Long non-coding RNAs and female infertility: What do we know?

Ten percent of people who are of reproductive age experience infertility. Sometimes the most effective therapies, including technology for assisted reproduction, may lead to unsuccessful implantation. Because of the anticipated epigenetic alterations of in vitro as well as in vitro fertilization growth of embryos, these fertility techniques have also been linked to unfavorable pregnancy outcomes linked to infertility. In this regard, a variety of non-coding RNAs such as long noncoding RNAs (lncRNAs) act as epigenetic regulators in the various physiological and pathophysiological events such as infertility. LncRNAs have been made up of cytoplasmic and nuclear nucleotides; RNA polymerase II transcribes these, which are lengthier than 200 nt. LncRNAs perform critical roles in a number of biological procedures like nuclear transport, X chromosome inactivation, apoptosis, stem cell pluripotency, as well as genomic imprinting. A significant amount of lncRNAs were linked into a variety of biological procedures as high throughput sequencing technology advances, including the development of the testes, preserving spermatogonial stem cells' capacity for differentiation along with self-renewal, and controlling spermatocyte meiosis. All of them point to possible utility of lncRNAs to be biomarkers and treatment aims for female infertility. Herein, we summarize various lncRNAs that are involved in female infertility.

The effects of selenium supplementation on glycemic control, serum lipoproteins and biomarkers of oxidative stress in infertile women diagnosed with polycystic ovary syndrome undergoing in vitro fertilization: A randomized, double-blind, placebo-controlled trial.

OBJECTIVES: This study aimed to evaluate the effects of selenium consumption on metabolic profile among infertile females diagnosed with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: The current randomized, double-blind, placebo-controlled trial was conducted among 40 infertile females with PCOS aged between 18 and 40 years. Patients were randomly allocated to two groups of intervention to receive selenium supplements (200 µg/day) or placebo (starch). Fasting blood samples were taken at baseline and after 8 weeks of intervention. RESULTS: Selenium administration significantly decreased fasting glucose (P = 0.03), homeostasis model assessment for insulin resistance (P = 0.007) and fasting insulin levels (P = 0.006), and elevated quantitative insulin sensitivity check index (P < 0.001). In addition, selenium supplementation significantly reduced malondialdehyde (MDA) levels (P = 0.006). We did not observe any significant effect of selenium supplementation on pregnancy rate, lipid profiles, total antioxidant capacity (TAC) and total glutathione (GSH) levels. CONCLUSIONS: Overall, our study demonstrated that selenium supplementation for 8 weeks in infertile women with polycystic ovary syndrome undergoing IVF had beneficial effects on glycemic control and MDA levels, but did not affect pregnancy rate, lipid profiles, TAC and GSH levels. CLINICAL TRIAL REGISTRATION NUMBER: This trial was registered at www.irct.ir as http://www.irct.ir: IRCT201701025623N100.

Comparison of two ovarian stimulation protocols among women with poor response: A randomized clinical trial.

This is a randomized controlled trial conducted in a tertiary referral fertility department. Participants were women with previous poor ovarian response undergoing in vitro fertilization. (IVF). One hundred and ninety-two women were randomized to the short GnRH agonist and antagonist regimens. The primary outcome was the number of oocytes retrieved. Secondary outcome measures were the number of embryos transferred, chemical and clinical pregnancy rate and live birth. The number of oocytes retrieved was higher with the gonadotrophin-releasing hormone (GnRH) antagonist regimen compared to the short agonist regimen (3.10 2.70 vs. 2.992.60), but there was no significant difference. The duration of stimulation and total gonadotropin dose were higher with short agonist regimens compared to antagonist regimens, with the latter being statistically significant (p < 0.001). The chemical pregnancy rate was 8.33 percent with the short agonist regimen and 7.29 percent with the antagonist regimen, with no statistically significant difference (p = 0.79). In terms of lower cycles cancelation and higher chemical pregnancy, short GnRH agonist regim is appropriate choice for poor responders.

Melatonin as an adjuvant treatment modality with doxorubicin.

Combination chemotherapy seems to be a beneficial choice for some cancer patients particularly when the drugs target different processes of oncogenesis; patients treated with combination therapies sometimes have a better prognosis than those treated with single drug chemotherapy. However, research has shown that this is not always the case, and this approach may only increase toxicity without having a significant effect in augmenting the antitumor actions of the drugs. Doxorubicin (Dox) is one of the most common chemotherapy drugs used to treat many types of cancer, but it also has serious side effects, such as cardiotoxicity, skin necrosis, testicular toxicity, and nephrotoxicity. Many studies have examined the efficiency of melatonin (MLT) as an anticancer agent. In fact, MLT is an anti-cancer agent that has various functions in inhibiting cancer cell proliferation, inducing apoptosis, and suppressing metastasis. Herein, we provide a comprehensive evaluation of the literature concerned with the role of MLT as an adjuvant in Dox-based chemotherapies and discuss how MLT may enhance the antitumor effects of Dox (e.g., by inducing apoptosis and suppressing metastasis) while rescuring other organs from its adverse effects, such as cardio- and nephrotoxicity.

Melatonin as an adjuvant treatment modality with doxorubicin.

Combination chemotherapy seems to be a beneficial choice for some cancer patients particularly when the drugs target different processes of oncogenesis; patients treated with combination therapies sometimes have a better prognosis than those treated with single drug chemotherapy. However, research has shown that this is not always the case, and this approach may only increase toxicity without having a significant effect in augmenting the antitumor actions of the drugs. Doxorubicin (Dox) is one of the most common chemotherapy drugs used to treat many types of cancer, but it also has serious side effects, such as cardiotoxicity, skin necrosis, testicular toxicity, and nephrotoxicity. Many studies have examined the efficacy of melatonin (MLT) as an anticancer agent. In fact, MLT is an anti-cancer agent that has various functions in inhibiting cancer cell proliferation, inducing apoptosis, and suppressing metastasis. Herein, we provide a comprehensive evaluation of the literature concerned with the role of MLT as an adjuvant in Dox-based chemotherapies and discuss how MLT may enhance the antitumor effects of Dox (e.g., by inducing apoptosis and suppressing metastasis) while rescuring other organs from its adverse effects, such as cardio- and nephrotoxicity.

Molecular and cellular mechanisms of melatonin in breast cancer.

Breast cancer is considered as one of the most important health problems due to its poor prognosis and high rate of mortality and new diagnosed cases. Annually, a great number of deaths are reported in men and women; this means that despite all the improvements in cancer diagnosis and treatment, still, an intense need for more effective approaches exists. Melatonin is a multivalent compound which has a hand in several cellular and molecular processes and therefore, is an appropriate candidate for treatment of many diseases like cancer. Currently, considerable properties of this agent have oriented the research towards investigating its effects specifically in breast cancer. In this review, we gathered a bunch of evidence in order to give a new sight for breast cancer treatment utilizing melatonin. We expect that in coming years, melatonin will become one of the most common therapeutic drugs with lesser side-effects than other chemotherapeutic drugs.

Cesarean scar pregnancy treatment: a case series.

BACKGROUND: Cesarean scar pregnancy is a complicated and potentially life-threatening type of ectopic pregnancy. This study reports two women with cesarean scar pregnancy who were successfully treated with systemic methotrexate administration, and two other women who needed local re-administration of methotrexate after systemic injection. CASE PRESENTATION: Four Iranian pregnant women aged 29-34 years who were between 5  to 7 gestational weeks with cesarean scar pregnancy diagnosis are described. After a single dose of systemic methotrexate injection, the level of serum beta-human chorionic gonadotropin decreased in two of the women, while fetal activity was observed in the other two women. In the latter patients, methotrexate was injected under transvaginal ultrasound guidance into the gestational sac. As a result, the serum beta-human chorionic gonadotropin level first increased and then decreased in these patients. During the follow-up period, all the patients were stable and no complications were observed. Serum beta-human chorionic gonadotropin levels reached the non-pregnancy range from 4 to 9 weeks after treatment. CONCLUSION: When diagnosed at early gestation, cesarean scar pregnancy can be treated successfully with methotrexate administration alone. The clinicians should be aware that the beta-human chorionic gonadotropin level may initially increase after methotrexate injection in some patients. However, the final outcome will be promising if the patients remain stable.

A comparative study of transabdominal and transvaginal ultrasound guidance on consequences of embryo transfer at Mahdiyeh hospital of Tehran in 2020: An RCT.

Background: Infertility is an important problem that affects many couples worldwide. Assisted reproductive technology (ART) helps infertile couples to have offspring. One of the critical parts of ART is embryo transfer (ET). Objective: To compare the effect of transvaginal and transabdominal ultrasonography-guided ET on ART outcomes. Materials and Methods: In this randomized clinical trial study, 90 women who were candidates for in vitro fertilization (IVF) referred to Mahdiyeh hospital of Tehran, Iran during the yr 2020 were randomly divided into two groups (n = 45/each) of transvaginal and transabdominal ultrasonography-guided ET. The embryos were transferred two-three days after oocyte retrieval. The patient pain, duration and difficulty of the procedure, three-dimensional vision quality and successful pregnancy rate were measured. Results: In this study, 63.2% of the 45 women who underwent IVF under the guidance of the transvaginal guidance and 36.8% of the 45 women who underwent IVF under the transabdominal guidance had a successful pregnancy, which was not significantly different (p = 0.19). Also, based on other results there was no difference between the two groups in terms of patient pain (p = 0.53), duration (p ≥ 0.50), difficulty of procedures (p ≥ 0.50) and ultrasonography vision; however, the three-dimensional vision quality in the transvaginal ultrasonography was better than that in the transabdominal ultrasonography (p < 0.01). Conclusion: Overall, the ART outcomes in the transvaginal and transabdominal ultrasonography-guided ET were similar, so we suggest that physicians evaluate the patient's situation, the hospital equipment, and their ability before selecting the type of ultrasonography.

Evaluation of the effect of antenatal betamethasone on neonatal respiratory morbidity in early-term elective cesarean.

Background: Compared with vaginal delivery, early-term cesarean section (CS) is associated with an increased risk of neonatal respiratory morbidity. Given the role of steroids in lung maturation in preterm labor, few studies have investigated their effects on early-term delivery. Therefore, this study aimed to investigate the effect of antenatal betamethasone on neonatal respiratory morbidity in early-term elective cesarean (37-38 weeks and 6 d).Methods: This randomized clinical trial was conducted in Mahdieh Hospital in Tehran in 2017. Women with single pregnancy who were candidates for planned elective CS in 37-38 weeks and 6 d of gestation were randomly assigned to either betamethasone group (intramuscular injection of 12 mg of betamethasone in two doses with an interval of 24 h from the 37th week of gestation) or control group (routine treatment). Then, neonatal respiratory morbidities, hospitalization in NICU, and its cause and duration were recorded and compared between the two groups.Results: Of all, 16 neonates (7%) suffered from one or more respiratory morbidities, and there was no significant difference between the betamethasone and control groups (six cases (6%) and 10 cases (9%), respectively, p = .299). There was also no significant difference between betamethasone and control groups in terms of the frequency of respiratory morbidities at the gestational age of 37 and 38 weeks (p > .05). Grunting, retraction, or nasal flaring was the most common respiratory morbidity that was observed in 13 neonates (6%). We observed the need for CPAP in three neonates (1%), respiratory distress syndrome (RDS) in three neonates (1%), transient tachypnea of the newborn (TTN) in two neonates (1%), need for resuscitation at birth in one neonate (0.5%), and apnea in one neonate (0.5%). There was no significant difference between the two groups in terms of respiratory morbidities (p > .05). A total of 17 neonates (8%) were admitted to NICU; the number of neonates admitted to NICU was significantly lower in betamethasone group than in the control group (three neonates (7.2%) and 14 neonates (12.7%), respectively, p = .005). Respiratory distress in 11 neonates (5%), sepsis in two neonates (1%), and other cases in four neonates (2%) were the main reasons for NICU admission. The prevalence of respiratory distress, as a cause for admission, was significantly lower in the betamethasone group (p = .005).Conclusion: The findings of this study showed that intramuscular injection of 12 mg of betamethasone in two doses, with an interval of 24 h, after 37 weeks of gestation in women undergoing early-term CS did not have a significant effect on respiratory morbidities in neonates. However, it decreased the frequency of admission to NICU, especially admission due to respiratory distress; it could indicate that the respiratory morbidities were less severe in betamethasone group than in the control group.

The Effects of Selenium Supplementation on Clinical Symptoms and Gene Expression Related to Inflammation and Vascular Endothelial Growth Factor in Infertile Women Candidate for In Vitro Fertilization.

This study was performed to determine the effects of selenium supplementation on clinical symptoms and gene expression related to inflammatory markers in infertile women with polycystic ovary syndrome (PCOS) who were candidate for in vitro fertilization (IVF). Thirty-six women candidate for IVF were recruited in this randomized double-blinded, placebo-controlled trial. They (n = 18/group) were randomly assigned into intervention groups to take either 200 µg/day of selenium or placebo for 8 weeks. RT-PCR findings indicated that selenium supplementation downregulated gene expression of interleukin-1 (IL-1) (P < 0.004) and tumor necrosis factor alpha (TNF-α) (P = 0.02) in lymphocytes of patients with PCOS compared with the placebo. In addition, selenium supplementation upregulated gene expression of vascular endothelial growth factor (VEGF) (P = 0.001) in lymphocytes of patients with PCOS compared with the placebo. Selenium supplementation had no significant effect on clinical symptoms and gene expression of IL-8 (P = 0.10) and transforming growth factor beta (TGF-ß) (P = 0.63). Overall, our findings documented that selenium supplementation for 8 weeks to infertile women candidate for IVF improved IL-1, TNF-α, and VEGF gene expression, though selenium had no effect on clinical symptoms and, IL-8 and TGF-ß gene expression. Clinical trial registration number: http://www.irct.ir: IRCT20170513033941N23.

Evaluation of the effect of antenatal betamethasone on neonatal respiratory morbidities in late preterm deliveries (34-37 weeks).

Background: Since late preterm neonates (34-36 weeks) are more at risk of respiratory morbidities, the present study was conducted to evaluate the effect of antenatal betamethasone on neonatal respiratory morbidities in women with late preterm delivery.Methods: This randomized clinical trial was performed on 240 women with single pregnancy that was at high risk of late preterm delivery (34-37 weeks). The patients were randomly assigned to either betamethasone (intramuscular injection of 12 mg of betamethasone in two doses with an interval of 24 hours) or the control group. The two groups were compared with each other in terms of respiratory morbidities, NICU admission and its cause and duration, hospitalization in the neonatal ward for more than 6 hours, and the duration of hospitalization.Results: Of all, 79 neonates (33%) had one or more respiratory morbidities. The observed morbidities in the betamethasone group were significantly less prevalent than those in the control group (19 neonates (16%) and 60 neonates (50%), respectively, p < .001). The most frequently observed respiratory morbidity was needed for oxygen for more than an hour (34 infants, 14%). The need for oxygen for more than an hour, the need for continuous positive airway pressure (CPAP), respiratory distress syndrome (RDS), and the need for surfactant were significantly less observed in betamethasone group than in the control group. A total of 43 neonates (18%) were admitted to NICU and then hospitalized in the neonatal ward; the number of admitted neonates were significantly lower in the betamethasone group than in the control group (11 neonates (9%) and 32 neonates (27%), respectively, p < .001). Moreover, 15 neonates (6%) were admitted to the neonatal ward and there were no significant differences between the betamethasone and control groups (10 neonates (8%) and 5 neonates (4%), respectively, p = .182). Totally, 58 neonates (24%) were hospitalized; the number of hospitalized neonates was significantly lower in the betamethasone group than in the control group (21 neonates (18%) and 37 neonates (31%), respectively, p = .016).Conclusion: The results of this study showed that the antenatal administration of betamethasone in late preterm delivery (34-37 weeks) can improve respiratory morbidities and decrease the frequency of NICU admission.

The effects of probiotic and selenium co-supplementation on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome.

BACKGROUND: The aim of this study was to evaluate the effect of the co-administration of probiotic and selenium on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with PCOS. Data on the effects of selenium and probiotic co-supplementation on mental health, hormonal and inflammatory parameters of patients with polycystic ovary syndrome (PCOS) are scarce. This investigation was carried out to evaluate the effects of selenium and probiotic co-supplementation on mental health, hormonal and inflammatory parameters in women with PCOS. METHODS: This randomized, double-blinded, placebo-controlled clinical trial was conducted on 60 subjects, aged 18-40 years old. Participants were randomly allocated into two groups to intake 8 × 109 CFU/day probiotic plus 200 µg/day selenium supplements (n = 30) or placebo (n = 30) for 12 weeks. Hormonal and inflammatory parameters were measured at baseline and after the 12-week intervention. RESULTS: Probiotic and selenium co-supplementation resulted in a significant improvement in beck depression inventory (ß - 0.76; 95% CI, - 1.26, - 0.26; P = 0.003), general health questionnaire scores (ß - 1.15; 95% CI, - 1.97, - 0.32; P = 0.007) and depression anxiety and stress scale scores (ß - 1.49; 95% CI, - 2.59, - 0.39; P = 0.009) compared with the placebo. Furthermore, probiotic and selenium co-supplementation significantly reduced total testosterone (ß - 0.26 ng/mL; 95% CI, - 0.51, - 0.02; P = 0.03), hirsutism (ß - 0.43; 95% CI, - 0.74, - 0.11; P = 0.008), high-sensitivity C-reactive protein (hs-CRP) (ß - 0.58 mg/L; 95% CI, - 0.97, - 0.19; P = 0.004) and malondialdehyde (MDA) levels (ß - 0.29 µmol/L; 95% CI, - 0.56, - 0.02; P = 0.03), and significantly increased total antioxidant capacity (TAC) (ß + 84.76 mmol/L; 95% CI, + 48.08, + 121.44; P < 0.001) and total glutathione (GSH) levels (ß + 26.78 µmol/L; 95% CI, + 4.33, + 49.23; P = 0.02) compared with the placebo. CONCLUSIONS: Overall, the co-administration of probiotic and selenium for 12 weeks to women with PCOS had beneficial effects on mental health parameters, serum total testosterone, hirsutism, hs-CRP, TAC, GSH and MDA levels. This study was prospectively registered in the Iranian website ( www.irct.ir ) for registration of clinical trials ( http://www.irct.ir : IRCT20170513033941N22). TRIAL REGISTRATION: IRCT20170513033941N22 .

The Effects of Selenium Supplementation on Gene Expression Related to Insulin and Lipid in Infertile Polycystic Ovary Syndrome Women Candidate for In Vitro Fertilization: a Randomized, Double-Blind, Placebo-Controlled Trial.

This study was conducted to evaluate the effects of selenium supplementation on gene expression related to insulin and lipid in infertile women with polycystic ovary syndrome (PCOS) candidate for in vitro fertilization (IVF). This randomized double-blind, placebo-controlled trial was conducted among 40 infertile women with PCOS candidate for IVF. Subjects were randomly allocated into two groups to intake either 200-µg selenium (n = 20) or placebo (n = 20) per day for 8 weeks. Gene expression levels related to insulin and lipid were quantified in lymphocytes of women with PCOS candidate for IVF with RT-PCR method. Results of RT-PCR demonstrated that after the 8-week intervention, compared with the placebo, selenium supplementation upregulated gene expression of peroxisome proliferator-activated receptor gamma (PPAR-γ) (1.06 ± 0.15-fold increase vs. 0.94 ± 0.18-fold reduction, P = 0.02) and glucose transporter 1 (GLUT-1) (1.07 ± 0.20-fold increase vs. 0.87 ± 0.18-fold reduction, P = 0.003) in lymphocytes of women with PCOS candidate for IVF. In addition, compared with the placebo, selenium supplementation downregulated gene expression of low-density lipoprotein receptor (LDLR) (0.88 ± 0.17-fold reduction vs. 1.05 ± 0.22-fold increase, P = 0.01) in lymphocytes of women with PCOS candidate for IVF. We did not observe any significant effect of selenium supplementation on gene expression levels of lipoprotein(a) [LP(a)] in lymphocytes of women with PCOS candidate for IVF. Overall, selenium supplementation for 8 weeks in lymphocytes of women with infertile PCOS candidate for IVF significantly increased gene expression levels of PPAR-γ and GLUT-1 and significantly decreased gene expression levels of LDLR, but did not affect LP(a). CLINICAL TRIAL REGISTRATION NUMBER: http://www.irct.ir : IRCT201704245623N113.

The effects of dietary approaches to stop hypertension diet on weight loss, anti-Müllerian hormone and metabolic profiles in women with polycystic ovary syndrome: A randomized clinical trial.

OBJECTIVE: This study was designed to evaluate the effects of the dietary approaches to stop hypertension (DASH diet) on weight loss, anti-Müllerian hormone (AMH) and metabolic profiles in women with polycystic ovary syndrome (PCOS). DESIGN, PATIENTS AND MEASUREMENTS: A randomized controlled clinical trial was conducted among 60 overweight or obese patients with PCOS. Patients were randomly assigned to receive either low-calorie DASH (N=30) or control diet (N=30) for 12 weeks. The DASH and control diets were consisted of 52%-55% carbohydrates, 16%-18% proteins and 30% total fats; however, the DASH diet was designed to be rich in fruits, vegetables, whole grains, low-fat dairy products, cholesterol and refined grains. Both diets were equicaloric. RESULTS: Adherence to the DASH diet, compared to the control diet, resulted in a significant decrease in BMI (-1.6±0.5 vs -1.2±0.7 kg/m2 , P=.02). Significant decreases in AMH (-1.1±3.1 vs +0.3±0.7 ng/mL, P=.01), insulin (-25.2±51.0 vs -1.2±28.8 pmol/L, P=.02), homoeostasis model of assessment-estimated insulin resistance (-0.9±2.0 vs -0.1±1.0, P=.02), free androgen index (FAI; -0.03±0.09 vs +0.06±0.21, P=.02) and malondialdehyde (MDA) levels (-0.5±0.4 vs +0.2±0.3 µmol/L, P<.001), and significant increases in quantitative insulin sensitivity check index (+0.01±0.03 vs -0.004±0.01, P=.02), sex hormone-binding globulin (SHBG; +3.7±8.5 vs -1.5±7.2 nmol/L, P=.01) and nitric oxide (NO; +9.0±4.9 vs +0.6±2.3 µmol/L, P<.001) were also seen in the DASH group compared with the control group. CONCLUSIONS: Adherence to the DASH diet for 12 weeks among PCOS women had beneficial effects on BMI, AMH, insulin metabolism, SHBG, FAI, NO and MDA levels.

Anti-mullerian hormon level and polycystic ovarian syndrome diagnosis.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a common endocrinopathy that accompanied with long term complications. The early diagnosis of this syndrome can prevent it. OBJECTIVE: The aim was to determine the role of anti-mullerian hormon (AMH) in PCOS diagnosis and to find cut off level of it. MATERIALS AND METHODS: In this cross sectional study, 117 women between 20-40 years old were participated in two groups: 60 PCOS women (based on Rotterdam criteria consensus) as the case group and 57 normal ovulatory women as the control group. In day 2-4 of cycle, transvaginal sonography was performed and serum hormonal level of AMH, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), testosterone, fasting blood sugar (FBS), thyroid stimulating hormone (TSH), and prolactin (PRL) were measured in all of participants. For all of them score of hirsutism (base on Freeman-Galloway scoring) was determined. RESULTS: There were statistically significant in irregular pattern of menstruation, AMH and FSH level, and presence of hirsutism between two groups. But regarding mean of age, body mass index, plasma level of PRL, TSH, LH, Testosterone, FBS, and E2 differences were not significant. Construction by ROC curve present 3.15 ng/ml as AMH cut off with 70.37% sensitivity and 77.36% specificity in order to PCOS diagnosis. CONCLUSION: AMH with cut off level of 3.15 ng/ml with sensitivity 70.37% and specificity 77.36% could use for early diagnosis of PCOS patients.

Comparison of glyburide and insulin in women with gestational diabetes mellitus and associated perinatal outcome: a randomized clinical trial.

Insulin is currently the drug of choice in treating patients with gestational diabetes mellitus but insulin is expensive, inconvenient to store and use and probably associated with more risks of asymptomatic hypoglycemia in comparison with some oral agents. This randomized clinical trial was conducted to evaluate the efficacy and safety of glyburide in patients with gestational diabetes mellitus in comparison with insulin therapy. Pregnant women aged between 18-45 years with singleton pregnancies and in their 24-36 weeks of gestation were assessed for eligibility. Women with gestational diabetes mellitus were randomly allocated to two insulin and glyburide groups and compared with maternal and neonatal outcome. Ninety-six women with gestational diabetes mellitus enrolled in the study. At screen and treated fasting and post-prandial blood glucose levels were similar in both groups. Time for beginning the treatment to control the glycemic index was 28.30 (±20.60) days in the insulin group and 22.56 (±18.86) in the glyburide group. There was no statistically significant difference in time-to-control the blood glucose level in two studied group. Time, between beginning the treatment of GDM and delivery, was 53.22 (±28.96) days in the insulin group and 56.67 (±30.47) in the glyburide group. There was no statistically significant difference between the times of treatment-to-delivery in two studied groups. There were no statistically significant differences between maternal and neonatal outcomes in two studied groups. Glyburide can effectively and safely control the glycemic index in women with gestational diabetes mellitus in comparison with insulin.

Molar ectopic pregnancy after tubectomy.

Tubal ectopic hydatidiform mole is an uncommon but very important complication of pregnancy. The clinical manifestation is the same as ectopic pregnancy and in all of the cases management was the same as tubal ectopic pregnancy. We present a case of tubal ectopic pregnancy that after laparotomy and salpingectomy, pathologic examination reported hydatidiform mole within ectopic gestational tissue. So, a high index of suspicious is necessary for prompt diagnosis and correct fallow up of the patient.