In vitro fertilization outcome in frozen versus fresh embryo transfer in women with elevated progesterone level on the day of HCG injection: an RCT

Background: the effect of elevated progesterone level on human chorionic gonadotropin [HCG] day in in vitro fertilization cycles is controversial. Some suppose that rise in progesterone level seems to have a negative impact on implantation and pregnancy by desynchronizing the endometrium, while others disagree

Objective: to evaluate the superiority of the frozen cycle over fresh cycle on live birth in patients with elevated progesterone level on HCG day

Materials and Methods: in this double-blind, randomized clinical trial, 72 women undergoing assisted reproductive technology with elevated progesterone level [>/=1.8 ng/dl] on HCG day were included. The participants were grouped by fresh versus frozen embryo transfer, randomly. Finally, the clinical pregnancy and live birth rate were compared

Results: the implantation rate was 21.51%. The clinical pregnancy rate was 47.22% in fresh embryo transfer group [17/36] and 41.66% in frozen group [15/36] [p=0. 40]. The live birth rate was not significantly difference between two groups [p=0.56]

Conclusion: None of the fresh and frozen cycles are superior to the other and we recommend individualizing the decision for each patient. The frozen cycle may impose more emotional stress on patients

prevalence of Chlamydia trachomatis in patients who remained symptomatic after completion of sexually transmitted infection treatment

Sexually transmitted infections [STIs] are among the most common causes of illness in the world and have far-reaching health, economic and social consequences for many countries. Failure to diagnose and treat STIs at an early stage may result in serious complications and sequels. This study aimed to determine the prevalence of Chlamydia trachomatis infection in patients who remain symptomatic after completion of their first episode of treatment for STI. We conducted a cross-sectional study on 49 patients suffering from symptoms or signs of sexually transmitted infections despite their first complete anti STI treatment. Conducting physical exam and smear preparation from vaginal discharge, diagnosis was confirmed by Polymerase chain reaction [PCR] method on every patient's first-voided urine sample. Among the etiologic factors investigated in this study, Chlamydia was reported in 17 patients. Trichomoniasis, Candidiasis, Gonorrhea and nonspecific germs were next organisms with 11, 9, 6 and 6 patients, respectively. Sixteen specimens were PCR positive [32.65%], while 33 patients had negative PCR results [67.34%] for Chlamydia trachomatis. Gonorrheal infection was the most prevalent infection in patients with completed treatment [6/10], which must be remembered in patients follow ups, because this prevalence warrants empirical therapy for Gonorrheain similar clinical conditions. Chlamydia trachomatis was the responsible organism in approximately a quarter of patients [17/75] who despite their full compliance on anti-Chlamydial treatment still suffered from signs and symptoms of STI. This rate also recommends empirical therapy for Chlamydia trachomatis in the similar clinical signs and symptoms

Occurrence of Budd-Chiari syndrome as adverse effect of long term DMPA injections: a case report and review the literatures

Budd-Chiari syndrome [BCS] refers to thrombosis of hepatic veins as well as intrahepatic or suprahepatic inferior vena cava. We present for the first time a case of possible occurrence of Budd-Chiari syndrome with the history of depot medroxy progesterone acetate [DMPA] injections in a 33-year-old Iranian woman. An underlying disorder can be identified in most of patients with BCS. Many of these disorders are characterized by a hypercoagulable state, but it may occur due to other unknown pathophysiologic factors. Also, medical evaluation was performed for inflammatory, immunologic, and thrombotic disorders as well as hepatic imaging. Considering different case reports like this study may help to decrease the percentage of idiopathic cases

Prediction of assisted reproductive technique outcome in elevated early follicular phase follicle stimulating hormone with Mullerian inhibiting substance level

Detection of best predictor of ovarian reserve in patients with temporarily or consistently elevated early follicular phase serum levels of FSH is one of the most important goals in assisted reproductive technique [ART]. To evaluate whether high level of anti-mullerian hormone level is related to success of ART in patients with temporarily or consistently elevated early follicular phase serum levels of FSH. Sixty three women underwent intracytoplasmic sperm injection [ICSI] with GnRH-agonist long protocol or intrauterine insemination [IUI] in a prospective cohort study. FSH, inhibin B and anti-Mullerian hormone [AMH] levels were measured in these women whom were divided to three groups [persistently elevated FSH, variably elevated FSH and, normal FSH level]. Basal characteristics, stimulation parameters, and pregnancy occurrence were evaluated. AMH was significantly higher in women with persistently elevated early follicular phase FSH achieving pregnancy. Women with normal FSH did not have significant difference in AMH level between conceived and non conceived cycles. Women with only one elevated early follicular phase FSH achieving pregnancy did not have significant difference in AMH level with non pregnant women. Response to gonadotropin stimulation, recommendation to oocyte donation significantly differed between the groups. This study has demonstrated that relatively young women with persistently or intermittently elevated day 3 FSH levels have diminished ovarian reserve and lower ART success. However, in women whose FSH levels were constantly elevated, AMH [not inhibin B] concentrations were significantly higher in ART cycles resulting in pregnancy. Therefore, AMH level is a good predictor of ART outcome in patients with elevated early follicular phase serum levels of FSH

effectiveness of cabergoline for the prevention of ovarian hyperstimulation syndrome

Type 2 receptors for vascular endothelial growth factor are believed to be involved in the pathophysiology of ovarian hyper-stimulation syndrome [OHSS]. The objective of this study was to examine the preventive effects of cabergoline on OHSS and its complications. The study is a non randomized clinical trial conducted in 2006-2008 on 75 patients, which were at risk of OHSS and underwent assisted reproductive techniques. The diagnosis and severity of OHSS were determined using standard criteria. The study included an intervention and a control group. The intervention group comprised of 50 women at risk of OHSS, who were treated with cabergoline [1mg every other day for 8 days] commencing from the day of ovum pick up. The control group comprised of 35 historical cases, which were similar to the case group. The latter group did not receive cabergoline, and their OHSS, if occurred, were managed conservatively after hospital admission. The rates of OHSS, baseline characteristics, ovarian stimulation parameters, and pregnancy occurrence were compared. There was no significant difference between baseline characteristics or ovarian stimulation parameters from the two groups. The incidence of OHSS in the cabergoline-treated group, was significant [P=0.01] lower than that in the control group [12% vs 36%]. Embryo freezing was significantly [P=0.001] lower in the cabergoline group. The findings of the study indicate that cabergoline reduces the incidence of OHSS, and is not associated with adverse effects on pregnancy

Isolated fallopian tube torsion: a case report and review of literature

Isolated fallopian tube torsion is rare and often difficult to diagnose. Definitive diagnosis is always made at laparoscopic or via laparotomy exploration performed for suspected ovarian torsion. Early diagnosis and conservative laparoscopic treatment especially in a reproductive age woman is warranted as a means of preserving fallopian tube integrity and maintaining fertility. Here, we describe a case with isolated right fallopian torsion being managed by conservative laparoscopic surgery

Relationship between anti-mullerian hormone and assisted reproductive technique outcome in patients with polycystic ovary syndrome

Anti-mullerian hormone [AMH] levels may represent the ovarian follicular pool and could be a useful marker of ovarian reserve. The clinical application of AMH measurement has been proposed in the prediction of quantitative and qualitative aspects in assisted reproductive technologies. This study aimed to assess the relationship between the serum levels of AMH and results of assisted reproductive technique [ART] outcome in polycystic ovary syndrome [PCOS] patients versus control group. This cohort study was conducted on 61 [PCOS] patients and 28 patients without PCOS [controls] candidates for assisted reproductive technique. Serum levels of AMH were measured on the 3[rd] day of menstrual cycle and all the patients underwent controlled ovarian hyper stimulation and ART. The relationship between AMH serum level with retrieved oocytes, mature oocytes and pregnancy rate were assessed. There was significant correlation between the AMH level with number of total retrieved oocytes and mature oocytes in patients with PCOS and controls [p=0.001]. In PCOS and control groups AMH level in pregnant patients was higher, but it was not statically significant [p=0.65, p=0.46, respectively]. The major outcome of the study [pregnancy] did not differ significantly between two groups. This study revealed that AMH level was higher in pregnant patients undergoing ART; but AMH may not be an accurate predictor for pregnancy in PCOS patients

Bacterial vaginosis and urinary tract infection

Due to prevalence ofurogenital infection and lack of knowledge about the relationship between bacterial vaginosis and urinary tract infection in this country, this study was conducted in patients referred to Shohada Hospital during the years 2001-2002. This case control study was carried out on 134 candidates. Patients were labeled as having urinary tract infection when urinary culture was positive. Normal individuals with either negative culture, matched with our cases, have compromised the control group. Matching was designed for age, frequency of coitus, marriage years, and contraception. Bacterial vaginosis based on standard Amsel criteria was determined in both groups. The results were analyzed using t-test and x-test. The odds ratio and confidence intervals were calculated. 67 patients with urinary tract infection were compared with 67 normal individuals. Bacterial vaginosis was reported 40.3% and 62.7% in the control and; case group [p< 0.01, OR = 2.49]. Characteristic discharge, PH over 4.5 was reported in 91%, positive whiff in 74%, clue cell in 72% of patients with bacterial vaginosis, Individuals with urinary tract infection encountered bacterial vaginosis more than control group. Experimental studies seem to be useful to evaluate effectiveness of vaginitis treatment in prophylaxis of urinary tract infection and also Further attention to pregnant woman