Iranian Journal of Reproductive Medicine最新文献

Background: Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thyroid dysfunction. The prevalence of thyroid dysfunction in pregnant women is relatively high.

Objective: The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction including hyperthyroidism, hypothyroidism and thyroid autoimmune positivity on pregnancy outcomes.

Materials and methods: In this review, Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. We used a variety of studies, including randomized clinical trials, cohort (prospective and retrospective), case-control and case reports. Those studies on thyroid disorders among non-pregnant women and articles without adequate quality were excluded.

Results: Overt hyperthyroidism and hypothyroidism has several adverse effects on pregnancy outcomes. Overt hyperthyroidism was associated with miscarriage, stillbirth, preterm delivery, intrauterine growth retardation, low birth weight, preeclampsia and fetal thyroid dysfunction. Overt hypothyroidism was associated with abortion, anemia, pregnancy-induced hypertension, preeclampsia, placental abruption, postpartum hemorrhage, premature birth, low birth weight, intrauterine fetal death, increased neonatal respiratory distress and infant neuro developmental dysfunction. However the adverse effect of subclinical hypothyroidism, and thyroid antibody positivity on pregnancy outcomes was not clear. While some studies demonstrated higher chance of placental abruption, preterm birth, miscarriage, gestational hypertension, fetal distress, severe preeclampsia and neonatal distress and diabetes in pregnant women with subclinical hypothyroidism or thyroid autoimmunity; the other ones have not reported these adverse effects.

Conclusion: While the impacts of overt thyroid dysfunction on feto-maternal morbidities have been clearly identified and its long term impact on childhood development is well known, data on the early and late complications of subclinical thyroid dysfunction during pregnancy or thyroid autoimmunity are controversial. Further studies on maternal and neonatal outcomes of subclinical thyroid dysfunction maternal are needed.

Background: The aim of this study, we have compared the advantages of oral dydrogestrone with vaginal progesterone (cyclogest) for luteal support in intrauterine insemination (IUI) cycles. Progesterone supplementation is the first line treatment when luteal phase deficiency (LPD) can reasonably be assumed.

Objective: This study was conduct to compare the effect of oral dydrogestrone with vaginal Cyclogest on luteal phase support in the IUI cycles.

Materials and methods: This prospective, randomized, double blind study was performed in a local infertility center from May 2013 to May 2014. It consisted of 150 infertile women younger than35years old undergoing ovarian stimulation for IUI cycles. They underwent ovarian stimulation with oral dydrogesterone (20 mg) as group A and vaginal cyclogest (400 mg) as group B in preparation for the IUI cycles. Clinical pregnancy and abortion rates, mid luteal progesterone (7daysafter IUI) and patient satisfaction were compared between two groups.

Results: The mean serum progesterone levels was significantly higher in group A in comparison with group B (p=0.001). Pregnancy rates in group A was not statistically different in comparison with group B (p =0.58). Abortion rate in two groups was not statistically different (p =0.056) although rate of abortion was higher in group B in comparison with A group. Satisfaction rates were significantly higher in group A compared to group B (p<0.001).

Conclusion: We concluded that oral dydrogestrone is effective as vaginal progesterone for luteal-phase support in woman undergoing IUI cycles. Moreover, the mean serum progesterone levels and satisfaction rates in dydrogestrone group were higher than cyclogest group.

Background: Vitamin D in complex with its receptor by regulating gene expression, endometrium immune response and stimulation of endometrium decidualization can be involved in implantation. So, it seems that the amount of vitamin D in follicular fluids (FF) may have an association with ART success.

Objective: First, we intended to investigate the possible association between levels of follicular fluids 25-OH vitamin D with assisted reproductive outcomes. Second, we examined relationship between 25-OH vitamin D levels with number and quality of oocytes.

Materials and methods: In a prospective study, 80 infertile female candidates for IVF/ICSI were enrolled. Blood samples (on the day of human chorionic gonadotropin administration) and follicular fluids were taken, and then levels of serum estradiol and follicular fluids 25-OH vitamin D were measured. Also clinical characteristics of patients (duration of infertility, causes of infertility, menstrual status), number and quality of oocytes, number of fertilized oocytes, estradiol levels, and clinical pregnancy were evaluated.

Results: Concentration of FF 25-OH vitamin D in pregnant women was significantly higher than non-pregnant women (p=0.007) but there were no significant differences in age, body mass index (BMI), duration of infertility, menstrual status, number of oocytes, oocytes quality, number of fertilized oocytes, and serum estradiol levels between the two groups. Statistically positive correlation was found between 25-OH vitamin D levels with patient age and implantation rate (r=0.264, p=0.018 and r=0.301, p=0.007 respectively).

Conclusion: The obtained results suggest that vitamin D without affecting the number and quality of oocytes can independently improve implantation rate and IVF outcome.

Background: Submucous myomas may be associated with menorrhagia, infertility and dysmenorrhea.

Objective: The aim of this study was to determine the long term effects of submucousal myoma resection on menorrhagia and infertility; also to detect whether the type, size, and location of myoma affect the surgical success.

Materials and methods: Totally 98 women referred to hysteroscopy for symptomatic submucousal fibroids (menorrhagia (n=51) and infertility (n=47)) between 2005- 2010 were enrolled in this historical cohort study Pregnancy rates and menstrual improvement rates were compared according to myoma characteristics (size, type and location).

Results: After a mean postoperative period of 23±10 months in 51 patients with excessive bleeding, 13 had recurrent menorrhagia (25%). In Other 38 patients excessive bleeding was improved (75%). The improvement rates by location and myoma type: lower segment 100%, fundus 92%, and corpus 63%; type 0) 70%, type 1) 78%, type 2) 80%. The mean sizes of myoma in recurred and improved patients were 23.33 mm and 29.88 mm respectively. 28 of 47 infertile women spontaneously experienced thirty pregnancies (60%). Pregnancy rates according to myoma location and type: lower segment 50%, fundus 57%, and corpus 80%; type 0) 75%, type 1) 62%, type 2) 50%. The mean myoma size in patients who became pregnant was 30.38 mm; in patients who did not conceive was 29.95 mm.

Conclusion: The myoma characetesitics do not affect improvement rates after hysteroscopic myomectomy in patients with unexplained infertility or excessive uterine bleeding.

Adenomyosis is a widespread disease affecting the reproductive period of women's life. In the last ten years, different pathogenetic hypotheses have been proposed to explain the initiation and development of the disease. This article aims to present and discuss the most important pathophysiologic mechanisms underlying adenomyosis development in order to clarify the relationship between adenomyosis and infertility. A PubMed search was undertaken for English language literature using the MeSH terms 'adenomyosis', 'infertility', 'treatment', and 'pathogenesis'. Although the exact etiology of adenomyosis is unknown, many theories have been proposed. We analysed the most important pathogenic theories expressed and evaluated the potential consequences on women fertility. A better comprehension of the adenomyosis pathogenesis has allowed realizing that adenomyosis may affect young women and may have a great impact on their fertility through different mechanisms. The understanding of these mechanisms helps to clarify the potential usefulness of current therapies.

Background: It has been documented that cytokines play important roles in the induction of normal functions of the placenta. It has been hypothesized that abnormal expression of the cytokines may be associated with unsuccessful pregnancy.

Objective: The aim of this study was to compare the serum levels of interleukin-17A (IL-17A) and tumor growth factor (TGF-β) in pre-term, term neonates, and their corresponding mothers.

Materials and methods: This study was performed on 100 term and 60 pre-term neonates, and also on their corresponded mothers. Serum levels of IL-17A and TGF-β were examined by enzyme linked immunosorbent assay (ELISA).

Results: Our results revealed that the serum levels of IL-17A were significantly decreased in pre-term neonates in comparison to full-term neonates. However, the serum levels of IL-17A in the mothers either with pre-term or full-term neonates were not different. Also the serum levels of TGF-β were not changed in pre-term neonates and their mothers when compared with full-term neonates and their mothers, respectively.

Conclusion: Based on these findings, it can be concluded that IL-17A may play crucial roles in induction of normal pregnancies and also probably participates in normal growth of fetus.

Background: Premature rupture of membranes (PROM) is a common obstetric issue during pregnancy which might lead to serious fetal or maternal problems. Therefore, an appropriate diagnosis and management of PROM are of significant importance in patients.

Objective: The aim of this study was to determine the accuracy of placental alpha microglobuline-1 (PAMG-1) test in PROM diagnosis and compare this diagnostic method with other standard tests in diagnosis of PROM.

Materials and methods: In this prospective diagnostic accuracy study, patients with symptoms of membrane rupture in 16-39 weeks of gestation were involved. Three tests including Fern, Nitrazine and PAMG-1 were performed at the same time.

Results: PROM was confirmed in 86 patients out of 100. The sensitivity and specificity were respectively 81.3% and 100% for Fern test, 93% and 92.8% for Nitrazine test, 98.9% and 92.8% for PAMG-1 test. PAMG-1 test showed higher sensitivity (98.9% with p<0.001) and accuracy (98%) compared with conventional tests. Although PAMG-1showed a lower positive predictive value (PPV) compared to conventional tests such as Fern test (100%), it was shown to be more accurate.

Conclusion: The accuracy of PAMG-1 test was superior to both Fern and Nitrazine test in PROM diagnosis.

Background: Polycystic ovary syndrome (PCOS) is a common disorder of infertility which affects more than 100 million women. It is characterized by chronic anovulation, hyper androgenism and obesity. PCOS is also associated with oxidative stress changes.

Objective: Here, we aimed to investigate the level of antioxidants and oxidative stress in Iranian women with PCOS as a predictive factor for cardiovascular disease for the first time in Iran.

Materials and methods: In this cross sectional study 30 women with PCOS and 30 healthy women were included. C-reactive protein, serum insulin, advanced oxidation protein products, and level of total antioxidants status were measured from blood samples.

Results: The levels of serum insulin, C-reactive protein, advanced oxidation protein productswere significantly increased in women with PCOS compared with healthy women but there was a decrease in level of total antioxidants status in PCOS women.

Conclusion: These changes show that oxidative stress contributes to PCOS and the decrease of antioxidants leads to increase of oxidation products contributing to PCOS.

Background: Human menopausal gonadotropin (hMG) has contributed many improvements to human assisted reproduction. However, effects of hMG on oocyte development and clinical results remain controversial.

Objective: This study was conducted to investigate the effects of hMG on the zona pellucida of oocytes, as well as clinical results in superovulation treatment.

Materials and methods: This retrospective study was performed with 150 cycles of long-protocol treatment using recombinant follicle-stimulating hormone (r-FSH) with or without hMG. The number of retrieved oocytes, fertilization rate, implantation rate, pregnancy rate, and birefringence and thickness of the zona pellucida of oocytes were investigated.

Results: No significant differences were existed in r-FSH +hMG, and r-FSH groups in the number of retrieved oocytes (11.99±0.75 vs. 13.9±0.73, p=0.06), maturation rate (84.76% vs. 83.32%, p=0.42), pregnancy rate (37.31% vs. 37.66%, p=0.96), and embryo implantation rate (28.97% vs. 23.26%, p=0.30). However, fertilization rate (82.95% vs. 78.75%; p=0.02) was different. Zona pellucida birefringence was lower in the r-FSH +hMG group than in the r-FSH group (6.70±0.50 vs. 7.04±0.31; p=0.53). Thickness values of the metaphase-II zona pellucida of the r-FSH +hMG group on the first (19.20±0.14 vs. 18.75±0.10; p=0.01) and second (18.69±0.12 vs. 18.17±0.14; p=0.00) days of insemination were both higher than those of the r-FSH group.

Conclusion: hMG positively influenced the improvement of oocyte fertilization, as well as the birefringence and thickness of zona pellucida.

Background: Nowadays, The first step in treatment of ectopic pregnancy (EP) is medical treatment. Medical treatment with methotrexate (MTX) for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment.

Objective: The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX.

Materials and methods: In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or "success group" are the patients who were successfully treated with MTX. The second group or "failure group" consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and β-hCG level were compared between groups.

Results: Of 370 patients, 285 (77.1%) were successfully treated with MTX. 85 patients (22.9%) required surgery after a mean of 5.4 (range 2-15) days. Day-1 beta- human chorionic gonadotropin (β-hCG) and fall in β-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial β-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP.

Conclusion: The results showed that patients who have β-hCG levels below 1375 and the number of cases with decreasing β-hCG level on day 4 are the good candidates for medical treatment.