Successful pregnancy and live birth after intrauterine administration of autologous platelet-rich plasma in a woman with recurrent implantation failure: a case report

Background: platelets contain a significant amount of growth factors that have positive effects on local tissue repair and endometrial receptivity

Case: here we present a 45-yr-old woman with primary infertility and two failed in vitro fertilization [IVF] cycles who was candidate to receive donor eggs. Five consecutive frozen-thawed embryo transfer cycles with good quality embryos were performed within 2 yr. With the diagnosis of recurrent implantation failure [RIF], the patient was treated for improving endometrial receptivity with intrauterine administration of autologous platelet-rich plasma [PRP], 24 hr before embryo transfer. The patient gave birth to a healthy baby boy weighing 2350 gr in the cesarean section

Conclusion: extensive literature search suggests that this is the ?rst successful pregnancy after administration of PRP in a woman with RIF. Local administration of PRP before embryo transfer may play a vital role in successful implantation

relationship between some endometrial secretion cytokines and in vitro fertilization

Endometrial secretion analysis is a non-invasive and promising method in evaluation of endometrial receptivity. The aim of the present study was to assess the relationship between the success rate of IVF procedures and some endometrial secretion cytokines, including interleukin-1beta [IL-1beta], tumor necrosis factor [TNF-alpha], interferon gamma-induced protein 10 [IP-10], and monocyte chemoattractant protein [MCP]. In a prospective cohort study, 50 women selected for IVF met the study inclusion criteria. All the patients underwent endometrial secretion aspiration prior to embryo transfer. The level of IL-1beta, TNF-alpha, IP-10 and MCP were analyzed by enzyme-linked immunosorbent assay method using special standard kits. To detect successful implantation and pregnancy patients underwent serum human chorionic gonadotropin measurements and ultrasound evaluation. Five samples were excluded. Nine women [20%] had successful clinical pregnancies, which resulted in live birth. Other 36 women [80%] were classified as failed pregnancy. Comparison of cytokine levels showed lower concentrations of TNF-alpha, IP-10, and MCP in the group with successful clinical pregnancy compared to the group with failed pregnancy [p=0.007, 0.005 and 0.001, respectively]. However, no significant difference was revealed in IL-1beta levels between two groups [p=0.614]. The current study suggested that lower concentrations of TNF-alpha, IP- 10, and MCP in endometrial secretions might be associated with improved endometrial receptivity and IVF outcome. Regarding IL-1beta, no statistically significant differences were seen between the groups with and without successful pregnancy

Genetic identification of trichomonas vaginalis by using the actin gene and molecular based methods

Trichomonas vaginalis is the agent of urogenital tract infection that causes human trichomoniasis with some serious health complications. More under-standing about genetic features of the parasite can be helpful in the study of the pathogenesis, drug susceptibility and epidemiology of the infection. For this end, we conducted analysis of the actin gene of T. vaginalis by applying the PCR-SSCP [PCR-Single Stranded Conformational Polymorphism] and nucleotide sequencing method. Fifty T. vaginalis samples were collected from 950 women attending gynecology clinics in two cities of Iran, Hamadan and Tehran, from November 2010 to July 2011. After axenisation of isolates, all samples subjected to PCR-SSCP and nucleotide sequencing. According to the SSCP banding patterns and nucleotide sequencing, seven sequence types were detected among the isolates. Alignment of the nucleotide sequences showed five polymorphic sites in the different strain types. Amino acid substitution was not observed in the nucleotide sequence translation of the all sequences. The actin gene analysis represents genetic diversity of T. vaginalis and it suggests that various strains can be responsible for clinically different trichomoniasis in infected individuals. It is expected that further studies will be conducted to increase our knowledge about relationship between the actin gene polymorphism and different biological behavior of the parasite

relationship between clinicobiochemical markers and depression in women with polycystic ovary syndrome

Previous studies have demonstrated that clinical features of 16TPolycystic ovary syndrome16T [PCOS] are associated with a lower degree of health, self, and sex satisfaction. Our study aimed to investigate possible associations between depression and different clinicobiochemical markers of PCOS. In a cross-sectional analytic study, 120 PCOS women aged 18-45 yr, were enrolled. Beck Depression Inventory was used to assess depression. Also, all participants underwent biochemical studies. Individuals with 15 points and more in Beck test were referred to a psychiatrist to participate in a complementary interview for the diagnosis of depression based on Diagnostic and Statistical Manual of Mental Disorders IV [DSMIV-TR] criteria. Among the study participants, 82 women [68.3%] were non-depressed, and 38 patients [31.7%] had some degrees of depression. According to the psychiatric interview, 10 patients [8.3%] had major depression, 22 patients [18.3%] had minor depression and 6 patients [5%] had dysthymia. We failed to show any significant difference in body mass index, hirsutism, infertility, serum total testosterone, lipid profile, and the homeostasis model assessment of insulin resistance [HOMA-IR] between depressed and non-depressed subjects [p>0.05]. Using Spearman correlation, we did not find a positive correlation between BDI scores and clinicobiochemical markers for all PCOS subjects [-0.139 0.05]. In spite of high rate of depression in women with PCOS, there was no significant association between Clinicobiochemical Markers and depression

Metformin therapy decreases hyperandrogenism and ovarian volume in women with polycystic ovary syndrome

It is well known that there is a close relationship between elevated androgen plasma levels and the ultrasound findings of stromal hypertrophy in polycystic ovary syndrome [PCOS]. The objective of this study was to investigate the effects metformin on the hyperandrogenism and ovarian volume in PCOS. The study is an unrandomized clinical trial with before-after design. Twenty eight patients with infertility [male or female factor] meeting the Rotterdam ESHRE/ASRM criteria for PCOS were studied during the 2008-2009. The anthropometric characteristics of the patients, mean bilateral ovarian volume, and morphology by trans vaginal sonography as well as the plasma levels of leutinizing hormone, follicle stimulating hormone, estradiol, testosterone, 17- alpha -hydroxyprogesterone, and dehydroepianderosterone sulfate were obtained before and after treatment with metformin [500 mg three times a day] for three months. Paired t, Pearson's Correlation Coefficient, or Partial Correlation test was used to analyze the findings. The patients had a mean age of 25.67 years. A significant reduction in mean ovarian volume [11.70 +/- 4.31 ml vs 8.27 +/- 3.71 ml P=0.001], body mass index [BMI, 28.11 +/- 4.55 kg/m[2] vs 26.84 +/- 4.55 kg/m[2] P=0.000] and serum androgen levels was seen after three months of treatment with metformin. There was positive correlations between the ovarian volume and serum testosterone level [r=0.589, P=0.001] or BMI [r=0.663, P=0.000]. Metformin therapy may lead to a reduction in ovarian volume. It is likely that the reduction of ovarian volume reflect a decrease in the mass of androgen producing tissues

Evaluation of the effect of oral ritodrine on implantation rate in in-vitro fertilization-embryo transfer cycles

Pregnancy rate with IVF cycle is almost 22%. Many investigations perform to increase this rate in IVF. Various factors affect the result of IVF cycles. One of these factors could be uterine contractions that expel transferred embryo. Ritodrine is a beta mimetic agent that can block and decrease uterine contractions. The objective of this study was to determine ritodrine effectiveness for increasing the implantation rate in IVF cycles, and its probable mechanisms in decreasing uterine contractions as well. A total of 100 patients of IVF-ET cycles were divided randomly in two groups in a university hospital, Hamadan, Iran. The case group were prescribed ritodrine 10 mg / bid orally after oocyte retrieval until 10 days. The control group didn't received ridotrine. In ritodrine group 14% of patients and in control group 16% had positive beta -hCG test [p-value>0.5]. Ritodrine did not improve the implantation rate in IVF-ET cycles

Frequency of trichomoniasis in patients admitted to outpatient clinics in Hamadan [2007] and relationship between clinical diagnosis and laboratory findings

Trichomoniasis is recognized as a major sexually transmitted disease [STD] in the world and has the highest prevalence and incidence of STD. The prevalence strongly is related to cultural and social norms in different societies, in relation to sexual partnership, monogamy, or polygamy. Our objective was to describe the frequency and natural history of infection and correlation of clinical signs with parasite detection. From February 2006 to March 2007, in a cross sectional study, clinical and wet mount examination of vaginal smear along with culture were performed on 683 women attending to private outpatient clinics in Hamada, western Iran. Tricomoniasis was diagnosed based on major clinical symptoms. Diagnosis was confirmed using wet mount microscopically and culture in Diamond medium. Only 2.2% of patients with clinically diagnosed trichomonal vaginitis were positive for Trichomonas vaginalis by wet smear and culture. The mean age of patients was 33.6 +/- 9.7 yr, and majority of them were married and non-pregnant. Some [5 patients] infected cases were divorced and others [7 patients] husband were car diver. There was not statistically significant relationship between clinical diagnosis and laboratory findings [P>0.5], because the most of patients diagnosed trichomoniasis, were infected by Candida or other vaginal infections. Because of special cultural background, the vaginal trichomoniasis has minor importance problem in this population and clinical diagnosis is not efficient for treatment decision

[Comparing the efficacy of intra-amniotic prostaglandin [PG] and oxytocin with rising induction in termination of second trimester pregnancy]

Termination of pregnancy in fetus with severe anomaly is legal in Iran. This study was done in order to compare the rate of effectiveness and complications of intra-amniotic PG and oxytocin, with rising induction in patient candidates for second trimester abortion, at Fatemieh Hospital, in Hamadan. In a randomized clinical trial study, 40 pregnant women in their second trimester with fetal CNS anomalies, were divided into two groups [N=20]. In the first group, one PG E2 Amp was injected intra-amniotic at first and then, 20 IU oxytocin was infused in 500 ml serum ringer for each patient. The infusion rate was increased up to induced effective concentrations every 15 to 30 minutes. In the second group, 50 IU oxytocin was infused with 1000 ml serum ringer and thereafter, another infusion of 50 IU oxytocin was added into the remaining 500 ml of serum. The rate of infusion was regulated on the basis of induced effective concentrations. Finally, both groups were compared for labor duration and probable side effects. The rate of success in both groups was 100%. The mean duration of labor was 19.75 +/- 5.9 hours and 30.2 +/- 6.49 hours in the group with intra-amniotic PG with oxytocin and rising induction group, respectively. This difference was statistically significant [P<0.00]. Diarrhea was seen in only one case with intra-amniotic PG injection. Differences between the frequency of side effects in both groups was not statistically significant. This study showed that the mean duration of laboring intra-amniotic PG with oxytocin method, is less than of rising induction method

[Fetal deaths and sex ratio among progenies of workers at lead mine and dye-houses]

Mutant genes, especially sex linked mutations can lead to fetal deaths and changing the secondary sex ratio, that can assume as long term or genetic consequences of exposure to the environmental and occupational hazards. The goals of present study were to determine the fetal deaths rate and sex ratios among progenies of workers at two high risk occupations [lead mine and dye-houses]. In a cross-sectional investigation, the outcomes of all pregnancies of two high risk groups [wives of lead and dye workers] were studied for fetal deaths rate and sex ratio of live births and then statistically compared with each other and with general population. Result of pregnancies of wives of all workers of Ahangran lead mine and dye workers at Hamadan, Iran, were studied. Total of pregnancies were 545 cases and total of live births were 473. The basic primary data were collected by face to face interviews and fill appropriate questionnaires. Sex ratio of live births among pregnancies of workers of lead mine and dye-houses were 91.60 and 98.95 percent respectively. Also the rates of fetal deaths [abortions plus stillbirths] among their wives' pregnancies were 13.15 and 13.30 percent respectively. Fetal death rates among those two groups were different with the same rate of general population [p<0.05]. The results of present study showed an increase in fetal death rate and decrease in sex ratios of subject groups in comparison with general population. Working in lead mine and dye-houses as results of long-term genetic consequences in such high risk places can be subject of another survey

Comparison between efficacy of single dose of tinidazole with a 7 day standard dose course of metronidazole in giardiasis

Giardia intestinalis is the most common intestinal protozoan in the under developed countries. Treatment of infection has some difficulties by metronidazole because of long course of therapy and various side effects. The objective of this study was to determine efficacy and side effects of tinidazole compared with metronidazole in the treatment of giardiasis in children. A randomized controlled clinical trial, 106 subjects [69 males, 37 females] with Giardia intestinalis infection admitted to out patients or private clinics in Hamdan, West of Iran, was treated with tinidazole or metronidazole. The study period was May 2002 to January 2003. Tinidazole 50 mg/kg single dose and metronidazole 15 mg/kg three times a day for seven days were given orally to children. Parasitological cure was documented when there was 3 times negative stool examination for giardiasis at 1-2 weeks after therapy. Thirty-seven of 42 individuals [88.1%] treated with tinidazole and 43 of 64 children [67.2%] treated with metronidazole had parasitological cure. Cure rates between two groups were significant statistically [P<0.01]. No major side effect were observed except two cases in metronidazole group who had mild headache and abdominal pain for two days and some had metallic taste. Three cases in tinidazole group had nausea, dizziness and headache. Tinidazole was more effective than metronidazole, produced fewer and mild side effects and is recommended as drug of choice in single dose therapy for giardiasis. Because of single dose administration, short course of therapy and good compliance of patients, this preparation is preferred to metronidazole in the treatment of giardiasis

Comparison of predictive value of 8, 12 and 24- hour proteinuria in pre-eclampsia

Hypertensive disorders of pregnancy are common major complications of pregnancy and are responsible for significant morbidity and mortality in the fetus the newborn infant and the mother. The objective of this study was to determine if a patients' eight and/or 12-hour urine total protein values correlate with the 24-hour value to confirm the diagnosis of preeclampsia. The study population included 57 patients with hypertensive disorders of pregnancy. Patients" urine was collected over 24 hours with the first 8 hours, next 4 hours, and remaining 12 hours in separate containers. The urine volume and total protein were measured in the 8, 12, and 24-hour samples. The 8 and 12 hour results were compared to the results by use of single regression analysis. Of the 57 patients, 49 had no proteiuria, six had mild proteinuria, and two had severe proteinuria. The results of the 8- hour sample correlated with those of the 24- hour sample for patients with mild [P<0.05] and severe disease [P<0.05]. The 12 hour sample correlated with the 24-hour sample for patients with no disease [p<0.02], mild proteinuria [P<0.02], and severe proteinuria [p<0.01]. Total protein values for 8- and 12- hour urine samples correlate positively with values for 24-hour samples for patients with proteinuria. The results for 12 and 24 hour samples correlate for patients without proteinuria