The effects of green tea tablets and metformin on ovulation and menstrual cycle regularity in women with polycystic ovary syndrome.

Polycystic ovary syndrome is the most common cause of oligo-ovulation and anovulation among women of reproductive age, contributing to infertility. This study aimed to compare the effects of green tea tablets and metformin on ovulation, menstrual cycle regularity, and antioxidant biomarkers in women with polycystic ovary syndrome (PCOS). In this clinical trial study, 94 women with PCOS were randomly assigned to three groups: green tea (n = 33), metformin (n = 29), and control (n = 32). Menstrual status and oxidative stress parameters, including total antioxidant capacity, thiol, and lipid peroxidation, were compared before and 3 months after the intervention among all three groups. Data analysis was conducted using SPSS software version 22 and employing the analysis of variance and paired t-tests. Following the intervention, the mean menstrual cycle duration in the green tea, metformin, and control groups was 32.22 ± 12.78, 48.72 ± 37.06, and 48.53 ± 31.04 days, respectively (P = 0.040). There was no statistically significant difference between the three groups in terms of biochemical, hormonal, and antioxidant indices before and after the intervention (P > 0.05). The intake of green tea tablets was associated with better outcomes in regulating the menstrual cycle in women with PCOS.

A comparative study on the effect of "black cohosh" and "evening primrose oil" on menopausal hot flashes.

INTRODUCTION: Hot flashes are considered to be a common experience for menopausal women and they can compromise the quality of life. The objective of this study is to assess the efficacy of Cimicifuga racemosa in comparison with evening primrose oil (EPO) in postmenopausal women with menopause-related symptoms. MATERIALS AND METHODS: This study was performed on 80 postmenopausal women with hot flashes. The participants were randomly divided into two groups by blocked randomization. The participants of one group received black cohosh and the other group received EPO for 8 weeks. The severity and number of hot flashes and quality of life were measured by four-point scale, and the Menopause-Specific Quality of Life (MENQOL) questionnaire at pre-intervention, 1st, 4th, and 8th weeks after treatment. Data were analyzed in SPSS Version 16 using independent t-test, Chi-square, and Fisher's exact test. RESULTS: Average severity of hot flashes in both groups and number of hot flashes in black cohosh group in 8th week were significantly lower than 1st week (P < 0.001), but number of hot flashes in primrose oil group in 8th week showed no significant differences (P = 0.32). The number of hot flashes and quality of life score in black cohosh arm compared to EPO showed a significant decrease in the 8th week (P < 0.05). All MENQOL scores were significantly improved in two groups (P < 0.05), but the percentage of improvement in black cohosh arm was significantly superior to EPO group. CONCLUSION: Both herbs were effective in reduction of severity of hot flashes and improvement of the quality of life, but it seems that black cohosh is more effective than primrose oil because it was able to reduce the number of hot flashes too.

Comparison the Effect of Fish-Oil and Calcium Supplementation on Treatment of Primary Dysmenorrhea.

BACKGROUND: Primary dysmenorrhea is common among young girls and childbearing women. Dysmenorrhea is a painful contraction of uterus which occurs in the beginning of bleeding or before the menstrual cycle begins. Regarding the mechanism of calcium in response to hormonal change and the role of fish oil on reducing prostaglandins, we compared the effectiveness of fish-oil and calcium supplementation in treating primary dysmenorrheal. METHODS: This randomized double-blinded clinical trial was conducted on women aged 18 to 45 years with moderate to severe primary dysmenorrhea symptoms from January 2015 to March 2015. The women were randomly divided to two groups (fish oil and calcium). The drugs were given every day in the first cycle and from 8 days before till 2 days after initiation of menstruation for the second and third cycles. The intensity of pain and other symptoms of dysmenorreha were recorded and data were analyzed in SPSS 16 using T-test and X2 tests. Significant level was considered to be less than 0.05. RESULTS: The mean ± SD age of the patients in the fish oil group was 25.0±4.3 and in calcium group was 25.48±6.6 years. According to this result, there was no statistically significant difference in the intensity of pain between fish-oil group and calcium group before and 1 month after the study (P>0.05). However, there was statistically significant difference between fish-oil group and calcium group before the study and 2 months (P=0.001) and 3 months after study (p<0.001). Besides, the fishoil patients needed less analgesic as compared to the calcium patients. CONCLUSION: It is concluded that omega-3 is more effective than calcium, what can be justified by pain mechanisms and symptoms pathology in dysmenorrheal.

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 first 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 .

Primary Disseminated Hydatid Cysts in a 14-Year-Old Girl: A Case Report.

Hydatid cysts in humans usually located in the liver or lungs primarily and some case in the other organs. Sometimes, because the trauma or medical manipulating, the cyst may be rupture and protoscoleces spillage resulted in secondary hydatid cyst. Primary dissemination of cyst to multiple organs is a rare phenomenon. Herein, we reported a 14-year-old teenage female patient with symptoms of abdominal pain with an unusual ultrasonographic and computed tomographic presentation mimicking polycystic ovarian syndrome PCOS. Due to numerous masses in the retrovesical region, she was admitted for surgical treatment in the gynecology ward, and after laparotomy, more than 50 cysts removed her internal organs.

The Healing Effect of Amniotic Membrane in Burn Patients.

BACKGROUND: Different methods for dressing of donor site of skin graft in burn patients have similarly pain, limitation of mobility of donor site and local complications such as infection and scar. Amniotic membrane has used for improvement of healing in some wounds. Accordingly in this study amnion was used as biologic dressing for donor site of skin graft to evaluate it's efficacy in improvement of pain, move score and the risk of local infection. METHODS: Study was done as clinical trial over 32 admitted patients in burn department of Beasat hospital. Amnion was prepared in elective caesarean section after rule out any placental site for risk of torch and viral infection. Skin graft was taken from two sites in every patient. One site dressed with amnion and another with routine dressing. Then two sites were compared about severity of pain, move score, infection and time of dressing sloughing. RESULTS: Fourteen patients were women and 18 men. Mean score of pain and movement up to fourth and fifth post operative day respectively was less than control site. No difference is seen about infection and dressing slough in two sites. CONCLUSION: It seems use of amnion for dressing of donor site probably cause rapid epithelialisation and wound healing and can improve pain and move score in early post operative days. Accordingly it is expected to need less analgesia and low rate of immobilization and following complications and earlier discharge of patients.

Oxidative stress biomarkers in endometrial secretions: A comparison between successful and unsuccessful in vitro fertilization cycles.

A potential role of oxidative stress has been implicated in the outcome of various steps of assisted reproductive technology (ART). In a prospective cohort study, a total of 100 patients undergoing IVF/ICSI procedure due to male factor infertility were recruited based on the inclusion criteria. In all patients, 1-2ml of endometrial secretions was aspirated prior to embryo transfer. The oxidative stress markers in endometrial secretions, including superoxide dismutase (SOD), catalase (CAT) activities, lipid peroxidation (LPO), total thiol groups (TTG), and total antioxidant power (TAP) were investigated and compared among study groups including term pregnancy, failed IVF cycle, and miscarriage. P<0.05 was considered statistically different. Of the 100 patients, 28 cases (28%) resulted in ongoing pregnancy (biochemical pregnancy followed by clinical pregnancy), 11 cases (11%) resulted in miscarriage, and 61 cases (61%), resulted in failed IVF cycle. SOD, LPO, CAT, and TAP levels in the endometrial secretions of the three groups were statistically different (P-value <0.01, <0.001, <0.001, and <0.001, respectively). TTG levels in endometrial secretion of three groups were not statistically different (P-value=0.837). Our results indicated that higher levels of antioxidants such as SOD, CAT, or TAP, and lower levels of oxidative stress markers such as LPO in the endometrial secretions were associated with successful IVF outcome.

In Vitro Susceptibility of Iranian Isolates of Trichomonas vaginalis to Metronidazole.

BACKGROUND: Metronidazole, a 5-nitroimidazole derivative, is the main antitrichomonal agent of choice for treatment of trichomoniasis. Since 1962, some cases of treatment failure with metronidazole have been reported and recently drug resistance is now on the rise in the world. This study was aimed to determine current susceptibility of Iranian isolates of Trichomonas vaginalis to metronidazole. METHODS: This study was performed on 50 T. vaginalis isolates collected from west and central areas of Iran. After axenisation of the parasites, susceptibility testing was carried out by using serial twofold dilutions of metronidazole (400 to 0.1 µg/ml). The minimum inhibitory concentration (MIC) and the minimum lethal concentration (MLC) of the trichomonads were determined after 48 h incubation at 35.5 °C. Drug susceptibility assays of the all isolates were carried out two times in triplicate under aerobic and anaerobic conditions. RESULTS: Ninety-eight percent of the T. vaginalis isolates (49/50) were sensitive to metronidazole. Metronidazole resistance was defined as aerobic MIC ≥50 µg/ml, detected in one isolate. The means of aerobic MICs and MLCs and that of anaerobic MICs of the parasites were 2.91, 1.95 and 0.28 µg/ml, respectively. CONCLUSION: This investigation showed in vitro low-level tolerance to metronidazole in a few T. vaginalis isolates that may be leading to the development of drug resistance.

The relationship between some endometrial secretion cytokines and in vitro fertilization.

BACKGROUND: Endometrial secretion analysis is a non-invasive and promising method in evaluation of endometrial receptivity. OBJECTIVE: 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-1ß (IL-1ß), tumor necrosis factor (TNF-α), interferon gamma-induced protein 10 (IP-10), and monocyte chemoattractant protein (MCP). MATERIALS AND METHODS: 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-1ß, TNF-α, 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. RESULTS: 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-α, 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-1ß levels between two groups (p=0.614). CONCLUSION: The current study suggested that lower concentrations of TNF-α, IP-10, and MCP in endometrial secretions might be associated with improved endometrial receptivity and IVF outcome. Regarding IL-1ß, no statistically significant differences were seen between the groups with and without successful pregnancy.

Comparison of prevalence of periodontal disease in women with polycystic ovary syndrome and healthy controls.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting 4-18% of them. Previous studies also showed that periodontal diseases are associated with different components of the metabolic syndrome. The aim of this study is to determine the association between PCOS and periodontal diseases. MATERIALS AND METHODS: A total of 196 women (98 with PCOS and 98 healthy controls) were enrolled. PCOS diagnosis was confirmed by history, clinical signs, physical examination, laboratory parameters, and ultrasound studies. Both cases and controls were examined by the same periodontist. Periodontal parameters including bleeding on probing (BOP), probing depth, clinical attachment loss (CAL), plaque index, and tooth loss were investigated in all participants. Pregnant women, smokers, individuals with a history of malignancy or osteoporosis, and those taking prophylactic antibiotics for dental procedures or receiving periodontal treatment during the 6-month period before examination were excluded. Data were analyzed using t-test, Chi-square test, and linear regression. Statistical significance was set at P < 0.05. RESULTS: CAL and sites with BOP were significantly higher in women with PCOS (P < 0.05). However, no significant difference was observed in the tooth loss rate between PCOS and non-PCOS participants (P = 0.384). CONCLUSION: The prevalence of periodontal disease seems to be higher in women with PCOS. This may be related to the role of chronic systemic inflammation in the pathophysiology of both PCOS and periodontal diseases.

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

BACKGROUND: Previous studies have demonstrated that clinical features of Polycystic ovary syndrome (PCOS) are associated with a lower degree of health, self, and sex satisfaction. OBJECTIVE: Our study aimed to investigate possible associations between depression and different clinicobiochemical markers of PCOS. MATERIALS AND METHODS: 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. RESULTS: 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≤r≤+0.121, p>0.05). CONCLUSION: In spite of high rate of depression in women with PCOS, there was no significant association between Clinicobiochemical Markers and depression.

Genetic Identification of Trichomonas vaginalis by Using the Actin Gene and Molecular Based Methods.

BACKGROUND: Trichomonas vaginalis is the agent of urogenital tract infection that causes human trichomoniasis with some serious health complications. More understanding 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Comparison of serum progesterone in non-viable pregnancy and ectopic pregnancy.

Ectopic pregnancy (EP) and miscarriage are important differential diagnosis of first trimester vaginal bleeding. In first trimester, serum progesterone value can be 5-20 ng/ml in EP and miscarriage. Since delay in diagnosis of EP could have high mortality and morbidity, the aim of this study was comparison of serum progesterone value in EP and miscarriage in order to differentiate these conditions. A total of 60 patients (30 EP and 30 miscarriages) with gestational age of 5-7 weeks by LMP were enrolled in this study. The titer of progesterone and ßhCG of serum were measured. The mean of progesterone and ßhCG titers were compared in two groups by Student's t-test. The mean progesterone titer for all patients was 6.36±5.62 ng/ml, with a minimum value of 0.44 and maximum value of 21.50 ng/ml. Serum progesterone level in 33 patients was lower than 5 ng/ml and in 27 patients was between 5-25 ng/ml. Mean serum progesterone for miscarriage was 6.803±5.72 and for EP was 5.915±5.45 ng/ml. Difference between two values was not significant statistically (P=0.067). Mean ßhCG for miscarriage was 1313.04 IU/l and for EP 1805.56 IU/l. Mean patients age were 27.2 totally that for miscarriage was 25.8 and for EP 28.5 years. This study indicated, the mean value of progesterone could not differentiate EP from miscarriage.

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

BACKGROUND: 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. METHODS: 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-α-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. RESULTS: 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). CONCLUSION: 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. TRIAL REGISTRATION NUMBER: IRCT138903244176N1.

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

BACKGROUND: 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. OBJECTIVE: 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. MATERIALS AND METHODS: 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. RESULTS: In ritodrine group 14% of patients and in control group 16% had positive ß-hCG test (p-value>0.5). CONCLUSION: 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 Diag-nosis and Laboratory Findings.

BACKGROUND: Trichomoniasis is recognized as a major sexually transmitted dis-ease (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 socie-ties, in relation to sexual partnership, monogamy, or polygamy. Our objective was to describe the frequency and natural history of infection and correlation of clini-cal signs with parasite detection. METHODS: 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 Hamadan, western Iran. Trichomoniasis was diagnosed based on major clinical symptoms. Diagnosis was con-firmed using wet mount microscopically and culture in Diamond medium. RESULTS: 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) hus-band were car driver. There was not statistically significant relationship be-tween clinical diagnosis and laboratory findings (P>0.5), because the most of pa-tients diagnosed trichomoniasis, were infected by Candida or other vaginal infec-tions. CONCLUSION: Because of special cultural background, the vaginal trichomoniasis has minor importance problem in this population and clinical diagnosis is not effi-cient for treatment decision.