[ causes and therapeutic results of infertility through laparoscopy]

Laparoscopy is one of the diagnostic and therapeutic methods used for infertility. With this method, the causes of infertility [including pelvic, tubal and ovarian factors] which are not usually signified in primary evaluations can be diagnosed and treated; thus, avoiding some unnecessary therapeutic expenditure such as ART [Artificial Reproductive Techniques]. This cohort study was performed on 140 infertile patients referring to a professional clinic of gynecology and infertility from 1383 [H.S.] to 1386 [H.S.]. Having gone under primary clinical and para-clinical evaluations as well as medical treatments, these patients were nominated for laparoscopy in Aria and Mousa-ibn-Ja'far hospitals. According to the laparoscopic results, the patients were identified with either primary or secondary infertility. Then, the patients were treated accordingly. Finally, the follow-up evaluation of the fertility outcomes [pregnancy rate and miscarriage] was carried out within one year thereafter. 74% of the patients were diagnosed with primary infertility and the other 26% with secondary infertility. The most common cause of primary infertility was found to be PCOS while secondary infertility was mostly caused by tubal factor. The successful rate of pregnancy in patients with endometriosis was 58.1%; with tubal factor 44.1%; with PCOS 66.7%; with uterus anomaly 40%; with both PCOS and endometriosis 71.4% and in patients with both PCOS and tubal factor, it was measured as 22.2%. As for miscarriage, the rate was found to be 6.4% in patients with endometirosis; 8.8% in patients with tubal factor; 2.5% in those with PCOS and 11.1% in the patients who were diagnosed with both PCOS and tubal factor. No miscarriage was observed neither in the patient with uterus anomaly nor in those with both PCOS and endometriosis. According to the results of this study, laparoscopy is a safe method in diagnosing tubal, pelvic and ovarian factors and can improve the fertility outcomes in the patients

Pregnancy outcome following inadvertent rubella vaccination in 1-4 weeks periconceptional period in 60 pregnant women

Rubella virus is a potent teratogen. Risk of rubella virus induced multisystem fetal malformation is highly dependent on the gestational age at the time of infection. Because the rubella vaccine is an attenuated live virus, its use is contraindicated during pregnancy. Our objective was to examine whether exposure to rubella vaccine during 1-4 weeks periconceptional period can cause any adverse pregnancy outcome or Congenital Rubella Syndrome [CRS]. This prospective study was performed in 60 pregnant women who received rubella vaccine inadvertently 1-4 wks pre or post conception. Time of conception was determined by last menstrual period [LMP] and first trimester sonography. In addition to gathering mother's obstetric and demographic information, all neonates were evaluated for CRS signs by systemic physical examination and anti rubella IgG and IgM antibody levels in cord blood samples. Mean maternal age was 21.8 +/- 2.9 years and 58.3% of pregnancies were unintended. In 90% of mothers there were no post vaccination side effects. None of the mothers had a history of drug abuse, smoking or teratogenic exposures. Mean neonatal weight was 3108 +/- 581 gr and 6.7% of them were premature. There was no increase in the rate of adverse pregnancy outcome, [abortion, preterm labour, post term pregnancy, fetal demise, obstetric hemorrhage, pregnancy related major malformation]. No signs of CRS were found in the neonates based on systemic physical exam. Mean value of cord blood anti-rubella IgG level was 143.9 +/- 69.5 IU/mL. Cord blood anti-rubella IgM was negative in all of the neonates. It seems that inadvertent rubella vaccination 1-4 weeks before and after conception does not cause CRS in neonate and therapeutic abortion is not indicated; however since in rare instances clinical manifestations of rubella have appeared years after the congenital infection, women planning to get pregnant should not be vaccinated against rubella one month before and throughout pregnancy

[Studying some of the hemodynamic effects of adding epinephrine to lidocaine for spinal Anesthesia]

Increasing use of regional anesthesia instead of general anesthesia may be the most important factor in decreasing anesthetic difficulties [e.g. difficult intubations, aspiration pneumonia, and analgesic side effect] in caesarean section. Quality of regional anesthesia is improved by adding morphine, fentanyl and sufentanil. The function of Epinephrine is dose-dependent. For instance, in small dosage, it has stimulating effects on Beta1 and Beta2 causing venous stasis to minimize. However, in large doses, Epinephrine's Alfa adrenergic is dominant. This study aimed at investigating the potential hemodynamic effects of adding Epinephrine to lidocaine during spinal anesthesia on expecting mothers who are candidates of caesarean section. This study was a prospective, randomized, double-blind, controlled trial on 100 pregnant women who were candidates for caesarean section with ASA class I, II in the year of 1387. The subjects of the study were divided into two groups, [1] and [2] on the basis of the randomized digital table as follows: Group 1:80 mg lidocaine 5% +2 micro gram sufentanil Group2: 80 mg lidocaine 5% +2 micro gram sufentanyl + 0.2 mg [0.2cc] Epinephrine. Both groups received the drugs intrathecally. Vital signs such as systolic and diastolic blood pressure, pulse rate and SPO2 were recorded both before the anesthesia and thereafter every 5 minutes until the end of the operation. The measuring procedure continued during and after the recovery stage. Besides, the side effects and the drugs needed were recorded. According to the findings in this study, there weren't any significant differences between the two groups in terms of age, weight, ASA, NPO timing and the previous surgery. There weren't any significant differences between the two groups of the study in terms of systolic and diastolic blood pressure, either. However, some hypotension was noted in Adrenaline group. Also, there weren't any significant differences in PR but some bradycardia was seen in Adrenaline group, too. There weren't any significant differences in SPO2 and side effects [nausea, vomiting, dysphagia, respiratory disorder, shivering] between the two groups. Adding Epinephrine to Lidocaine 5% increased the duration of spinal aesthesia in caesarean section whereas no significant difference was observed in terms of hemodynamic and side effects. Nevertheless, regarding the emergence of hypotension and bradycardia observed in the Adrenaline group, no matter how rare, close control of hemodynamic in this group is essential

Detection of antisperm antibodies by indirect flow cytometry: Comparison with direct mixed agglutination reaction test

The immunobead binding test [IBT] and the mixed agglutination reaction [MAR] are the most commonly used methods for detection of antisperm antibodies [ASA]. The detection of ASA by flow cytometry [FCM] was first described by Haas and Cunningham. Both assays can be performed as direct or indirect methods. In this study, indirect FCM was compared with the direct MAR for detection of ASA. Semen samples were obtained from 80 men [infertile couples] in Isfahan Fertility and Infertility Center. Seminal plasma samples were incubated with ASA-negative donor sperm. Then, surface-bound antibody was detected with FITC-labeled antihuman immunoglobulin directed against IgA and IgG in the indirect FCM assay. ASAs bound to the surface of patients' sperm were detected by direct MAR test. The indirect FCM correlates with direct MAR for detection of IgA antisperm antibodies [r=0.55 and P=0.006]. The indirect FCM, however, does not correlate with direct MAR for the detection of IgG antisperm antibodies [r=0.25 and P=0.25]. Some of the ASAs in seminal fluid bind to spermatozoa. Therefore, indirect tests to detect ASAs in seminal plasma are likely to miss the presence of IgG antisperm antibodies while they effectively detect IgA antisperm antibodies