adolescent , Female , Humans , Middle Aged , Young Adult , Infertility, Female/psychology , Quality of Life , Surveys and Questionnaires , Cross-Sectional StudiesABSTRACT
Background: In order to empower infertile individuals and provide high quality patient-centered infertility care, it is necessary to recognize and meet infertile individuals' educational needs. This study aims to examine infertility patients' knowledge and subsequently their education needs given their attitudinal approach to infertility education in terms of patients who undergo assisted reproduction treatment
Materials and Methods: This descriptive study enrolled 150 subjects by convenience sampling of all patients who received their first assisted reproductive treatment between July and September 2015 at a referral fertility clinic, Royan Institute, Tehran, Iran. We used a questionnaire that measured fertility and infertility information [8 questions] as well as attitude toward education on the causes and treatment of infertility [5 questions]. Chi-square, independent sample t test, and one way ANOVA analyses were conducted to examine differences by sex. P<0.05 was considered statistically significant
Results: Total mean knowledge was 3.08 +/- 0.99. Clients' responses indicated that the highest mean knowledge scores related to knowledge of factors that affected pregnancy [3.97 +/- 1.11] and infertility treatment [3.97 +/- 1.16]. The lowest mean knowledge scores related to knowledge of the natural reproductive cycle [2.96 +/- 1.12] and anatomy of the genital organs [2.94 +/- 1.16]. Most females [92.1%] and males [83.3%] were of the opinion that infertility education programs should include causes of infertility and types of treatment associated with diagnostic and laboratory procedures. No statistically significant difference existed between male and female participants [P=0.245]
Conclusion: Most participants in this study expressed awareness of factors that affect pregnancy and infertility treatment. It is imperative to educate and empower infertile individuals who seek reproduction treatment in terms of infertility causes and types of treatment, as well as diagnostic and laboratory procedures to enable them to make informed decisions about their assisted reproductive procedures