Evaluation of Uterine Temperament in Iranian Infertile Women using a Quantitative Instrument for Uterine Temperament Detection.

BACKGROUND: The temperament is a basic concept of maintaining health in Traditional Persian Medicine. The two main grouping of temperament is hot/cold and wet/dry. Many female disorders include infertilities are diagnosed and treated based on the dystemperament therapies. This report describes design of a questionnaire for uterine temperament detection and its use to evaluate the uterine temperament of a population of infertile women. METHODS: The uterine temperament parameters derived from main textbooks were used to design a questionnaire which its validity and reliability was proven by statistical methods. The questionnaire was then used to detect the uterine temperament of 54 infertile females. Also full history and physical exam and vaginal sonography was performed in the 3rd day of the menstrual cycle for all study participants. RESULTS: The mean age was 30.92 ± 5.53 years old. Mean uterine temperament score was 3.21 ± 0.53 for hotness and 4.28 ± 1 for wetness. Mean general body temperament was 138.88 ± 17.61. The general body temperament hotness/coldness was significantly correlated with the uterus hotness/coldness (r = 0.0842); while the wetness/dryness temperament of the body and uterus were not correlated. Moreover, uterus temperament was not correlated with the size of the uterus and ovaries in sonography, but pelvic width was correlated with hot uterine temperament (r = 0.354, P = 0.0145). CONCLUSIONS: In the present study, the most prevalent achieved temperament was cold and wet in patients with infertility complaint. Moreover, the hot/cold temperament of body and pelvic width were correlated with uterus temperament. This may propose new prevention and also treatment methods in the field of infertility, which needs to be further evaluated.

The Effects of Carum Carvi (Bunium Persicum Boiss) on Early Return of Bowel Motility After Caesarean Section: Double-Blind, Randomized, Placebo-Controlled Trial.

Objective: To investigate the effect of the Carum carvi (Bunium persicum Boiss) plant, a gas solvent, on resumption of bowel motility after caesarean section. Materials and methods: A randomized controlled trial was done on a group of 98 women undergoing elective caesarean section under general anesthesia in a university hospital. Patients in the intervention group (Group A) drank 10 ml of a syrup containing 8 g of Bunium persicum Boiss in 20 ml of syrup 6 to 7 hours after surgery. The control group (Group B) comprised 10 patients who drank 10 ml of placebo syrup 6 to 7 hours after surgery. Demographic characteristics, time to first hearing of normal intestinal sounds, time to first flatus, time to first bowel movement, and length of hospital stay were compared between the two groups. Results: Compared with the control group, the intervention group had a significantly shorter mean time to hearing the first intestinal sounds (10.66 ± 2.38 vs. 19.54 ± 3.85 h), mean time to first flatus (13.91 ± 3.73 vs. 24.82 ± 5.83 h), mean time to first bowel movement (19.31 ± 4.63 vs. 30.70 ± 10.21 h), and mean length of hospitalization (31.70 ± 7.70 vs. 49.20 ± 10.16 h) (p < 0.05). No patients developed serious side effects associated with consumption of the syrup. Conclusion: The use of a gas solvent such as Bunium persicum Boiss after caesarean section can speed the resumption of postoperative bowel motility.

Comparative Study of the Effects of Chamomile (Matricaria Chamomilla L.) and Cabergoline on Idiopathic Hyperprolactinemia: A Pilot Randomized Controlled Trial.

Chamomile is a fascinating plant quoted in several traditional medicine texts, which has broad-spectrum pharmacological activity and medicinal uses. The aim of this study was to assess the efficacy of chamomile syrup in reducing serum prolactin in women with idiopathic hyperprolactinemia. The study was a randomized, controlled clinical trial that was conducted on 56 women with idiopathic hyperprolactinemia for a study period of four weeks. Patients were randomly enrolled in two parallel arms and were treated by chamomile syrup at a dose of 5 mL twice daily or cabergoline tablet orally at a dose of 0.25 mg twice weekly. Serum prolactin levels were measured at baseline and the end of the 4-week study period. Any report of adverse events was also recorded. Results revealed that within the cabergoline group the reduction in the mean prolactin level was significantly greater than that of the chamomile group (p <0.0001). It was also found that decline in the mean prolactin level was statistically significant within the chamomile group (p <0.0001). Chamomile syrup seems to be effective on serum prolactin reduction in women with idiopathic hyperprolactinemia. However, studies with a larger sample size and for a longer follow-up period are recommended.

The effect of Glycyrrhiza glabra L. on Primary Dysmenorrhea compared with Ibuprofen: A Randomized, Triple-Blind Controlled Trial.

Primary dysmenorrhea is a common gynecological disorder in women of reproductive age. Despite the effective conventional treatments such as nonsteroidal anti-inflammatory drugs and oral contraceptives, researchers have always been looking for alternative drugs due to the adverse effects and limited efficacy of these medications. Glycyrrhiza glabra L. (G. glabra), commonly known as Licorice, has been applied for a long time as a plant with multiple therapeutic potencies in Traditional Persian Medicine (TPM). This study was designed to evaluate the effect of the G. glabra on primary dysmenorrhea. Sixty patients with moderate and severe dysmenorrhea were randomly divided into two groups; one group received 400 mg Ibuprofen tablets every 8 h and placebo syrup and the other received 5 cc of G. glabra syrup two times a day and placebo tablets. The patients took the drugs from the first day of menstruation to fifth for two consequent cycles. The primary pain intensity and its changes were evaluated in each group and compared between two groups. The reduction of pain intensity was 5.85 (±3.11) in the G. glabra group compared with 6.92 (±1.87) in the Ibuprofen group (p < 0.001). No significant difference detected between the two groups (p = 0.151). No serious side effects were reported during the study. This study suggests that we can use G. glabra to relieve pain in the patients with primary dysmenorrhea; although studies with a larger sample size may lead to more comprehensive perceptions about the efficacy of G. glabra.

Management of Breast Milk Oversupply in Traditional Persian Medicine.

Comprehensive explanation about milk oversupply is not available in the current literature because few studies have been done on this topic. In traditional Persian medicine, milk oversupply and its management have been described. The aim of this study was to investigate milk oversupply from the perspective of medieval Persian practitioners. In this study, some main medical resources of traditional Persian medicine such as Al-Havi and the Canon of Medicine were studied to extract valuable information about milk oversupply. Etiology of milk overproduction according to traditional Persian medicine is based on humors theory and cannot be easily compared with current medical concepts. Diet modifications and natural remedies have been applied for managing this condition but the majority of traditional Persian medicine interventions for reducing milk oversupply have not been scientifically investigated in modern medicine. The knowledge of milk oversupply in traditional Persian medicine may be helpful to conduct further related studies.

Comparison of quince with vitamin B6 for treatment of nausea and vomiting in pregnancy: a randomised clinical trial.

This trial was performed to compare quince (Cydonia oblonga) fruit with vitamin B6 on 76 pregnant women with a gestational age of 6-14 weeks and mild-to-moderate nausea and vomiting (NVP) (40 in the quince and 36 in the B6 group). The 'Pregnancy-Unique Quantification of Emesis' (PUQE-24) scale was used to examine the severity of NVP. The quince syrup (1 tablespoon/TDS) or vitamin B6 tablets (20 mg/TDS) were used as intervention for 1 week. The mean (±SD) age was 27.5 (±5.2) years. The score of the PUQE was decreased from 9.5 (± 2) at baseline to 5.2 (±2.3) on the 7th day and 5.3 (±2.6) on the 14th day (p < .001) in the quince group. In the other group, the scores were 8.4 (±1.8), 7.3 (±2.4) and 7.7 (±3.8), respectively (p = .001). The change in symptoms were more marked in the quince group (p < .001). Quince syrup seems to be a suitable treatment for NVP. Impact statement What is already known on this subject: Pregnancy-induced nausea and vomiting (NVP) is one of the most common problems during gestation. Treatment is mainly symptomatic, ranging from dietary changes and oral pharmacological treatment to hospitalization in severe forms. In early pregnancy, the use of chemical drugs is avoided, so there is an increasing tendency to use alternative therapies. According to the literature review in Iranian Traditional Medicine (ITM), the quince fruit (Cydonia oblonga) can be useful in NVP. Quince has a wide range of pharmacological activities including antioxidant, antibacterial, antifungal, anti-inflammatory, hepatoprotective and antidepressant effects. ITM literature suggests some therapeutic effects of the quince fruit on important organs like brain, heart, liver and stomach. What the results of this study add: The results of this study demonstrated the significant efficacy of quince in comparison with vitamin B6. What the implications are of these findings for clinical practice and/or further research: This fruit is also safe to be administered in pregnant women suffering from NVP.

Improvement in Sperm Parameters With Traditional Iranian Remedy: A Case Report.

INTRODUCTION: Idiopathic male infertility is a global problem with almost no definite medicinal treatment. Most patients have to go through intrauterine insemination or assisted reproductive technology for achieving fertility. Unfortunately, success rates are low in cases with very low sperm count. Therefore it seems that improvement in sperm quality can have beneficial effects on assisted reproductive technology outcome. CASE REPORT: A 39-year-old man with history of infertility for 6 years was referred to the traditional medicine clinic with a recurrent unsuccessful intracytoplasmic sperm injection trial. His sperm analysis showed severe oligoasthenoteratozoospermia. After taking a traditional remedy he had a remarkable improvement in his sperm parameters, which led to the formation of 8 embryos in the following intracytoplasmic sperm injection cycle. CONCLUSION: Traditional medicine presents various food and remedy options for treating male infertility. It seems that combination therapy can be beneficial in obtaining better results in treatment of male idiopathic infertility.

Comparison of Biomedical Variables in PCOS Patients with Normal Iranian Women.

OBJECTIVE: To compared serum CRP levels and biochemical relation in PCOS patients with normal Iranian women. MATERIALS AND METHODS: This case-control study was performed on 52 individuals with PCOS (Rotterdam 2003 criteria). The cases were compared to 104 healthy non-PCOS, 20 to 35-year-old female subjects with no history of diabetes or renal diseases. Blood samples were taken on the 2(nd) to the 5(th) day of menstrual cycle for the evaluation of CRP levels, triglyceride, insulin, androstronedion, testestrone and total cholesterol. RESULTS: The mean CRP was 1.38 (± 0.43) mg /dl in the PCOS group, and 1.08 (± 0.49) mg /dl (p= 0.240) in control group.High-Sensitivity C-Reactive Protein (HS-CRP) was positively correlated with the Body Mass Index (BMI) (r = 0.36, p= 0. 001). Before adjusting for age and BMI, CRP was correlated with LDL (r= 0.16, p= 0.03), total cholesterol (TC) (r= 0.17, p= 0. 03), Triglycerid (TG) (r= 0.23, p= 0.003), and the insulin (r= 0.20, p= 0. 01) notably in PCOS group. However, after adjustment was made for age and BMI, the correlation was attenuated in PCOS. The regression analyses depicted that CRP level was not under the influence of other medical parameters Conclusion:The results showed that mean CRP level was not significantly different between PCOs and normal women. After adjustment for age and BMI, CRP was not associated with any biochemical marker evaluated in this study. It seems that studied biochemical serum levels were mostly associated with obesity. So reduction of BMI may normalize the serum levels of CRP and other biochemical parameters.

Frequency and epidemiologic aspects of male infertility.

According to different geographical conditions, human health in different sub-regions of the world and cultural differences, the male factor infertility has heterogeneous causes in the world. This study was performed in an attempt to clarify the associated factors which might play a role in this respect in a group of Iranian infertile men. This study was a cross - sectional, descriptive and retrospective study. The information was obtained from the men who had attended the clinic from March 2004-2006. The factors which were studied in this research are the demographic characteristics, smoking, addiction, alcohol drinking, and exposure to lead, cimetidine and history of surgery. In 23.7 % of couples the cause of infertility was pure male factor and in 19.3 % of them the problem was related to male and female factor both. The most important associated factors for male factor included smoking (29%) and history of varicocele operation (22%). Since the quality of individual and social life is related to fertility state, it seems that more comprehensive studies on factors affecting male fertility at the community level are justified and recommended.

Effect of Piroxicam on ART Outcome: A Pilot Study.

BACKGROUND: One of the most important factors affecting success rates in assisted reproductive techniques (ART) besides the number of oocytes retrieved and high quality embryos derived from them is the technical aspects of embryo transfer. It seems that pretreatement with uterine relaxants can be helpful in preventing un- pleasant cramps which can have an adverse effect on ART outcome. In this respect, some drugs such as prostaglandin inhibitors or sedatives have been evaluated but not confirmed yet remain controversial. This study was performed in order to assess the effect of administrating Piroxicam prior to embryo transfer on pregnancy rates in ART cycles. MATERIALS AND METHODS: This pilot study was performed from August 2010 through December 2011 on 50 infertile women in ART cycles. Recombinant follicle stimulating hormone (rFSH) with a long gonadotropin releasing hormone (GnRH) analogue protocol were used for controlled ovarian hyperstimulation. The subjects were randomly allocated into two groups of 25 patients after obtaining written consent. Group A received a 10 mg Piroxicam capsule 30 minutes before embryo transfer and group B was the control group with no treatment. Data were analyzed by Chi-square and analysis of variance (ANOVA). RESULTS: Pregnancy rate was 34% (n=17) totally, with 32% (n=8) in group A and 36% (n=9) in group B (p=0.75). Uterine cramps were experienced by 4 women (16%) in group B, while none were reported by women in group A (p=0.037). CONCLUSION: It seems that Piroxicam administration 30 minutes prior to embryo transfer can- not increase pregnancy rates, but can prevent or reduce uterine cramps after the procedure.

Sexual dysfunction in patients with polycystic ovary syndrome and its affected domains.

BACKGROUND: Polycystic Ovary Syndrome (PCOS) is presented with characteristic complications such as chronic an ovulation, obesity, and hyperandrogenism which can affect sexual function in women of reproductive age. OBJECTIVE: Herein we evaluated the frequency and predisposing factors of sexual dysfunction in infertile PCOS patients. MATERIALS AND METHODS: In this cross-sectional study, 130 married women with a definite diagnosis of PCOS who were referred due to infertility were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire. RESULTS: The frequency of sexual dysfunction was verified 57.7% in PCOS patients with the domains of desire and arousal being commonly affected in 99.2% and 98.5%of cases respectively. BMI had a significant effect on sexual desire and arousal (p=0.02) while the effect of hirsutism was significant on all domains (p<0.001 for total FSFI score) except for dyspareunia. CONCLUSION: PCOS patients markedly suffer from sexual dysfunction as comorbidity. It seems appropriate to screen all PCOS patients for sexual function with a simple short questionnaire such as FSFI. Targeted interventions could be considered to help improve their quality of life along with other treatments.

Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo - controlled study.

BACKGROUND: Tribulus terrestris as a herbal remedy has shown beneficial aphrodisiac effects in a number of animal and human experiments. This study was designed as a randomized double-blind placebo-controlled trial to assess the safety and efficacy of Tribulus terrestris in women with hypoactive sexual desire disorder during their fertile years. Sixty seven women with hypoactive sexual desire disorder were randomly assigned to Tribulus terrestris extract (7.5 mg/day) or placebo for 4 weeks. Desire, arousal, lubrication, orgasm, satisfaction, and pain were measured at baseline and after 4 weeks after the end of the treatment by using the Female Sexual Function Index (FSFI). Two groups were compared by repeated measurement ANOVA test. RESULTS: Thirty women in placebo group and thirty women in drug group completed the study. At the end of the fourth week, patients in the Tribulus terrestris group had experienced significant improvement in their total FSFI (p < 0.001), desire (p < 0.001), arousal (p = 0.037), lubrication (p < 0.001), satisfaction (p < 0.001) and pain (p = 0.041) domains of FSFI. Frequency of side effects was similar between the two groups. CONCLUSIONS: Tribulus terrestris may safely and effectively improve desire in women with hypoactive sexual desire disorder. Further investigation of Tribulus terrestris in women is warranted.

A Review of Pioneer Physicians' Work on Maternal Health in Pregnancy in Ancient Iran; Narrative Systematic Review.

Background Maternal lifestyle and behaviors during pregnancy have been associated with future health outcomes for mothers and babies. Iranian Traditional medicine, which is a holistically-oriented medical discipline, has special attitudes towards pregnancy. The purpose of the study is the investigation of maternal health in medical books of ancient Iran. This study is a systematic review scrutinizing issues concerning lifestyle during pregnancy based on "Avicenna's Canon medicine" and "Rhazes Al-Havi" and for complete discussion, other reliable sources in traditional medicine which was conducted following the categorization and analysis of the gleaned data. Based on approaches by Iranian Traditional Medicine, the most important topics in lifestyle habits during pregnancy are divided into four main groups: Nutrition, physical exercise, sexual activity and psychological stress. Then special recommendations are suggested which include a regimen to facilitate labor. Eating behaviors and other lifestyle habits have a major role in optimizing the health of women in pregnancy. Regarding to traditional medicine viewpoints paying special attention to correcting diet, life style and preventive attitude with effective and simple therapeutic procedures, it seems that traditional medicine can offer efficient managements to alleviate some pregnancy complications.

Comparison of highly purified urinary versus recombinant FSH: Effect on ART outcomes in polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common cause of ovulatory disorders and infertility with high LH to FSH ratio. In order to prevent further increase of LH and follicle atresia, different regimens for ovulation induction have been recommended using FSH alone. OBJECTIVE: This study was performed in PCOS patients to compare ART outcomes in cycles induced by FSH alone, using either recombinant or urinary products. MATERIALS AND METHODS: In a randomized trial, from 623 patients who underwent down regulation with GnRH analogue in a long protocol, 160 PCOS patients were randomly divided into two groups of 80. Group A received 150 IU/d recombinant FSH (Gonal-F) and group B 150 IU/d urinary FSH (Fostimon). RESULTS: 33 cases (41.2%) in group A and 36 (45%) in group B achieved clinical pregnancy, which was not significantly different (p=0.67). Total number of oocytes retrieved (13.03±5.56 vs. 14.17±4.89, p=0.17), quality and number of embryos (7.42±3.35 vs. 7.63±3.28, p=0.68) and OHSS rate were similar in group A compared to group B. Endometrial thickness which was 9.66±1.67 mm in group A and 10.36±1.35 mm in group B, showed a significant difference (p=0.004). CONCLUSION: It seems that in PCOS patients, both pure FSH products used for controlled ovarian hyperstimulation have similar effects on ART outcome and can be used according to availability and patient acceptance without significant difference.

Comparison of two embryo scoring systems for prediction of outcome in assisted reproductive techniques cycles.

Cumulative embryo score (CES) is one of the many embryo scoring methods which have been developed to help clinicians to transfer high quality embryos and predict pregnancy rate in assisted reproductive techniques (ART) cycles. Regarding the existing difference in CES calculation this study was done to compare two methods in order to determine the more practical and preferable one. In a retrospective, cross sectional descriptive analytical study, a total of 508 ART cycles in infertile patients treated from November 2002 until March 2004, were evaluated using two methods of CES calculation in embryonic scoring to predict ART outcome. According to one method, CES was obtained by adding the individual scores of all transferred embryos. Whereas in the other reference method, CES was calculated by the sum of each embryo score multiplied by its number of blastomeres on the day of transfer. The mean score of transferred embryos (MSTE) was referred to CES divided by the total number of embryos transferred in either method. A total of 109 clinical pregnancies (pregnancy rate 21.5%) including 96 singletons, 10 twins and triplets occurred in the 508 ART cycles. The pregnancy rate was strongly correlated to CES & MSTE. According to one method, CES was 12.6±6.4 in pregnant versus 9.2±5.8 in non-pregnant group (P<0.0001). According to the other one, in the pregnant group CES was 86.7±48 versus 68.7±55 in the non-pregnant group (P<0.002). Both methods showed a significant difference. Regarding MSTE, using the first method, in the pregnant group it was 3±0.6 versus 2.8±0.7 in the non-pregnant group (P<0.011) whereas with the other approach it was 21.3±8.6 in the pregnant group versus 19.9±9.07 in non-pregnant (P<0.152) showing that the first method can also predict pregnancy outcome with MSTE. Considering that both MSTE and CES in the first method can significantly predict outcome in ART cycles, it seems this method is preferable and more useful in practice. Moreover, sometimes due to continuous division, on the third post oocyte retrieval day the blastomere number cannot be counted precisely which can be misleading if taken into account according to the method introduced by Steer.

Evaluation of insulin resistance and metabolic syndrome in patients with polycystic ovary syndrome.

AIM: Polycystic ovary syndrome (PCOS) is associated with the clustering of states including insulin resistance (IR), obesity, elevated blood pressure, and dyslipidemia that are termed as metabolic syndrome (MBS). This study was designed to assess the differences between homeostatic model assessment (HOMA) values in PCOS and healthy women. METHODS: In a case-control study, 55 women with PCOS and 59 women with normal cycles (control group) aged 15-40 years old were evaluated. In all the subjects (after obtaining written informed consent), blood pressure, body weight, height, body mass index (BMI), waist /hip ratio(WHR) and fasting blood glucose (FBG), triglycerides (TG), HDL, C-peptide, insulin, HOMA Index, and FGIR (fasting glucose to insulin ratio) were measured. RESULTS: In this study, the prevalence of MBS was significantly higher in PCOS group compared with the control group (p = 0.028). There were no significant differences in age, waist/hip ratio, fasting glucose, insulin, and C-peptide levels between patients with PCOS and control group. Furthermore, the prevalence of impaired fasting glucose (IFG) and the mean of HOMA and FGIR did not differ significantly between PCOS and control group. CONCLUSION: Criteria of MBS are frequently present in young women with PCOS and may be more useful as a prognostic factor than IR indexes in this age group. We suggest evaluation of IR in older age women with PCOS.