The Association of Soluble VEGFR-1 Serum Level and Genetic (rs7993418) Polymorphism with In Vitro Fertilization and Embryo Transfer Outcome in the Population of Northern Iran.

Background: Vascular endothelial growth factor receptors (VEGFRS) play an important role in embryo implantation. The aim of the present study was to examine the association of VEGFR1 circulating level and gene polymorphism with in vitro fertilization and embryo transfer (IVF-ET) outcome. Methods: In this case-control study, 120 women who had unsuccessful IVF (IVF-) history and 120 women who had successful IVF outcome (IVF+) as controls were included. Genomic DNA was extracted from blood samples. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The serum levels of soluble VEGFR1 (sVEGFR1) were measured by ELISA. ANOVA test was used for statistical analysis. Results: The frequency of T and C alleles in IVF+ individuals were 87.5%, 12.5% and among IVF- were 75.5%, 24.5%, respectively (p=0.0006). The minor allele (C) was associated with an increased risk of IVF failure based on results from co-dominant (OR=3.86, 95%CI 1.19-12.47), dominant (OR=2.32, 95%CI 1.31-4.10), recessive (OR=3.22, 95%CI 1.00-10.29), and allele models (OR=2.28, 95%CI 1.40-3.69). We also showed that there is a significant decrease in serum sVEGFR1 levels in IVF as compared to IVF+ (p=0.006) groups. Moreover, TT genotype is significantly associated with increased serum sVEGFR1 concentration in IVF group (TT, CT, and CC serum levels were 106.55±11.04, 94.33±10.75, and 83.33±9.13 ng/ml, and in IVF+ group were 156.11±18.08, 120.66±16.51, and 84.66±20.31 ng/ml, respectively). Conclusion: The results of this study indicate that VEGFR1 polymorphism and sVEGFR1 circulating levels are associated with IVF-ET outcome. Moreover, CC genotype is associated with decreased sVEGFR-1 serum concentration and IVF-ET failure.

Seizure in Pregnancy Following Cerebral Venous Sinus Thrombosis.

INTRODUCTION: Seizure involves less than 1% of pregnancies; however it is associated with increased maternal and fetal complications. Cerebral venous sinus thrombosis is a rare, but potentially life-threatening cause of seizure during pregnancy, presenting primarily as seizure in 12% - 31.9% of cases. Pregnancy and puerperium are known as the risk factors of cerebral venous sinus thrombosis. CASE PRESENTATION: Here is presented a case of seizure after delivery by cesarean section in an otherwise healthy woman. The final diagnosis was cerebral venous sinus thrombosis probably due to hypercoagulable state in pregnancy. CONCLUSIONS: If seizure occurs during the peripartum period, along with providing complete cardiovascular and respiratory support, advanced diagnostic measures are needed and cerebral venous sinus thrombosis should be considered as a possible diagnosis.

Development of mouse preantral follicle after in vitro culture in a medium containing melatonin.

OBJECTIVE: Improvements in cancer treatment have allowed more young women to survive. However, many cancer patients suffer from ovarian failure. Cryopreservation is one of the solutions for fertility restoration in these patients. The cryopreservation of isolated follicles is a more attractive approach in the long term. Many endocrine and paracrine factors can stimulate the granulosa cells of preantral follicles to proliferate. Melatonin acts as direct free radical scavenger and indirect antioxidant. In this study, we investigated the direct effects of melatonin on follicle development and oocyte maturation by exposing in vitro cultured mouse vitrified-warmed ovarian follicles to melatonin. MATERIALS AND METHODS: In an experimental study, preantral follicles with diameter of 150-180 µm were isolated from prepubertal mouse ovaries. Follicles were vitrified and thawed using cryolock method. They were then cultured individually for 7 days in droplets supplemented with 0, 10 and 100 pM melatonin, while ovulation was induced using epidermal growth factor (EGF) and human chorionic gonadotropin (hCG). The survival rate of follicles and nuclear maturation of ovulated oocytes were determined. RESULTS: At the end of culture, significant increases in follicle survival (p<0.001) and in diameter (p<0.05) were noticed in 10 pM melatonin group compared to control group. In the 100 pM group, survival rate was not affected by melatonin. It was revealed that after induction of ovulation, total number of metaphase II oocytes in treatment groups were not influenced by melatonin (p>0.05). CONCLUSION: Culture of mouse vitrified-warmed preantral follicles in a medium supplemented with 10 pM melatonin increased the number of surviving follicles.

Comparison of 25 µg sublingual and 50 µg intravaginal misoprostol for cervical ripening and labor: a randomized controlled equivalence trial.

BACKGROUND: Sublingual misoprostol, used for labor induction, produces earlier and higher peak plasma concentrations of misoprostol than vaginal or rectal misoprostol. The sublingual route could be expected to be more effective and safer than the vaginal route and by avoiding a direct effect on the cervix, it might reduce the risk of uterine hyperstimulation and be safer. This study aimed to compare the efficacy of 25-µg sublingual misoprostol with 50-µg intravaginal misoprostol for cervical ripening prior to labor induction in primiparous women. METHODS: In a double-blind, parallel randomized controlled equivalence trial, we recruited 131 primiparous women at 36-42 weeks of gestation requiring labor induction who referred to Alzahara hospital in Rasht, Iran. The women were randomly assigned to receive 25-µg sublingual misoprostol with vaginal placebo (n = 63) or 50-µg intravaginal misoprostol with sublingual placebo (n = 63). The dose was repeated every 4 h (maximum 4 doses). The primary outcome was the interval from the start of induction to vaginal delivery. RESULTS: There were no significant differences between the two groups with regard to the interval from the start of induction to vaginal delivery(13.2 ± 3.07 h in the vaginal group vs. 13.1 ± 3.46 h in the sublingual group), duration of active phase, Bishop Scores after 4h, and rate of the vaginal delivery under 12 h. Also, the rate of hyperstimulation, tachysystole, type of delivery, cause of cesarean section, Apgar scores less than 7 and admission to the NICU were similar in these two groups. The mean dose of misoprostol applied was significantly lower in the sublingual group (P = 0.001). CONCLUSION: Sublingual administration of 25-µg of misoprostol appears to be as effective as 50 µg intravaginal misoprostol for cervical ripening and labor induction. TRIAL REGISTRATION: This trial has been registered under IRCT 38903131096N3.

Evaluation of Relation between Anthropometric Indices and Vitamin D Concentrations in Women with Polycystic Ovarian Syndrome.

OBJECTIVE: To determine the association between serum 25 - hydroxy vitamin D concentration and anthropometric indices in patients with polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: This is a descriptive cross - sectional study which was carried out on women with PCOS aged 19-39 years old referred to an infertility clinic of Alzahra Hospital, Rasht, Iran during September2011- March2012. The study was conducted based on the Rotterdam criteria. Exclusion criteria were hyperandrogeniema and thyroid dysfunction. The data were gathered through an interview with focus on demographic characteristics and history of infertility. The height, weight and waist and hip circumferences were measured and BMI had been calculated. Also, blood sample had been checked to indicate the level of hydroxy vitamin D. While all statistical analyses were carried out using software package used for statistical analysis (SPSS) version 16 (SPCC Inc., Chicago, IL, USA). RESULTS: Over 68% of patients had vitamin D deficiency (Vit D<15). Level of vitamin D had a significant correlation with waist circumference (p<0.02), height (p<0.001) and waist-to-hip ratio (WHR) (p<0.007). CONCLUSION: Based on the anthropometric indices, it seems that we can predict the level of 25-hydroxyvitamin D in women with PCOS.

The impact of different time intervals between hCG priming and oocyte retrieval on ART outcomes.

BACKGROUND: Abnormal oocyte morphology has been associated with the hormonal environment to which the gametes are exposed. OBJECTIVE: In this study, we evaluated the oocytes morphology, fertilization rate, embryos quality, and implantation rate resulted of retrieved oocytes in different times after human chorionic gonadotrophin (HCG) administration. MATERIALS AND METHODS: A total of 985 metaphase II oocytes were retrieved 35, 36, 37 and 38 h after the injection of HCG as groups 1, 2, 3, and 4 respectively. Oocyte morphology was divided into (I) normal morphology, (II) extracytoplasmic abnormalities, (III) cytoplasmic abnormalities and (IV) intracytoplasmic vacuoles and in each group, oocytes were evaluated according to this classification. RESULTS: Extracytoplasmic abnormalities were encountered in 17.76% and 31.1% of these oocytes (groups 3 and 4 respectively, p=0.007) in comparison with 12.23% group 2. Cytoplasmic abnormalities in group 4 were higher than other groups. 23.88% (p=0.039) and 43.25% (p=0.089) of resulted 2PN (two pronucleus) from groups 3 and 4 showed grade Z3 respectively in comparison to group 2 (16.44%). Normal and various categories of abnormal oocytes did not differ regarding fertilization and cleavage rates (p=0.061). However, group 4 showed significant difference in the rate of embryos fragmentation (grade III and IV embryo) in comparison with group 2 (40.96% vs. 24.93%, p=0.078). The pregnancy rate was higher in G2 and G3 groups (28.5 and 24.13% respectively). CONCLUSION: Oocyte retrieval time following HCG priming affected on oocyte morphology, 2PN pattern and embryos qualities subsequently. Both good quality embryo formation and pregnancy outcomes were noticeably higher when oocytes were retrieved 36 h after HCG priming in ART program.

Survey of predictive value of 4-hour urine collection for diagnosis of proteinuria in preeclampsia.

BACKGROUND: Measuring the 24-hour urine protein ≥300 mg is the standard threshold value for diagnosis of preeclampsia. OBJECTIVE: This study was intended to determine if a patient's 4-hour urine protein correlate with the 24-hour value for diagnosis of preeclampsia. MATERIALS AND METHODS: This was a cross sectional study performed on 84 women with suspected preeclampsia due to positive urinary test strip with minimum protein content of 1+ and BP ≥140/90 at Al-zahra Educational Hospital in Rasht (Iran) from May 2007 to January 2008. Urine samples were collected within 24 hours in successive periods: The first 4-hour and the next 20-hours urine, in separate containers. The protein contents of 4-hour and 24-hour urine samples were calculated. Data were analyzed by intra-class correlation coefficient, and Receiver Operating Characteristic (ROC) curve. RESULTS: The ROC curve showed the cut-off point of 55.5 for 4-hour urine protein. The correlation between 4- and 24-hour urine protein excretions identified that most women (about 85.1%) with protein excretion rate of 300 mg/24h or more (with preeclampsia) had the same amount of protein of 55.5 or more in their 4-hour urine excretion (p<0.001). Also, most of them (about 83.7%) with a total urinary protein excretion of less than 300 mg/24h (no preeclampsia) had a protein excretion rate of less than 55.5 mg/4h. CONCLUSION: This study showed 4-hour protein collection can be used as acceptable substitute for assessing the protein content of 24-hour urine samples as a more convenient, faster, and cheaper method for diagnosis of preeclampsia and the cut-off point for 4-hour urine protein is 55.5 mg. This article extracted from a submitted thesis. (Mina Moslehi).

Perinatal outcomes of pregnancies with borderline versus normal amniotic fluid index.

BACKGROUND: Amniotic fluid is an indicator of placental function on the fetal development. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. OBJECTIVE: The purpose of this study was to compare the pregnancy outcomes of a borderline versus normal AFI. MATERIALS AND METHODS: This cross-sectional study was carried out on a total of 235 pregnant women referred to Alzahra Medical Center between 2009-2011. Women with a singleton pregnancy in third trimester were enrolled into this study; of these subjects, 141 cases were in normal AFI group and 94 cases in borderline AFI group. Adequate information was obtained from the patients' medical record and the groups were compared on maternal and fetal complications. Data analysis was performed by using SPSS. RESULTS: The mean maternal age in borderline AFI group was 25.96±5.92 years and in normal AFI group was 27.88±6.5 years (p=0.023). Maternal outcomes such as preterm delivery and labor induction in women with borderline AFI were considerably higher than those in normal group (p=0.01 and p=0.001). There were no significant differences between the two groups in terms of high blood pressure, preeclampsia, diabetes and neonatal respiratory distress. The borderline AFI group had higher rate of neonatal complications such as Apgar score of less than 7 (p=0.004), IUGR (0.0001), LBW (0.001), and crucial need to NICU (0.003). CONCLUSION: Findings indicated that there are statistical differences between adverse outcomes in borderline AFI group and normal group. This article extracted from M.D. thesis. (Samira Naimian).

Role of dyslipidemia in preeclamptic overweight pregnant women.

BACKGROUND: Obesity is an independent risk factor of preeclampsia with unknown mechanism and hyperlipidemia might be a probable case of it. OBJECTIVE: The objective of this study was to determine the role of hyper-triglyceridemi in association with high prepregnancy body mass index and the risk of preeclampsia. MATERIALS AND METHODS: The authors conducted this case-control study of 42 preeclamptic and 41 normotensive overweight pregnant women. The two groups were comparable with respect to age, gestational age, and body mass index. Blood samples were collected at the time of diagnosis of preeclampsia, after 14 hour fasting to determine plasma lipid concentrations. Enzymatic photometric tests were used to determine lipid profile. Data was analyzed with independent "t-test", Chi-square and one-way ANOVA and post HOC Tukey HSD test. The statistical significance was set at 0.05 levels. RESULTS: In the subjects with preeclampsia, serum triglyceride and total cholesterol levels were significantly increased and plasma HDL-cholesterol concentrations were decreased compared with the controls, (p<0.05), but plasma LDL cholesterol levels didn't differ between the two groups. Women who developed severe preeclampsia had higher concentrations of TG and cholesterol and lower levels of HDL compared to noromotensive group. Mean TG: 375.16 vs. 202.85, p<0.001, Mean cholesterol: 245.64 vs. 214.32, p=0.04, Mean HDL: 40.80 vs. 48.95, p=0.03). CONCLUSION: We noted that dyslipidemia, particularly hypertriglyceridemia was highly correlated with prepregnancy high BMI in preeclamptic women. These findings continue to support a role for dyslipidemia in BMI related preeclampsia.

Evaluation of serum creatine phosphokinase in diagnosis of tubal ectopic pregnancy compared with intrauterine pregnancy and threatened abortion.

BACKGROUND: Vaginal sonograghy and serial -hCG are the most common diagnostic methods for ectopic pregnancy but about 50% of cases are initially misdiagnosed. In tubal pregnancy the zygote lies next to the muscular layer, and this invasion causes an increase in creatine phosphokinase (CPK) in blood. OBJECTIVE: assessment of CPK and its isoenzyme CPK-MB as a diagnostic marker for tubal pregnancy. MATERIALS AND METHODS: In this case-control study, 111 women between 16-40 years in first-trimester pregnancy admitted to emergency ward of Rasht Alzahra hospital with abdominal pain or vaginal bleeding were included and according to sonography and ßhCG divided into 3 groups (N=37): tubal pregnancy (1), threatened abortion (2) and normal pregnancy (3). Blood samples were taken for totalCPK and CPK-MB before any invasive procedure. RESULTS: Mean total CPK level were 96.27±63.9 u/lit (group 1), 55.37±14.1 u/lit (group 2) and 48.94±19.2 u/lit (group 3) and was significantly higher in tubal pregnancy compared to other groups. Mean CPK-MB levels in 3 groups were 15.62±5.2 u/lit, 17.32±6.9 u/lit, and 15.1±4.7 u/lit, respectively which was not significant. CONCLUSION: It seems that determination of total CPK can enhance the diagnostic value of tubal pregnancy.

Evaluation of serial thawing-refreezing on human spermatozoa resistance using cryovials and straws.

BACKGROUND: We designed this study to detect the cryoinjury rate on human sperm after serial freezing and thawing, taking into consideration the effects of using cryovials and straws. MATERIALS AND METHODS: In this experimental study, semen specimens obtained from 15 subjects were divided into normozoospermic and oligozoospermic groups. Each of the normozoospermic and oligozoo spermic semen specimens were additionally divided into two groups: i. washed and ii. unwashed. Specimens were repeatedly freeze-thawed by using cryovials and straws with the fast liquid nitrogen vapor method, until no motile sperm remained. Sperm motility, recovery, and morphology rate were then determined after thawing, and compared between the groups while taking into consideration the effects of using cryovials and straws. RESULTS: Motile spermatozoa were observed in all normozoospermic samples up to thaw 6 with both cryovials and straws while in oligozoospermic specimens up to thaw 4 (straw) and thaw 3 (cryovial) in the freeze-thawing cycle. Normozoospermic sample analysis showed no significant difference in morphology rate. There was a significant increase in motility and recovery percentages for washed samples, which was observed with straws in compared to the unwashed groups. Oligozoospermic sample analysis indicated a significant increase in motility, recovery (p<0.01), and morphology (p<0.001) rates in washed specimens compared to unwashed specimens using straws. The importance of washing sperm was obvious for oligozoospermic specimens. CONCLUSION: Normozoospermic sperm resisted freezing longer than oligozoospermic sperm. Use of straws and cryovials made significant differences in motility, recovery, and morphology of sperm in each thaw. This difference was slightly higher for oligozoospermic specimens. Results indicated that the percentage of motility was higher for washed normozoospermic specimens in each thaw when straws were used, whereas the percentage of motility, recovery, and morphology were promoted after frozen oligozoospermic specimens were washed using straws.

A study of menarcheal age in northern iran (rasht).

OBJECTIVES: The event of menarche is an exceptional phenomenon, which occurs once in a lifetime. It is the precursor of future fertility. The onset of menarche is mainly dependent on genetic factors, however geographical and nutritional factors among other factors have been attributed to the events of menarche. The aim of this study is to determine the age of onset of menarche and the factors which induce it in northern Iran. METHODS: This is a cross sectional study which will assess the onset of menarche in girls between the age of 11-16 years. The subjects were either in middle or high school and had experienced menarche within 6 months prior to the study. This study revolves around 600 girls who were selected using stratified randomized sampling techniques. The data was collected in the form of a questionnaire which focused on age, weight (was measured to the nearest 0.1 kg using a balance beam scale), height (was measured to nearest 0.1cm with a manual height board), and Body Mass Index (BMI: kg/m2) was used as an index of relative weight. Principal Component Analysis (PCA) was applied to analyze Socio-economic Status (SES). The defined standard age of the first menstrual event was applied as the standard. The data collected was analyzed using the Statistical Package for the Social Sciences (SPSS.10) statistical analysis software and the Chi-square and Analysis of Variance (ANOVA) tests were applied. In an effort to establish the factors associated with the age of menarche, multivariate analysis was performed based on linear logistic regression which was performed using a model where all the variables changing the risk estimated by more than 10%. Statistical significance was determined at P<0.05. RESULTS: The mean age at menarche was observed to be 12.99±1.33yrs (ranging from 10.16 to 15.91 yrs). The study showed that menarche occurred during the summer for 270 (45%) patients making it the most common season for menarche while winter was the least common season. The mean age of menarche was delayed in patients from low SES groups and it occurred earlier in patients from high SES. In girls with low BMI, menarche occurred earlier in comparison to girls with high BMI. There was a significant correlation between session and age of menarche (p<0.05). There was no significant relationship statistically between BMI and age of menarche (p>0.05). Linear regressions showed no significant effect of BMI on the age of menarche but there was a significant correlation between season and SES on the age of menarche. CONCLUSION: The age of menarche and the most common seasons for menarche were similar to previous studies. Results from this study showed that the age of menarche decreased with higher SES, and also the age of menarche in girls with high and low BMI occurred earlier. However, previous studies showed that it ocurred earlier in high BMI and later in low BMI. It appears that genetic and environmental factors have influenced these differences.