Menstrual pattern following tubal ligation: a historical cohort study

Background: Tubal ligation [TL] is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders

Materials and Methods: A historical cohort study was carried out on 140 women undergoing tubal ligation [TL group] and on 140 women using condom as the main contraceptive method [Non-TL group]. They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart [PBLAC] was also used to measure the menstrual blood loss

Results: Women with TL had more menstrual irregularity than those without TL [24.3 vs. 10%, P=0.002]. Women with TL had more polymenorrhea [9.3 vs. 1.4%, P=0.006], hypermenorrhea [12.1 vs. 2.1%, P=0.002], menorrhagia [62.9 vs. 22.1%, P<0.0001] and menometrorrhagia [15.7 vs. 3.6%, P=0.001] than those without TL. There is a significant difference in the PBLAC score between women with and without TL [P<0.0001]. According to logistic regression, age odds ratio [[OR=1.08, confidence interval [CI]:1.07-1.17, P=0.03]], TL [OR=5.95, CI: 3.45-10.26, P<0.0001] and cesarean section [OR=2.72, CI:1.49-4.97, P=0.001] were significantly associated with menorrhagia

Conclusion: We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures

Evaluation of risk factors associated with endometriosis in infertile women

Background: Endometriosis affects women's physical and mental wellbeing. Symptoms include dyspareunia, dysmenorrhea, pelvic pain, and infertility. The purpose of this study is to assess the correlation between some relevant factors and symptoms and risk of an endometriosis diagnosis in infertile women

Materials and Methods: A retrospective study of 1282 surgical patients in an infertility Institute, Iran between 2011 and 2013 were evaluated by laparoscopy. Of these, there were 341 infertile women with endometriosis [cases] and 332 infertile women with a normal pelvis [comparison group]. Chi-square and t tests were used to compare these two groups. Logistic regression was done to build a prediction model for an endometriosis diagnosis.

Results: Gravidity [odds ratio [OR]: 0.8, confidence interval [CI]: 0.6-0.9, P=0.01], parity [OR: 0.7, CI: 0.6-0.9, P=0.01], family history of endometriosis [OR: 4.9, CI: 2.1-11.3, P0.001], history of galactorrhea [OR: 2.3, CI: 1.5-3.5, P=0.01], history of pelvic surgery [OR: 1.9, CI: 1.3-2.7, P0.001], and shorter menstrual cycle length [OR: 0.9, CI: 0.9-0.9, P=0.04] were associated with endometriosis. Duration of natural menstruation and age of menarche were not correlated with subsequent risk of endometriosis [P>0.05]. Fatigue, diarrhea, constipation, dysmenorrhea, dyspareunia, pelvic pain and premenstrual spotting were more significant among late-stage endometriosis patients than in those with early-stage endometriosis and more prevalent among patients with endometriosis than that of the comparison group. In the logistic regression model, gravidity, family history of endometriosis, history of galactorrhea, history of pelvic surgery, dysmenorrhoea, pelvic pain, dysparaunia, premenstrual spotting, fatigue, and diarrhea were significantly associated with endometriosis. However, the number of pregnancies was negatively related to endometriosis

Conclusion: Endometriosis is a considerable public health issue because it affects many women and is associated with the significant morbidity. In this study, we built a prediction model which can be used to predict the risk of endometriosis in infertile women

Evaluating the effective factors in pregnancy after intrauterine insemination: a retrospective study

Controlled ovarian hyperstimulation [COM] in conjunction with intrau-terine inseminations [IUI] are commonly used to treat infertile couples. In this study we evaluated the relationship between IUI outcome and special causes of infertility. We also aimed to examine parameters that might predict success following IUI. In this cross-sectional study, we included 994 IUI cycles in 803 couples who referred to the infertility Institute. All statistical analyses were performed by using SPSS program, t tests and chi-square. Stepwise multiple linear regression analysis was performed to compare the association between dependent and independent variables. Logistic regression was conducted to build a prediction model of the IUI outcome. Overall pregnancy rate per completed cycle [16.5%] and live birth rate per cycle [14.5%]. The mean age in the pregnant group was significantly lower than that of the non-pregnant group [P=0.01].There was an association between cause of infertility and clinical pregnancies [P=0.001]. Logistic regression identified four significant factors in determining the success of the IUI [menstrual irregularites [OR:2.3, CI: 1.6-3.4, P<0.001], duration of infertility [OR:0.8, CLO.8-0.9, P<0.001], total dose of gonado-tropin [OR:1.02, CL1.003-1.04, P=0.02] and semen volume [ORrl.l, CL1.008-1.2, P=0.03]] which were the most predictive of IUI success. Our study defined prognostic factors for pregnancy in COH+IUI. These variables can be integrated into a mathematical model to predict the chance of pregnancy rate in subsequent COH+IUI cycles

Comparison of 25-hydroxyvitamin D and calcium levels between polycystic ovarian syndrome and normal women

Given the relationship of vitamin D deficiency with insulin resistance syn-drome as the component of polycystic ovary syndrome [PCOS], the main aim of this study was to compare serum level of 25- hydroxyvitamin D [25[OH]D] between PCOS patients and normal individuals. A cross sectional study was conducted to compare 25[OH]D level between117 normal and 125 untreated PCOS cases at our clinic in Arash Hospital, Tehran, Iran, during 2011-2012. The obtained levels of 25[OH]D were classified as follows: lower than 25 nmol/ml as severe deficiency, between 25-49.9 nmol/ml as deficiency, 50-74.9 nmol/ml as insufficiency, and above 75 nmol/ml asnormal. In addition, endocrine and metabolic variables were evaluated. Among PCOS patients, our findings shows 3[2.4%] normal, 7[5.6%] with insufficiency, 33[26.4%] with deficiency and 82[65.6%] with severe deficiency, whereas in normal participants, 5[4.3%] normal, 4[3.4%] with insufficiency, 28[23.9%] with deficiency and 80[68.4%] with severe deficiency. Comparison of 25[OH]D level between two main groups showed no significant differences [p= 0.65]. Also, the calcium and 25[OH]D levels had no significant differences in pa-tients with overweight [p=0.22] and insulin resistance [p=0.64]. But we also found a relationship between 25[OH]D level and metabolic syndrome [p=0.01]. Furthermore, there was a correlation between 25[OH]D and body mass index [BMI] in control group [p=0.01], while the C-reactive protein [CRP] level was predominantly higher in PCOS group [p<0.001]. Although the difference of 25[OH]D level between PCOS and healthy women is not significant, the high prevalence of 25[OH]D deficiency is a real alarm for public health care system and may influence our results

ICSI outcome in infertile couples with different causes of infertility: a cross-sectional study

Different success rate of Intracytoplasmic Sperm injection [ICSI] has been observed in various causes of infertility. In this study, we evaluated the relation between ICSI outcome and different causes of infertility. We also aimed to examine parameters that might predict the pregnancy success rate following ICSI. This cross sectional study included1492 infertile women referred to Infertility Center of Royan Institute between 2010 and 2011. We assigned two groups including pregnant [n=504] and non-pregnant [n=988], while all participants underwent ICSI cycles. All statistics were performed by SPSS program. Statistical Analysis was carried out using Chi-square and t test. Logistic regression was done to build a prediction model in ICSI cycles. The overall clinical pregnancy rate in our study was 33.9% [n=1492]. There was a statistically significant difference in mean serum concentration on day 3 after application of luteinizing hormone [LH] between the pregnant and the non-pregnant groups [p<0.05]. However, There were no significant differences between two groups in the serum concentrations on day 3 after application of the following hormones: follicle-stimulating hormone [FSH], thyroid-stimulating hormone [TSH], and metoclopramide-stimulated prolactin [PRL] . We found no association between different causes of infertility and clinical outcomes . The number of metaphase II [MII] oocytes, embryo transfer, number of good embryo [grade A, B, AB], total dose of gonadotropin, endometrial thickness, maternal age, number of previous cycle were statistically significant between two groups [p<0.05]. Our results indicate that ICSI in an effective option in couples with different causes of infertility. These variables were integrated into a statistical model to allow the prediction for the chance of pregnancy following ICSI cycles. It is required that each infertility center gather enough information about the causes of infertility in order to provide more information and better assistance to patients. Therefore, we suggest that physicians prepare adequate training and required information regarding these procedures for infertile couples in order to improve their knowledge