The effect of letrozole versus artificial hormonal endometrial preparation on pregnancy outcome after frozen-thawed embryos transfer cycles: a randomized clinical trial.

BACKGROUND: Considering that clinical trial studies are limited in polycystic ovary syndrome (PCOS) patients, and there is no consensus on an optimum endometrial preparation protocol for frozen embryo transfer (FET), the present study was designed as a randomized clinical trial to compare the reproductive outcomes following stimulated cycles with letrozole plus human menopausal gonadotropin (HMG) for endometrial preparation compared with routine AC-FET. METHODS: This randomized controlled trial was carried out on infertile PCOS patients who underwent IVF/ICSI and FET cycles in Arash Women's Hospital affiliated to Tehran University of Medical Sciences between September 2018 and January 2020. PCOS diagnosis was based on the Rotterdam criteria. Eligible patients were randomly allocated into two groups: stimulated cycle with letrozole plus (HMG) (intervention group) and routine artificial hormonal endometrial preparation (control group). RESULTS: One hundred seventy-seven infertile patients were recruited for participation in the study. Of these, 57 women were excluded due to non-eligibility for entering the study, and a total of 120 patients were randomly assigned to two study groups. After follow up, the cycle outcomes of 57 patients in the intervention group and 59 patients in the control group were compared. The data analysis showed that the two groups did not have significant differences in fundamental and demographic characteristics. After the intervention, there were no significant differences in implantation rate, chemical, ectopic, and clinical pregnancy rates between groups. Moreover, the rates of miscarriage and ongoing pregnancy were similar between groups (P > 0.05). CONCLUSIONS: We found similar pregnancy outcomes with two endometrial preparation methods. Noting that each treatment centre should select the most beneficial and cost-effective method with the least adverse effects for patients, letrozole preparations for FET could be incorporated into possible options; however, establishing this approach as first-line treatment is premature in light of current evidence, and future randomized clinical trials with larger sample sizes are required for widespread application. TRIAL REGISTRATION: The study was also registered in the Iranian Registry of Clinical Trials on March 20th, 2020. ( IRCT20090526001952N12 at www.irct.ir , registered retrospectively).

Effects of Phytoestrogens in Alleviating the Menopausal Symptoms: A Systematic Review and Meta-Analysis.

The aim of this study was to perform a meta-analysis of high-quality, randomized, controlled trials (RCTs), to investigate the effectiveness of phytoestrogens in alleviating the menopausal symptoms (vaginal atrophy). Variety of databases including PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CCRCT) were searched up to May 2015 according to the below-mentioned pre-specified search strategy and using the relevant MeSH terms. The mean difference was applied as an estimate of the main effect size. Moreover, due to the considerable heterogeneity among studies, the random-effects model was used to obtain the pooled effect size derived from primary studies. Results showed that while the standardized mean difference of vaginal cell maturation index was increased up to 0.164 percent (with the confidence interval at 95%: (-0.419-0.746), but this increase was not statistically significant (P=0.582). The absence of the publication bias was confirmed using the Egger's regression intercept test (P = 0.24). Also, meta-analysis of soybeans studies showed that while the standardized mean difference of vaginal maturation index increased 0.072% in (95% CI: -0.42 to 0.5.), this increase was not statistically significant (p = 0.777). The results confirm that soybeans and phytoestrogens have non-significant positive effects on the vaginal atrophy index. Hence, it is suggested that with regard to non-significant positive effects, non-hormonal treatments along with other treatments such as the vaginal gels and so on should be used more in cases with non-severe vaginal atrophy.

Investigating the effects of treatment based on single high blood glucose in gestational diabetes screening on maternal and neonatal complications.

PURPOSE: To create a positive step toward achieving an efficient method for gestational diabetes treatment, the present study was carried out to compare the treatment outcomes based on single impaired blood glucose versus regular method in health care centers in Iran. METHODS: This randomized clinical trial was carried out in Tehran/Iran between March 2012 and August 2013. Study sample consisted of mothers whose fasting blood sugar was disturbed or a disturbed blood sugar was seen in OGTT with 75 g glucose load, according to ADA standards. For each outcome, multiple logistic regressions were used to control for the effects of potential confounders. When a confounder was measured on a continuous scale (e.g., age), LOWESS (locally weighted scatter plot smoothing) algorithm was used to determine whether the effect of that variable was linear. We also used the fractional polynomial regression to determine the optimal transformation of continuous covariates. RESULTS: The information of 189 pregnant women was used in this study; 87 in the interventional group (46 %) and 102 in the control group (54 %). Treatment based on the new protocol has very high protective effect (OR 0.25, 95 % CI 0.68-0.88) in terms of neonatal hyperbilirubinemia. This difference was not seen in other outcomes including stillbirth, macrosomic newborn delivery, hypoglycemia, and hypocalcemia. The risk of neonatal hypoglycemia reduced after the 25th week of gestation (OR 0.39, 95 % CI 0.15-0.98). CONCLUSIONS: Although the treatment of mild gestational diabetes could not significantly decrease severe neonatal outcomes, it did significantly reduce the risk of hyperbilirubinemia and its subsequent complications.

Cannabinoids and their interactions with diazepam on modulation of serum corticosterone concentration in male mice.

Experimental results indicate a mutual interaction between cannabinoidergic and GABAergic systems; however, the interaction between these systems on corticosterone release has not been fully investigated. In this study, we treated male mice with either cannabinoid compounds alone or in combination with diazepam. Blood samples were collected at 60 min post-injection. The serum corticosterone (CORT) level was measured using ELISA technique. Acute treatment of mice by cannabinoid receptor agonist WIN55212-2 (2.5 mg/kg; i.p.) resulted in a significant reduction of CORT, while treatment with either endocannabinoid reuptake inhibitor AM404 or endocannabinoid degradation enzyme inhibitor URB597 increased CORT compared to control group. Co-administration of AM404 or URB597 with cannabinoid CB1 receptor antagonist AM251 blocked the effect of these compounds on CORT. Treatment of mice with different doses of diazepam alone did not alter CORT compared to control group. However, co-administration of diazepam and either AM404 or WIN55212-2 significantly reduced CORT compared to the respective group treated with cannabinoid compound alone. Co-administration of ineffective dose of URB597 and ineffective dose of diazepam increased CORT level compared to groups treated with each compound alone. In conclusion, our findings suggest that the endogenous cannabinoid system is active as a modulator of CORT in mice and diazepam can alter the effect of cannabinoid system in the modulation of neuroendocrine functions.