Comparison of pre-treatment with OCPs or estradiol valerate vs. no pre-treatment prior to GnRH antagonist used for IVF cycles: an RCT

Background: both oral contraceptive pills [OCPs] and estradiol valerate [E2] have been used to schedule a gonadotropin-releasing hormone antagonist in vitro fertilization [IVF] cycles. Since the suppression of follicle-stimulating hormone by OCPs can stay 5-7 days after stopping the pills, it seems that starting the gonadotropin-releasing hormone [GnRH] after 6 days of pre-treatment discontinuation may be important in IVF outcomes

Objective: the aim of the present study was to determine the number of mature oocyte and pregnancy rate of three pretreatment methods for fresh embryo transfer cycles

Materials and Methods: in this randomized controlled trial, two-hundred ten women [18-35 yr and less than 2 previous IVF attempts] undergoing IVF with the GnRH antagonist protocol were randomized to the OCP, E2, and no pretreatment arms. OCP group [n=53] received OCP [ethinyl estradiol30 micro g and levonorgestrel150 micro g], E2 group [n=63] received 4 mg/day oral E2 [17beta?E2] for 10 days from day 20 of the previous cycle and GnRH antagonist stimulation was started 6 days after the interruption of OCP and E2. The control group [n =70] did not receive any pretreatment

Results: no significant difference was observed in the mean number of the mature oocyte, endometrial thickness, and embryo quality. The pregnancy rate in E2 group was higher than the two other groups [42.9% vs 39.6% and 34.3% in OCP and control group, respectively], but the difference was not statistically significant [p=0.59]

Conclusion: it seems OCP or E2 pretreatment could not improve the fresh IVF-embryo transfer outcomes

Fertility outcome after operative laparoscopy versus no treatment in infertile women with minimal or mild endometriosis

Background: Endometriosis is the presence of endometrial glands and stroma in sites other than the uterine cavity, which is associated with infertility. The objective of this study was to evaluate the effect of laparoscopic surgical treatment on clinical pregnancy in infertile women with minimal or mild endometriosis

Materials and Methods: This clinical trial study was performed in infertile women who were referred to the gynecological clinic between April 2008 and March 2009. After confirmation of minimal or mild endometriosis by diagnostic laparoscopy, patients were randomly assigned into two groups using consecutively numbered, opaque sealed envelops. The first group consisted of women who only underwent diagnostic laparoscopy [no treatment] before randomization. The second group of patients underwent operative laparoscopies. T-test and chi-square test were used when appropriate. A p-value less than 0.05 was considered statistically significant

Results: Analysis with 38 patients in each group showed characteristics such as age, body mass index [BMI], and duration of infertility were statistically similar in both groups. At 9 months follow-up, 9 [24%] women who had operative laparoscopies became pregnant compared with 7 [18%] women in the diagnostic laparoscopy group. The pregnancy rate showed no statistically significant difference between both groups [p=0.49]. No complications were reported in either group

Conclusion: The present study suggested that laparoscopic surgical treatment was not superior to diagnostic laparoscopy in pregnancy occurrence in infertile women with minimal and mild endometriosis. [IRCT Number: IRCT201012311952N2]

Prevalence of metabolic syndrome in polycystic ovarian syndrome women in a hospital of Tehran

Polycystic ovarian syndrome [PCOS] is a condition associated with chronic anovulation, insulin resistance and androgen excess. Women with this syndrome are at increased risk of metabolic syndrome. The aim of the present study was to determine the prevalence of metabolic syndrome [MBS] in women with PCOS referred to Arash Hospital in different ages and body mass index [BMI]. A cross-sectional study was conducted in Gynecologic Clinic at Arash Hospital affiliated with Tehran University. A total of 282 women with PCOS ages between 15-40 years were included. The prevalence of Metabolic Syndrome and its components in this population were the main outcomes. Height, weight, waist circumference, blood pressure and laboratory tests [FBS, TSH, HDL-C, serum prolactin, triglycerides and total cholesterol] were measured in this population. The prevalence of MBS in PCOS women was 22.7% [64 cases]. The rate of central obesity, FBS more than 110 mg/dl, triglycerides more than 150 mg/dl, high-density lipoprotein cholesterol levels [HDL-C] less than 50 mg/dl, and blood pressure >/= 130/85 mmHg in PCOS women was 31% [87], 3.2% [9], 33% [93], 68.8% [194], and 10.6% [30], respectively. The risk of MBS was increased in older and the obese women [BMI >/= 30 kg/m[2]]. The present sample showed women with PCOS have a high prevalence of MBS and its individual components, particularly decreased HDL-C

Intrathecal fentanyl for prevention of shivering in spinal anesthesia in cesarean section

Shivering is one of the common problems in spinal anesthesia. The objective of the present study was to evaluate the effect of intrathecal fentanyl [25 microg] on incidence and severity of intraoperative and postoperative shivering. A double-blind randomized controlled study was conducted in eighty healthy women [ASA Physical status I] scheduled for elective cesarean section under spinal anesthesia. Subjects were randomly divided into two equal groups. The patients received 12.5 mg [2.5ml] of 0.5% hyperbaric bupivacaine combined with 25 microg [0.5 ml] fentanyl in Group F as a study group and 12.5 mg [2.5ml] of 0.5% hyperbaric bupivacaine combined with 0.5 ml normal saline in Group S as a control group. Incidence of shivering during 30 and 60 minutes of surgery and recovery and complications were evaluated. The total incidence of shivering in Group F was significantly lower than Group S [10% in group F; 75% in group S, p< 0.0001]. Almost all patients started shivering in the first hour after spinal anesthesia and the rate of shivering especially in second 30 minutes was higher than first 30 minutes in both groups. None in Group F but 22 patients [55%] in Group S had shivering during recovery and all of them reported shivering at the first 30 minute at recovery. The severity of shivering in Group F was significantly lower than Group S [p<0.0001]. Intrathecal bupivacaine combined with fentanyl is associated with a lower incidence and severity of shivering

Continous infusion of remifentanil plus ketamine compared with continous remifentanil for pain relief in labor

Pain relief during labour is an important determinant of a women's birth experience. There are numerous pain relief techniques which can be used either with or without pain medication. The aim of our study was to compare the effect of remifentanil alone and its effect in pain relief while using with ketamine during labour. After obtaining informed consent and approval of hospital ethics committee, 40 women with gestational age between 38 and 42 weeks gestation in early labour were recruited for this study. They were randomly allocated into two groups: group RK [20 cases] received 25 micro g remifentanil as a starting dose and continuous infusion of 0.06 micro g/kg/min remifentanil plus 0.5 mg/kg/h ketamine for 4 hours via pump and group R [20 cases] received 25 micro g remifentanil as a starting dose and continous infusion of 0.06 micro g/kg/min remifentanil. The baseline of pain scores were similar in both groups [5.75 +/- 2.51 vs 7 +/- 2.45, p= 0.12] but after 30 minutes to 120 minutes the VAS scores were significantly higher in R group [p< 0.001]. The rate of patients who were satisfied [excellent and very good] in RK was 80% but in R group was 45% [p = 0.03]. Nausea and vomiting were significantly higher in R group [p<0.05]. The remifentanil plus ketamine produced better pain relief during labour with continous monitoring than continous remifentanil with no adverse effects for mothers and infants

Comparing intramuscular progesterone, vaginal progesterone and 17 alpha-hydroxyprogestrone caproate in IVF and ICSI cycle

Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment. The objective of this study was to compare the efficacy of three types of progesterone on biochemical, clinical and ongoing pregnancy rates and abortion and live birth rates. A prospective randomized study was performed at Royan Institute between March 2008 and March 2009 in women under 40 years old, who use GnRH analog down-regulation. One hundred eighty six patients in three groups were received progesterone in oil [100 mg, IM daily], intravaginal progesterone [400 mg, twice daily] and 17-alpha hydroxyprogestrone caproate [375mg, every three days], respectively. Final statistical analysis after withdrawal of some patients was performed in 50, 50 and 53 patients in group 1, 2 and 3 respectively. No differences between the groups were found in baseline characteristics. No statistical significance different was discovered for biochemical, clinical and ongoing pregnancies. Although the abortion rate was statistically higher in group 1 [p=0.025] the live birth rate was not statistically significant between the three groups. The effects of three types of progesterone were similar on pregnancies rate. We suggest the use of intravaginal progesterone during the luteal phase in patients undergoing an IVF-ET program because of the low numbers of abortions, and high ongoing pregnancy rates

Comparison of serum uric acid, iron and total iron binding capacity [TIBC] levels in pre-eclamptic and normal pregnant women

The objective of our study was to compare uric acid, iron and TIBC levels in normal and preeclamptic pregnant women and determine their relations with maternal and fetal complications. A case control study was conducted in 200 normal and preeclamptic pregnant women. At 32-40 weeks of pregnancy [third trimester] a blood test was taken in order to measure the uric acid, iron and TIBC and their relation with maternal and fetal complications. Uric acid level showed significant difference [4.58 +/- 0.73, 4.87 +/- 0.58, p=0.002] between two groups of pre-eclamptic and normal women. The iron and TIBC level had no significant difference in either group. The uric acid level and iron had significant differences between two groups with and without maternal complication, respectively [4.69 +/- 0.66, 5.05 +/- 0.59, p<0.05] [387.42 +/- 82, 405.24 +/- 57, p<0.05]. There was not any difference in three parameters between groups with and without fetal complication. The BMI was significantly higher in preeclamptic group and has positive relation with uric acid level. If we consider 29 as BMI cut-off point; it will be associated with 73% sensitivity and 67% specificity in preeclampsia determination. Using 4.55 as uric acid cut-off point, the sensitivity is 76% and specificity is 49%.Although the higher level of uric acid, higher BMI scale and positive roll-over test are associated with preeclampsia, but they are not very strong predictors as single test

Paradoxical increases in serum levels of highly chlorinated PCBs in aged women in clear contrast to robust decreases in dietary intakes from 1980 to 2003 in Japan

<p><b>OBJECTIVE</b>Exposure to polychlorinated biphenyls (PCBs) is considered to have culminated between 1950 and 1970 in Japan, and exposure through diet, the major exposure route, has decreased significantly over the last 10 years. The primary goal of the present study was to investigate the long-term trends and congener profiles of serum and dietary levels of PCBs using historical samples.</p><p><b>METHODS</b>Using banked samples collected in 1980, 1995, and 2003 surveys, we determined the daily intakes and serum concentrations of 13 PCB congeners (#74, #99, #118, #138, #146, #153, #156, #163, #164, #170, #180, #182, and #187) in women.</p><p><b>RESULTS</b>The total daily PCB intake [ng/day, geometric mean (geometric standard deviation)] decreased significantly from 523 (2.5) in 1980 to 63 (3.2) in 2003. The serum total PCB level (ng/g lipid) in women <40 years of age decreased significantly from 185 (1.8) in 1980 to 68 (1.8) in 2003. In contrast, the level in women >50 years of age increased significantly from 125 (1.7) in 1980 to 242 (1.7) in 2003. Specifically, the serum concentrations of hexa (#138, #146, #153, #156, #163, and #164) and hepta (#170, #180, #182, and #187) congeners increased significantly. A comparison of the serum PCB levels of women born from 1940 to 1953 revealed that their serum total PCB level was significantly higher in the 2003 survey [242 (1.7), n = 9] than in the 1995 [128 (2.0), n = 17] surveys. This increase in the total PCB level was attributable to increases in the hepta congener groups.</p><p><b>CONCLUSION</b>Present results suggest a decreased rate of elimination of hepta congeners with aging in females, rather than a birth-generation phenomenon.</p>