Frozen thawed embryo transfer cycles; a comparison of pregnancy outcomes with and without prior pituitary suppression by GnRH agonists: an RCT

Background: To perform an in-vitro fertilization cycle, pretreatment with gonadotropin-releasing hormone [GnRH] agonist is widely used as a part of controlled ovarian hyper-stimulation protocols to prevent endogenous luteinizing hormone surge and spontaneous ovulation. GnRH agonist pretreatment is relatively costly and there is a risk of hypo estrogenic side effect. It would also lengthen the preparation period until pituitary desensitization occurs

Objective: Our study is aimed at evaluating the pregnancy outcome rate of frozen thawed embryo transfer with and without GnRH agonists pretreatment

Materials and Methods: Women with documented infertility who were candidate for frozen thawed embryo transfer were recruited and randomly assigned to two groups. In group A [n=100], patients received GnRH agonist, Buserelin, to induce pituitary desensitization prior to endometrial preparation and embryo transfer. Individuals in group B [n=100] received steroid manipulation without prior down-regulation of the pituitary. Chemical pregnancy, implantation rate, clinical pregnancy and ongoing pregnancy were measured and statistically compared between the two groups

Results: None of the outcome measures including clinical and chemical pregnancy rates, implantation rate, and ongoing pregnancy rate showed significant difference between the two groups. Similarly, the rate of miscarriage did not vary between the two groups

Conclusion: In this study, we found that removing the GnRH agonists pretreatment from the programmed cycles did not negatively influence the pregnancy outcome or implantation rate. Moreover, it will cause a considerable reduction in cost of assisted reproductive technology as well as adverse effects related to GnRH agonists, while having a favorable implantation and pregnancy outcomes

Fetal Rhd genotyping using real-time polymerase chain reaction analysis of cell-free fetal DNA in pregnancy of rhd negative women in south of Iran

Background: Maternal-fetal RhD antigen incompatibility causes approximately 50% of clinically significant alloimmunization cases. The routine use of prophylactic anti-D immunoglobulin has dramatically reduced hemolytic disease of the fetus and newborn. Recently, fetal RHD genotyping in RhD negative pregnant women has been suggested for appropriate use of anti-D immunoglobulin antenatal prophylaxis and decrease unnecessary prenatal interventions

Materials and Methods: In this prospective cohort study, in order to develop a reliable and non-invasive method for fetal RHD genotyping, cell free fetal DNA [cffD-NA] was extracted from maternal plasma. Real-time quantitative polymerase chain reaction [qPCR] for detection of RHD exons 7, 5, 10 and intron 4 was performed and the results were compared to the serological results of cord blood cells as the gold standard method. SRY gene and hypermethylated Ras-association domain family member 1 [RASSF1A] gene were used to confirm the presence of fetal DNA in male and female fetuses, respectively

Results: Out of 48 fetuses between 8 and 32 weeks [wks] of gestational age [GA], we correctly diagnosed 45 cases [93.75%] of RHD positive fetuses and 2 cases [4.16%] of the RHD negative one. Exon 7 was amplified in one sample, while three other RHD gene sequences were not detected; the sample was classified as inconclusive, and the RhD serology result after birth showed that the fetus was RhD-negative

Conclusion: Our results showed high accuracy of the qPCR method using cffDNA for fetal RHD genotyping and implicate on the efficiency of this technique to predict the competence of anti-D immunoglobulin administration

Prevalence, severity and factors related to mastalgia among women referring to health centers affiliated with Shiraz university of medical sciences

Background: Mastalgia is a common problem among women. Severe mastalgia can have a negative impact on sexual, physical and sleep activities and behaviors. Regarding the absence of a study on the prevalence and severity of mastalgia in southern Iran, the current study was conducted

Methods: This is an analytical cross-sectional study. The participants were women who referred to health centers affiliated to Shiraz University of Medical Sciences in Shiraz. The inclusion criteria were willingness to participate in the study, not being pregnant and breastfeed. The severity of breast pain was calculated with visual analog scale. The data of 845 questionnaires were analyzed with SPSS software

Results: The participants' age ranged from 15-50 years; the mean age was 32.84+/-9.49 years. Among 845 participants, 33% [279] of them had experienced mastalgia in the past three months. Among those who had experienced mastalgia, 81% [226] had cyclical mastalgai and 19% [53] had non-cyclical mastalgia. The mean of pain score was 4.32+/-2.38 and 12.9% of the participants [36] had pain scores of 8 to 10. The impact of mastalgia on daily and sexual activities and sleep behaviors was reported 9.31% [26], 12.66% [29] and 13.97% [36], respectively

Conclusion: Results of this study showed that the spread of mastalgia in women referred to health centers affiliated to Shiraz University of Medical Sciences is lower than that reported in western studies and has lesser effects on their daily, sexual and sleep activities and behaviors. We suggest further studies about mastalgia in others locations in Iran

Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/ intracytoplasmic sperm injection: a randomized clinical trial

The direct effect of hCG on the human endometrium was studied several times. The objectives of this study were to evaluate the effectiveness of intrauterine injection of recombinant human chorionic gonadotropin [rhCG] before embryo transfer [ET]. In this randomized placebo-controlled clinical trial, a total number of 182 infertile patients undergoing their first in vitro fertilization/ intracytoplasmic sperm injection [IVF-ICSI] cycles were randomly assigned to receive 250 micro g intrauterine rhCG [n=84] or placebo [n=98] before ET. The implantation and pregnancy rates were compared between groups. Patients who received intrauterine rhCG before ET had significantly higher implantation [36.9% vs. 22.4%; p=0.035], clinical pregnancy rates [34.5% vs. 20.4%; p=0.044] and ongoing pregnancy rate [32.1% vs. 18.4%; p=0.032] when compared to those who received placebo. The abortion [2.4% vs. 2.0%; p=0.929] and ectopic pregnancy rates [1.2% vs. 1.0%; p=0.976] were comparable between groups of rhCG and placebo, respectively. Intrauterine injection of 250 micro g of rhCG before ET significantly improves the implantation and pregnancy rates in IVF/ICSI cycles.

Association between angiotensinogen M235T polymorphism and preeclampsia in Iranian pregnant women

To determine the possible association between the M235T variant of angiotensinogen gene and preeclampsia in Iranian preeclamtic women with hypertension during pregnancy. During a case control study, we used polymerase chain reaction-based restriction fragment length polymorphism [PCR-RFLP] analysis to investigate the association between M235T polymorphism in preeclamtic women compared to normotensive controls. The M235T polymorphism was significantly associated with increased preeclampsia risk in the studied population as supported by a p value of 0.017 and chi-square value of 8.12. The frequency of mutated allele and genotype distribution showed a significant difference between preeclamtic women and control groups. The result indicates that the AGT M235T polymorphism plays a significant role in preeclampsia observed in selected Iranian preeclamtic women, and it can be considered as a major risk factor for preeclampsia

Anti-nuclear antibodies in patients with polycystic ovary syndrome before and after laparoscopic electrocauterization

Polycystic ovary syndrome [PCOS] has been suggested to be linked with autoimmune processes. Laparoscopic ovarian electrocauterization has the potency to stimulate more autoimmune reactions in PCOS patients. In the present study, we considered anti-nuclear antibodies [ANAs] as the hallmark of autoimmune reactions, and investigated the serum level of these antibodies in 35 patients with PCOS [21-38 years old] pre and one-month after electrocauterization, and in 35 fertile healthy women [25-35 years old] as the control group. Serum levels of ANAs, as well as ANA subtyping, were investigated using the Enzyme-Linked Immunosorbent Assay [ELISA]. While 3 out of the 35 patients [8.6%] were positive for ANAs before electrocauterization, none of the controls was positive. The number of ANA-positive cases increased following electrocauterization [3 out of 35 [8.6%] before vs. 10 out of 35 [28.6%] after the procedure]. The main ANA subtype in the positive samples was SS-A. The higher ANA level among the PCOS patients suggests association of the disease with autoimmune reactions. Laparoscopic ovarian electrocauterization seems to increase the number of positiveANA patients

Metformin versus chromium picolinate in clomiphene citrate-resistant patients with PCOs: a double-blind randomized clinical trial

Chromium picolinate could be effective in clomiphen citrate resistant PCOS patients. To compare the effects of chromium picolinate vs. metformin in clomiphen citrate resistant PCOS patients. The present randomized clinical trial was performed on 92 women with clomiphen citrate-resistant PCOS at the clinics which were affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The subjects were randomly assigned to two groups receiving either chromium picolinate [200micro g daily] or metformin [1500mg daily] for 3 months. Anthropometric and hormonal profile were measured and compared both before and after the treatment. Ovulation and pregnancy rate was measured in the two study groups, as well. Chromium picolinate significantly decreased fasting blood sugar [FBS] after 3 months of treatment [p=0.042]. In the same way, the serum levels of fasting insulin had significantly decreased leading to an increase in insulin sensitivity as measured by QUICKI index [p=0.014]. In comparison to the patients who received chromium picolinate, those who received metformin had significantly lower levels of testosterone [p=0.001] and free testosterone [p=0.001] after 3 months of treatment. Nevertheless, no significant difference was found between the two study groups regarding ovulation [p=0.417] and pregnancy rates [p=0.500]. Chromium picolinate decreased FBS and insulin levels and, thus, increased insulin sensitivity in clomiphene citrate-resistance PCOS women. These effects were comparable with metformin; however, metformin treatment was associated with decreased hyperandrogenism. Overall, chromium picolinate was better tolerated compared to metformin; nonetheless, the two study groups were not significantly different regarding ovulation and pregnancy rates

pregnancy outcome in patients with minor beta-thalassemia

beta-thalassemia is the most common hereditary disease in Iran and more than 2 million carriers of the beta-thalassemia mutant gene are living in this country. To determine pregnancy outcome of women with beta-thalassemia minor. In this retrospective, case-control study in two universities affiliated hospitals in Shiraz, all pregnancies occurred between 2006 and 2008 were included. Patients were divided in two groups regarding the presence of beta-thalassemia minor. Patients in case and control groups were matched according to maternal age, gestational age and number of previous pregnancies. Cesarean delivery, hypertensive disorders, gestational diabetes mellitus, premature rupture of membranes and preterm labor were recorded in each group and were compared using the lampda 2 or Fisher exact tests. Overall 510 beta-thalassemia minor subjects and 512 healthy controls were studied. Cases with beta-thalassemia minor had significantly higher prevalence of oligohydramnios [p<0.001] and cesarean section delivery [p=0.001]. There was no significant difference regarding Apgar score in 1[st] [p=0.65] and 5[th] minute [p=0.25], IUGR [p=0.073], gestational diabetes mellitus [DM] [p=0.443] and preeclampsia [p=0.116] between two study groups. beta-thalassemia minor does not significantly influence the pregnancy outcome in the negative way

Serum HER2 level in epithelial ovarian cancer

The proto-oncogene HER2 plays a key role in the control of cellular proliferation. Its overexpression has been reported to be associated with a poor prognosis in cancer, particularly in breast cancer. In the present study, serum HER2 levels were investigated in patients diagnosed with epithelial ovarian cancer. Serum HER2 levels were detected by an ELISA commercial kit in 51 patients and 33 healthy individuals. The mean serum HER2 level was found to be significantly higher in patients than healthy controls [P=0.005]. In 29% of patients, serum HER2 levels were higher than the cut-off value. HER2 serum level was not associated with tumor stage at diagnosis. Elevation of HER2 in a high proportion of patients with epithelial ovarian cancer further strengthens the importance of this molecule in the pathogenesis of ovarian cancer

Maternal serum levels of transforming growth factor B1 [TGF-beta1] in normal and preeclamptic pregnancies

Successful pregnancy in allopregnant women depends upon the control of graft rejection mechanisms. It has been suggested that some immunosuppressive cytokines contribute to successful pregnancy and transplantation. Transforming growth factor beta [TGF-beta] exhibits potent immunoregulatory and anti-inflammatory properties which might prolong graft survival. Recent studies suggest a role for TGF-beta in the generation of T-regulatory lymphocytes which preserves the tolerance to peripheral self antigens and may control the response to allogenic tissues and thereby promote the transplantation tolerance. Also, the function of TGF-beta in trophoblast differentiation and hypertension is reported. To evaluate the maternal serum TGF-pl level in normal allopregnant women and in pregnancies complicated by preeclampcia [PE]. Sixty one pregnant preeclamptic women [32 cases with severe and 29 with mild PE], 22 normotensive healthy pregnant, and 20 non-pregnant controls constituted the studied groups. The active form of TGF-beta in serum from all cases was investigated by indirect ELISA technique. The results showed that TGF-beta1 level was higher in all three pregnant groups as compared with the non-pregnant controls. No significant changes in serum levels of TGF-pl were found in PE as compared with the normal pregnancy. TGF-beta may function as a regulatory factor in fetal allograft survival during pregnancy, and TGF-beta1 does not have a pathophysiological role in PE

Serum level of HER 2 extracellular domain in Iranian patients with breast cancer: a follow up study

A soluble form of HER-2/neu extracellular domain [sHER-2] is reported to be released in the sera of metastatic breast cancer patients. To measure the level of sHER-2 in sera of 115 breast cancer patients. Serial samples of 27 patients with metastasis, 18 non-metastatic patients, 15 patients in stage 0/I and 14 patients with accompanying benign breast disease were also included in this study. No significant difference was observed between sHER-2 level in the pre-operative sera of breast cancer patients and that of healthy individuals. Only 8 out of 27 patients whom later developed metastasis showed elevated levels of sHER-2 in their first serum sample. However, a trend of increase in the level of sHER-2 was observed in 14 [51.8%] of 27 metastatic sera before clinical diagnosis of the metastasis. A significant association between sHER-2 positive status and vascular invasion of the tumor was observed [P = 0.02]. In addition, significant correlation of sHER-2 level with CEA [highest r = 0.74] and CA 15.3 [highest r = 0.74] tumor marker levels in the serial sera were observed. The mean time from sHER-2 positivity to tumor metastasis was calculated to be 98 days [range = 29-174]. Our results indicate that a relatively high percentage of Iranian patients with breast cancer show an elevated level of sHER-2 in their sera before clinical diagnosis of the tumor metastasis. Therefore, measuring the level of this oncoprotein, not only helps physicians in monitoring the patients during HERCEPTINTM therapy, but also can be helpful in choosing more aggressive treatments at the early satges of tumor metastasis

Placental transfer of respiratory syncytial virus-specific IgG in iranian mothers

Background: Respiratory Syncytical virus infection is the most common cause of bronchioMtis and viral pneumonia in infancy

Objective: To investigate the placental transfer of RSV-specific IgG in Iranian mothers

Methods: The antibodies were measured in sera of 146 mother/newborn pairs using a commercially available indirect Enzyme Linked Immunosorbent Assay [ELISA]. The studied subjects were among healthy pregnant women who attended to the Zeinabieh Hospital of Shiraz University of Medical Sciences in a one year period

Results: A highly significant correlation was observed between RSV-specific IgG in newborns and mothers [r = 0.88]. However, mean RSV-specific IgG antibodies in neonates was significantly higher than that of their mothers [P = 0.019]. In addition, the mean cord/maternal ratio of RSV-specific IgG was detected to be 1.27 +/- 0.60. Maternal blood group, age, parity, previous abortions and neonatal gestational age had no correlation with placental transfer of RSV-specific IgG antibodies

Conclusion: Our finding demonstrates that placental transfer of RSV-specific IgG antibodies is an active process and the main factor that influences this transfer is maternal concentration of these immunoglobulins