N-acetyl cysteine in ovulation induction of PCOS women underwent intrauterine insemination: an RCT

Background: N-acetyl cysteine [NAC] was proposed as an adjuvant to clomiphene citratefor ovulation induction in patients with polycystic ovary syndrome [PCOS] without clomiphene citrate resistance

Objective: to evaluate the effect of NAC on pregnancy rate in PCOS patients who were candidates for intrauterine insemination

Materials and Methods: in this randomized clinical trial 97 PCOS women aged 18-38 years were enrolled in two groups, randomly. For the case group [n=49], NAC [1.2 gr]+ clomiphene citrate [100 mg] + letrozole [5mg] were prescribed Daily from the third day of menstruation cycle for five days. The control group [n=48] had the same drug regimen without NAC. In order to follicular development, GONALF was injected on days of 7-11 menstrual cycles in all participants. When the follicle size was 18mm or more, HCG [10000 IU] was injected intramuscular and the intrauterine insemination was performed after 34-36 hr

Results: there were not significant differences between study groups regarding mean endometrial thickness [p=0.14], mean number of mature follicles [p=0.20] and the pregnancy rate [p=0.09]

Conclusion: NAC is ineffective in inducing or augmenting ovulation in PCOS patients who were candidates for intrauterine insemination and cannot be recommended as an adjuvant to CC in such patients

Relationship between progesterone level on the day of human chorionic gonadotropin administration with outcomes of intra-cytoplasmic sperm injection in infertile couples

Gonadotropin-releasmg hormone agonists or antagonists are used in assisted reproductive technique cycles as premature luteinizing hormone secretion inhibition. Studies have been reported different and contradictory results on the serum progesterone effect on intra-cytoplasmic sperm injection. The purposeof this study was to evaluate the effect of serum progesterone level on the day of Human chorionic gonadotropin [HCG] administration on the intra-cytoplasmic sperm injection [ICSI] outcome in infertile women. 249 infertile couples candidated for ICSI were enrolled in the study. Their serum progesterone level on the day of HCG administration was measured and according to serum level, patients were divided into four groups of less than 0.9, 0.9-1.4, 1.5-1.9, and 7/= ng/mL. The four groups were compared with each other regarding fertility outcomes. Pregnancy rate was not significantly different among the four groups [p>0,05]. Also, there was no significant difference among the groups regarding frequency of abortion and ectopic pregnancy. Serum progesterone level on the day of HCG administration does not have any significant effect on pregnancy outcomes, including abortion, ectopicpregnancy, and pregnancy rate in patients undergoing ICSI treatment

Persistence of hemorrhage and hypertensive disorders of pregnancy [HDP] as the main causes of maternal mortality: emergence of medical errors in Iranian healthcare system

This study aimed to assess factors affecting substandard care and probable medical errors associated with obstetric hemorrhage and HDP at a Northwestern Iranian health care system. In a community-based descriptive cross-sectional study, data on all maternal deaths occurred at West Azerbaijan Province, Iran during a period of 10 years from March 21, 2002 to March 20, 2011 was analyzed. The principal cause of death, main contributory factors, nature of care, main responsible staff for sub-standard care and medical error were determined. The data on maternal deaths was obtained from the national Maternal Mortality Surveillance System [MMSS] which were covered all maternal deaths. The "Three delays model" was used to recognize contributing factors of maternal deaths due to obstetric hemorrhage and HDP. There were 183 maternal deaths, therefore the Mean Maternal Mortality Ratio [MMR] in the province was 32.8 per 100 000 live births [95% CI, 32.64-32.88]. The most common causes of maternal deaths were obstetric hemorrhage in 36.6% of cases and HDP in 25.7%. The factors that most contributed to the deaths were all types of medical errors and substandard care with different proportions in management of obstetric hemorrhage and HDP. A substandard care and medical error was the major contributing factor in both obstetric hemorrhage and HDP leading to maternal mortality, therefore, it is necessary to improve the quality of health care at all levels especially hospitals

Effects of Antibiotic Consumption on Children 2-8 Years of Age Developing Asthma / 한국역학회지

OBJECTIVES: Antibiotic exposure in children is a possible contributor to the increasing asthma prevalence in several countries. The present study aimed to investigate the association between antibiotic exposure and the risk of developing childhood asthma at 2-8 years of age. METHODS: A case-control study was undertaken among children aged 2-8 years old between March and September 2010 in the Urmia district in the northwest of Iran. The cases were doctor-diagnosed asthmatic children based on Global Initiative for Asthma criteria (n=207), and the controls were children without respiratory symptoms (n=400) selected by frequency matching by age and gender. Clinical data including antibiotic exposure was collected by a validated and reliable questionnaire, which was completed by interviewing parents/guardians. RESULTS: Antibiotic consumption during the first year of life increased the odds ratio [OR] of asthma symptoms at 2-8 years of age (crude OR, 2.26; 95% confidence interval [CI], 1.53-3.35; p<0.01), and the strength of association was similar after adjusting for a family history of asthma or atopic disorder, preterm delivery, birth order, and delivery method (adjusted OR, 1.91; 95% CI, 1.27-2.88; p=0.03). CONCLUSIONS: Our study suggests that antibiotic consumption in children was associated with an increased risk of childhood asthma, and an additional confirmative study is needed.

[Evaluation of serum estradiol/ progestrone ratio on day of embryo transfer and it's effect on intra- cytoplasmic sperm induction outcome]

One of the important problems in fertilization in vitro [IVF] is failure of implantation. This could be the result of estrogen and progesterone effects in endometrial acceptance during ovulation stimulation. Although progesterone has a vital role in primary phase of pregnancy, but the estradiol role in luteal phase is unknown. The aim of this study is assessment of the ratio of estradiol to progesterone in embryo transfer day on Intracytoplasmic sperm injection [ICSI] outcomes. This is a cohort study. The subjects were 311 infertile women referred to Urmia Kosar infertility clinic and Urmia reproductive health research center who treated with ICSI method between August-Jan 2011. Five cc blood was drawn for determine of estradiol and progesterone in transfer day. Transfer occurred after a variable in vitro culture period ranging from 48 to 72 hours after ovulation induction. Chemiluminescent ELICA the level of mention hormones was used to determine the ratio of the progesterone level to the estradiol serum level and was compared based on treatment outcomes. A total of 311 patients, 115 [37%] were pregnant and happened abortion were 18 [5.8%]. The mean ratio of estradiol to progesterone in transfer day in two groups of miscarriage/ non miscarriage and pregnant/ non pregnant was 32.26 +/- 23.86, 28.17 +/- 26.5 and28.58 +/- 2.4, 36.09 +/- 4.39 respectively. There is no significant difference between two groups in regard of estradiol on progesterone ratio [P=0.5, P=0.2]. The results of this prospective cohort study show that there is no effect of estradiol to progesterone ratio on day of embryo transfer, successful pregnancy in ICSI cycles and abortion rate following of ICSI.