Aberrant expression of microRNAs 16 and 21 and gene targets in women with unexplained recurrent miscarriage: a case-control study

Background: Recurrent miscarriage, as the occurrence of two or more of pregnancy loss before the 20[th] wk, can occur for multiple causes. One of the causes of miscarriage may be a defect in the process of angiogenesis because the delivery of nutrients to the fetus is decreased and it may lead to miscarriage. Also, micro ribonucleic acids play an important role in the development of diseases. The microRNAs 16 and 21 are the most well-known angiogenesis-related miRNAs, which their gene targets are vascular endothelial growth factor-A and phosphatase and tensin homolog, respectively

Objective: To evaluate the changes in expression of microRNAs 16 and 21 and their association with the gene targets in women with unexplained RM

Materials and Methods: In this case-control study, blood samples were taken from 25 women with unexplained RM and 25 controls. After extraction of RNA, the relative expression of microRNAs and their gene targets was measured using real-time quantitative reverse transcription-PCR method

Results: Our findings showed that miR-21 expression was significantly decreased in both plasma and peripheral mononuclear cells [p=0.04 and p=0.02, respectively] and could be associated with the PTEN expression [p=0.03], however, there is no significant correlation between miR-16 and VEGF-A

Conclusion: One of the most remarkable results of this study is that miR-21 showed significant changes in both plasma and peripheral mononuclear cells, which can be related to the etiology and progression of RM

frequency of gonorrheal and chlamydial infections in Zanjanian women in 2013-2014

Background: Chlamydia trachomatis and Neisseria gonorrhoeae are the most prevalent bacterial sexually transmitted diseases in women

Objective: The purpose of this study was to investigate the prevalence of gonorrheal and chlamydial infections and determination of related risk factors in married women with vaginal discharge attending gynecological outpatient department [OPD] in Zanjan in 2013-2014

Materials and Methods: In this cross sectional study, 100 married women aged 18-49 years with vaginal discharge were evaluated for signs and symptoms of gonococcal and chlamydial infections. Then cervical discharge samples and blood samples were collected from each subject for the detection of Nisseria gonorrhea and Chlamydia trachomatis by bacterial culture and serological tests, respectively

Results: The overall prevalence of Chlamydia trachomatis and Nisseria gonorrhoeae were 16% and 4%, respectively. There was no significant relationship between the contraception methods, previous history of vaginal infections, previous history of urinary tract infections, number of coitus per week and self-reported symptoms [itching, burning, abdominal pain] with prevalence of Nisseria gonorrhoeae and Chlamydia trachomatis

Conclusion: According to our results, the prevalence of gonococci infection in Zanjan was remarkable and relatively was higher than other parts of Iran, therefore it is necessary to put emphasis on education and further preventive and therapeutic programs

Final follicular maturation by administration of GnRH agonist plus HCG versus HCG in normal responders in ART cycles: an RCT

Background: Gonadotropin-releasing hormone agonists [GnRH-a] was increasingly used for triggering oocyte maturationfor the prevention of ovarian hyperstimulation syndrome. Studies suggest that GnRH-a might be used as a better trigger agent since it causes both Luteinizing hormone and follicle stimulating hormone release from a physiologic natural cycle

Objective: The aim of this study was to evaluate the effect of dual-triggering in assisted reproductive technology outcomes

Materials and Methods: 192 normal responder women aged

Results: The mean of retrieved oocytes and obtained embryos were statistically higher in the dual-trigger group [group I], but the implantation and pregnancy rates were similar in two groups

Conclusion: The results of our study did not confirm the favorable effect of dual-triggered oocyte maturation with a GnRH-a and a standard dosage of hCG as an effective strategy to optimize pregnancy outcome for normal responders in GnRH-antagonist cycles. We think that this new concept requires more studies before becoming a universal controlled ovarian hyperstimulation protocol in vitro fertilization practice

Evaluation of the appropriate size of follicles on success rate in patient undergoing controlled ovarian stimulation and intrauterine insemination cycles

Objectives: Intra-Uterine Insemination [IUI] is one of the methods for infertility treatments. The size of the follicles and endometrial thickness are two important factors in pregnancy rate of patients undergoing controlled ovarian stimulation and intrauterine insemination cycles [COH-IUI]. The aim of this study was to investigate the success rate of IUI and follicular size and other associated factors in infertile couples

Materials and Methods: The study group was the patients who were undergoing COH-IUI. BMI of all women recorded and ovulation induction was propelled and when there was appropriate endometrial thickness and at least one dominant follicle in trans-vaginal ultrasonography. 36 hours after HCG injection, IUI was performed. Then pregnancy rate between patients who had follicle size fewer than 20 mm and higher than 20 mm was assumed

Results: 159 cases of IUI were performed and pregnancy happened in 22[14.1 %]. In non-pregnant group [134 cases], 78 cases had under 20 mm follicles and 47 cases had higher than 20 mm follicles. In pregnant group [22 cases] 10 cases had fewer than 20 mm follicles and 12 cases had higher than 20 mm follicles in the time of HCG injection. Endometrial thickness was 8.01+/-1.42 mm in patients with follicles more than 20 mm

Conclusion: The success rate in controlled ovarian stimulation and intrauterine insemination cycles closely related to obtaining of optimal size of follicles and endometrial thickness

Does progesterone suppository to luteal phase support have any effect on pregnancy rates in the intrauterine insemination cycles?

Objectives: Rate of infertility in overall is around 15-10%. Intra-Uterine Insemination [IUI] is one procedure for infertility treatment. Luteal phase support defect is a main factor in fail of pregnancy. Goal of this study was to evaluate the effect of luteal phase support with progesterone suppository in patients who undergoing IUI cycles

Materials and Methods: 100 infertile couples who were undergoing IUI treatment included in this study. Ovulation induction was done for all patients. When IUI was done, patients were distributed into two groups. The study group [n=50] received progesterone suppository and control group [n=50] doesn't received any medicine. Then biochemical pregnancy rate, clinical pregnancy rate and abortion rate compared between two study groups

Results: There were no differences in basic characteristics between two groups. Biochemical and clinical pregnancy were parallel in the study and control groups. There were no statistically significant increases in abortion rate between the study groups [P=0.49]

Conclusion: Luteal phase support by progesterone suppository does not improve the pregnancy rate of stimulated IUI cycles

effect of luteal phase gonadotropin-releasing hormone antagonist administration on IVF outcomes in women at risk of OHSS

Background: gonadotropin-releasing hormone [GnRH] plays essential roles in embryo implantation, invasion of trophoblastic tissue, and steroid synthesis in the placenta

Objective: the aim of this study was to evaluate the effect of GnRH antagonist administration on pregnancy outcomes in early implantation period

Materials and Methods: in this retrospective study, 94 infertile women undergoing GnRH antagonist protocol who were at risk of ovarian hyperstimulation syndrome [OHSS] were included. Sixty-seven patients [group I] received Cetrorelix 0.25 mg/daily in the luteal phase for 3 days while in 27 participants [group II], it was not administered. Pregnancy outcomes were assessed based on chemical and clinical pregnancy rates

Results: the pregnancy outcomes were not significantly different between two groups [p=0.224]

Conclusion: the present study proposed that luteal phase GnRH antagonist administration does not influence the chance of successful pregnancy outcomes

Effect of laparoscopic ovarian drilling on outcomes of in vitro fertilization in clomiphene-resistant women with polycystic ovary syndrome

Background: Recently the laparoscopic ovarian drilling [LOD] has been used as a surgical treatment for ovulation in women with polycystic ovarian syndrome [PCOS], although its mechanism and outcomes are still unclear. This study was undertaken to evaluate the in vitro fertilization [IVF]/intracytoplasmic sperm injection [ICSI] outcomes in clomiphene-resistant women with PCOS who were treated with LOD

Materials and Methods: In this retrospective study, we reviewed the medical records of 300 women between 20 to 35 years old with clomiphene-resistant PCOS who had an ovulatory infertility and who were nominated for IVF/ICSI. Based on their treatment history, they were located into the following two groups: group I [n=150] including PCOS women who had history of LOD at least 6 months to 3 years before IVF/ICSI, and group II [n=150] including PCOS patients without history of drilling. Both groups were treated with antagonist protocol in the assisted reproductive technology [ART] process. The duration of treatment cycles, number of oocytes and embryos obtained, chemical and clinical pregnancy rate, the number of embryos transferred, and presence of ovarian hyper stimulation syndrome [OHSS] were measured. To compare means and frequencies, Student's t test, Mann-whitney and chi-square tests were used

Results: Our results showed that ovarian cauterization before IVF/ICSI in patients with PCOS reduced the risk of OHSS [P=0.025]. Despite the same pregnancy rate in both groups [P=0.604], more obtained oocytes and embryos were seen on women without ovarian drilling than women with LOD [P<0.001 and P=0.033, respectively]

Conclusion: There is no difference between the pregnancy rate in both groups. Due to significant reduction in OHSS in women undergoing LOD, this surgical treatment may be considered as a useful technique in the management of patients who have previously developed OHSS. However, there are ongoing concerns about long-term effects of LOD on ovarian function

Efficacy of Intrauterine infusion of granulocyte colony stimulating factor on patients with history of implantation failure: a randomized control trial

Background: Although pregnancy rate in in vitro fertilization-embryo transfer [IVF-ET] cycles has been increased over the preceding years, but the majority of IVF-ET cycles still fail. Granulocyte colony stimulating factor [GCSF] is a glycoprotein that stimulates cytokine growth factor and induces immune system which may improve pregnancy rate in women with history of implantation failure

Objective; The aim of this study was to evaluate GCSF ability to improve pregnancy rate in women with history of implantation failure

Materials and Methods: 0.5 ml [300 microg/ml[ GCSF was infused intrauterine in intervention group. Pregnancy outcomes were assessed based on clinical pregnancy

Results: The mean age of participants was 31.9S+/-4.71 years old. There were no significant differences between demographic characteristics in two groups [p>0.05]. The pregnancy outcome in GCSF group was improved significantly [p=0.043]

Conclusion: GCSF can improve pregnancy outcome in patients with history of implantation failure

Effect of granulocyte colony stimulating factor [G-CSF] on IVF outcomes in infertile women: An RCT

Background: Despite major advances in assisted reproductive techniques, the implantation rates remain relatively low. Some studies have demonstrated that intrauterine infusion of granulocyte colony stimulating factor [G-CSF] improves implantation in infertile women

Objective: To assess the G-CSF effects on IVF outcomes in women with normal endometrial thickness

Materials and Methods: In this randomized controlled clinical trial, 100 infertile women with normal endometrial thickness who were candidate for IVF were evaluated in two groups. Exclusion criteria were positive history of repeated implantation failure [RIF], endocrine disorders, severe endometriosis, congenital or acquired uterine anomaly and contraindication for G-CSF [renal disease, sickle cell disease, or malignancy]. In G-CSF group [n=50], 300 micro g trans cervical intrauterine of G-CSF was administered at the oocyte retrieval day. Controls [n=50] were treated with standard protocol. Chemical, clinical and ongoing pregnancy rates, implantation rate, and miscarriage rate were compared between groups

Results: Number of total and mature oocytes [MII], two pronuclei [2PN], total embryos, transferred embryos, quality of transferred embryos, and fertilization rate did not differ significantly between two groups. So there were no significant differences between groups in chemical, clinical and ongoing pregnancy rate, implantation rate, and miscarriage rate

Conclusion: our result showed in normal IVF patients with normal endometrial thickness, the intrauterine infusion of G-CSF did not improve pregnancy outcomes

Comparison of pregnancy outcome after letrozole versus clomiphene treatment for mild ovarian stimulation protocol in poor responders

Poor ovarian response to controlled ovarian stimulation is one of the most important interest points in assisted reproduction. Mild ovarian stimulation seems to be preferable to high dose of FSH regimens in women with a history of poor ovarian response in previous protocol. Clomiphene citrate and letrozole alone or in combination with FSH have been used in mild ovarian stimulation protocol. To compare the efficacy of letrozole and clomiphene citrate for mild ovarian stimulation on assisted reproductive technology outcomes in poor responders. In a randomized control study, 184 women aged between 20 and 45 years with the history of poor response to ovarian stimulation who were candidate for ART were randomly subdivided into two groups: group I [n= 80], women who underwent the clomiphene/gonadotropin/antagonist protocol; and group II [n= 87], patients who underwent the letrozole/gonadotropin/antagonist protocol. Groups were compared regarding implantation, chemical and clinical pregnancy rates, There was a significant difference in the mean endometrial thickness between two groups [9.16 +/- 1.2 mm vs. 83 +/- 0.3 mm]. The implantation rate was significantly higher in letrozole group compare to clomiphene group [7.2 vs. 6.6%, p=0.024 respectively]. No significant differences were found in chemical and clinical pregnancy rate between two groups. In mild ovarian stimulation protocol, letrozole and clomiphene have similar value for the poor responder. The optimal treatment strategy for these patients remains debated

Transvaginal perfusion of G-CSF for infertile women with thin endometrium in frozen ET program: a non-randomized clinical trial

We often see patients with a thin endometrium in ART cycles, in spite of standard and adjuvant treatments. Improving endometrial growth in patients with a thin endometrium is very difficult. Without adequate endometrial thickness these patients, likely, would not have reached embryo transfer. We planned this study to investigate the efficacy of intrauterine granulocyte colony-stimulating factor [G-CSF] perfusion in improving endometrium, and possibly pregnancy rates in frozen-thawed embryo transfer cycles. This is a non-randomized intervention clinical trial. Among 68 infertile patients with thin endometrium [-7 mm] at the 12[th]-13[th] cycle day, 34 patients received G-CSF. G-CSF [300 microgram/lniL] to improve endometrial thickness was direct administered by slow intrauterine infusion using IUI catheter. If the endometrium had not reached at least a 7-mm within 48-72 h, a second infusion was given. Endometrial thickness was assessed by serial vaginal ultrasound at the most expanded area of the endometrial stripe. The cycle was cancelled in the patients with thin endometrium [endometrial thickness below 7mm] until 19[th] cycle day ultimately The cycle cancelation rate owing to thin endometrium was similar in G-CSF group [15.20%], followed by [15.20%] in the control group [p=1.00]. The endometrial growth was not different within 2 groups, an improvement was shown between controlled and G-CSF cotreated groups, with chemical [39.30% vs. 14.30%] and clinical pregnancy rates [32.10% vs. 12.00%] although were not significant. Our study fails to demonstrate that G-CSF has the potential to improve endometrial thickness but has the potential to improve chemical and clinical pregnancy rate of the infertile women with thin endometrium in frozen-thawed embryo transfer cycle

Preservation of ovarian function during chemotherapy and radiotherapy in young women with malignancies

Malignancies are not rare in girl and women during their reproductive years. Over the past three decades, the survival rate for cancer has been improving due to progress in cancer diagnosis and treatment. These patients frequently experience a variety of treatment, and disease-related side effects that diminish their quality of life during and after treatment; among these are loss of fertility and sexual dysfunction. There have been recent advances in the field of fertility preservation, which can allow many of these genital cancer survivors to have children in the future. This topic review discusses available options and specific strategies for fertility preservation in adolescent and young women with malignancies who wish to preserve their ability to become pregnant in the future

Coexisting pelvic tuberculosis and endometriosis presenting in an infertile woman: report of a rare case

Primary and secondary infertility are the most common presenting symptom in patients with pelvic tuberculosis [PT]. Endometriosis is commonly associated with an increased risk of infertility. Here, we report a rare case of coexisting PT and endometriosis in a 30-year- old woman, and the effects of controlled ovarian stimulation on reactivation of pathogen. Coexisting endometriosis and tuberculosis of fallopian tube and ovary, as in present case, may alter clinical and radiological features, leading to difficulty in diagnosis. Early diagnosis with surgical exploration and adequate treatment can improve the chances of conception and also minimize morbidity

Evaluation of clinical factors influencing pregnancy rate in frozen embryo transfer

Frozen embryo transfer [FET] is one of the most important supplementary procedures in the treatment of infertile couples. While general information concerning the outcome of fresh embryo transfer has been documented, paucity of investigations has addressed the clinical factors influenced on pregnancy rates in FET. In this study, we performed a retrospective analysis of clinical factors that potentially influence the outcome of FET. We reviewed the data from 372 women who were subjected to FET registered from April 2009-2011 at the Research and clinical center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Baseline data and pregnancy rate were collected. The data were analyzed statistically using the Kolmogorov-Smirnov, and Mann-Whitney tests. The clinical pregnancy rate was 57.7 and 29.2% in women <35 years old, and women >35 years old, respectively [p<0.0001]. Clinical pregnancy rates in women with FSH <10 IU/ml, and FSH >10 IU/ml were 56.3% and 17.5%, respectively [p<0.0001]. Whereas the other clinical parameters consist of reason of fetus freezing, primary IVF protocol, IVF procedure, endometrial thickness, treatment duration to fetal transfer found to be unrelated to FET outcomes [p>0.05]. Female age and basal FSH level are the most important factors influencing the clinical pregnancy rate following FET

Effect of vitamin D insufficiency treatment on fertility outcomes in frozen-thawed embryo transfer cycles: a randomized clinical trial

Frozen- thawed embryo transfer is an essential part of ART treatment and outcomes of this procedure are associated with several clinical factors. Several studies have showed an increase level of IVF outcomes in women with sufficient vitamin D. whether treatment of vitamin D insufficiency can improve pregnancy rates in frozen-thawed embryo transfer cycles. This is an interventional, randomized clinical trial. Serum 25-[OH] vitamin D level of 128 women who had undergone IVF/ICSI with cryopreservation of embryos was checked. One hundred fourteen infertile women with insufficient serum vitamin D [less than 30 ng/ml] were included in the study. Fifty seven women were treated with supplementary vitamin D, 50000 IU weekly, for 6-8 weeks and fifty seven women were received no supplementation. One hundred six women completed frozen thawed embryo transfer cycles and included in the final analysis. Primary and secondary outcomes were chemical and clinical pregnancy respectively. Our study did not show any significant difference between vitamin D insufficient and treated women in term of chemical [29.40% vs. 29.10% respectively, p=1.00] or clinical [25.50% vs. 21.80% respectively, p=0.81] pregnancy rates. Vitamin D insufficiency treatment is not associated with higher pregnancy rate in frozen-thawed embryo transfer cycles

Effect of oocyte activation with calcium ionophore on ICSI outcomes in teratospermia: a randomized clinical trial

Chemical activation is the most frequently used method for artificial oocyte activation [AOA], results in high fertilization rate. This prospective, randomized, unblinded, clinical study aimed to evaluate the efficiency of oocyte activation with calcium ionophore on fertilization and pregnancy rate after intracytoplasmic sperm injection [ICSI] in infertile men suffer from teratoospermia. Thirty eight women with teratoospermic partner underwent ICSI with antagonist protocol. A total of 313 metaphase 2 [M2] oocytes were randomly divided into two groups: In the oocytes of the control group [n=145], routine ICSI was applied. Oocytes in the AOA group [n=168] immediately after ICSI, were entered in culture medium supplemented with 5 Micro calcium ionophore [A23187] for 5 minutes and then washed at least five times with MOPS solution. In both groups, the fertilization was evaluated 16-18 hours after ICSI. The number of fertilized oocytes and embryos obtained were significantly different between two groups [p=0.04]. There was no significant difference between the two studied groups regarding the fertilization and cleavage rate [95.33% vs. 84.4%, p=0.11; and 89.56% vs. 87.74%, p=0.76, respectively]. Implantation rate was higher in AOA group than in control group, but the difference was not significant [17.64% vs. 7.4%, p=0.14]. No significant differences were observed in chemical and clinical pregnancy rate between groups [47.1% vs. 16.7%, p=0.07; and 41.2% vs. 16.7%; p=0.14, respectively]. We didn't find significant difference in the implantation, fertilization, cleavage and pregnancy rates between the two groups but could significantly increase the number of fertilized oocytes and embryos obtained. Finally oocyte activation with calcium ionophore may improve ICSI outcomes in infertile men suffer from teratoospermia. Further study with more cases can provide greater value

Microdose GnRH agonist flare-up versus ultrashort GnRH agonist combined with fixed GnRH antagonist in poor responders of assisted reproductive techniques cycles

This study compares the microdose flare-up protocol to the ultrashort gonadotropinreleasing hormone [GnRH] agonist flare combined with the fixed multidose GnRH antagonist protocol in poor responders undergoing ovarian stimulation. In this randomized clinical trial, 120 women who were candidates for assisted reproductive techniques [ART] and had histories of one or more failed in vitro fertilization [IVF] cycles with three or fewer retrieved oocytes were prospectively randomized into two groups. Group I [60 patients] received the microdose flare-up regimen and group II [60 patients] received the ultrashort GnRH agonist combined with fixed GnRH antagonist. There were no significant differences between the groups in the number of used gonadotropin ampoules [p=0.591], duration of stimulation [p=0.610], number of retrieved oocytes [p=0.802], fertilization rate [p=0.456], and the number of transferred embryos [p=0.954]. The clinical pregnancy rates were statistically similar in group I [10%] compared with group II [13.3%, p=0.389]. According to our results, there is no significant difference between these protocols for improving the ART outcome in poor responders. Additional prospective, randomized studies with more patients is necessary to determine the best protocol [Registration Number: IRCT201105096420N1]

Surrogacy as a good option for treatment of repeated implantation failure: a case series

Background: repeated implantation failure [RIF] is defined as pregnancy failure after two to six times with at least ten high grade embryo transfer to uterus. A variety of causes have been anticipated for RIF, including anatomical, autoimmune, genetics, endocrine and thrombotic anomalies. Factors responsible for RIF have important implication regarding treatment however in many couples a perfect cause cannot be found

Cases: in these case series, we reported nine couples with RIF that after investigation no definitive etiology was found for RIF and empirical therapy by heparin, aspirin and or immunotherapy was not effective. In these cases we recommended transfer of embryos to surrogate uterus. Nine patients were studied and six of them developed a normal pregnancy [pregnancy rate=66.66%]

Conclusion: this study showed that surrogacy is a good option for treatment of RIF

Comparison of pregnancy outcome in half-dose triptorelin and short-acting decapeptyl in long protocol in ART cycles: a randomized clinical trial

Background: gonadotrophin-releasing hormone [GnRH] agonist is used for controlling ovarian stimulation in assisted reproductive technology [ART] cycles which has some benefits

Objective: to compare the efficacy of two different formulations of GnRH agonist: short-acting and long-acting, for ART protocols

Materials and Methods: in a prospective randomized study, one hundred women who underwent ART cycles were randomly divided into two groups. In group I, the patients received one single injection of 1.87 mg Triptorelin in previous mid-luteal phase. In group II, Decapeptyl 0.1 mg per day started from previous mid-luteal phase. Pregnancy outcome in in vitro fertilization [IVF] cycle was compared between two groups

Results: there were no statistically significant differences in the number of retrieved oocyte [p=0.545], fertilization [p=0.876], implantation [p=0.716] and pregnancy rate [p=0.727] between the two groups

Conclusion: there were not any advantages in IVF outcome between half-dose long-acting and short-acting GnRH agonist groups in ART cycle

Effect of progesterone supplementation on natural frozen-thawed embryo transfer cycles: a randomized controlled trial

The transfer of cryopreserved embryos can be timed with ovulation in a natural cycle or after artificially preparing the endometrium with exogenous hormones. Progesterone is essential for the secretory transformation of the endometrium that permits implantation as well as maintenance of early pregnancy. The purpose of this study is to assess the effect of luteal phase supplementation on pregnancy rates in natural frozen-thawed cycles. The study was designed as a prospective randomized clinical trial of 102 women who underwent embryo transfers in natural cycles. The women in the interventional group [n=51] received intra muscular [IM] progesterone 50 mg twice a day starting from 36 hours after hCG administration. The control group [n=51] did not receive any progesterone support. There were no significant differences in demographic characteristics between the groups and no statistically significant differences were observed between study and control groups in clinical pregnancy rate [33.3% vs. 27.5%, p=0.66]. There were no differences in implantation rate or spontaneous abortion rate. Our results suggest that luteal phase support does not affect clinical pregnancy rates in natural frozen-thawed embryo transfer cycles [Registration Number: IRCT201108044339N6]