Journal of Family and Reproductive Health
Volume:1 Issue: 2, Jun 2007

Since health related quality of life is an important issue for infertile couples a review was conducted to examine the literature. This was a minireview of the literature covering all full publications that have been appeared in the English language biomedical journals. The search strategy included a combination of key words ‘quality of life', ‘infertility, and ‘infertile' in title. A total of 8 citations were identified and were examined in this minireview. The major findings are summarized and presented in several headings including instruments used, and findings from each individual study. There were quite a few studies that reported on health related quality of life in infertile couples. It seems that there is need to conduct more studies on the topic using valid and standard measures.

This study investigated the efficacy of bupivacaine wound infusion for pain control and opioid sparing effect after cesarean delivery. We conducted a randomized double blind, placebo controlled clinical trial on 60 parturients undergoing cesarean section at a university hospital in Tehran. Patients were randomized to receive a pump infusion system that was filled with either 0.25% bupivacaine or equal volume of distilled water. A catheter was placed above the fascia and connected to electronic pump for 24 hours. Postoperative analog pain scores and morphine consumption were assessed at 6, 12 and 24 hours. Also time interval to first ambulation, length of hospitalization, complications and patient satisfaction were recorded. Data were analyzed using the SPSS software and P < 0.05 was considered statistically significant. Mann-Whitney u-test, student t-test and chi-square were used. There were no differences in patient demographics and length of hospitalization and patient-generated resting pain scores between the two groups. Pain scores after coughing and leg raise during the first 6 postoperative hours were significantly less in the Bupivacaine group (P<0.001). The total dose of morphine consumption during the 24 hours study period was 2.5 ± 2.5 mg vs. 7.3 ± 2.7 mg for the bupivacaine and control groups, respectively (P<0.001). Compared with the control group, time to first ambulation was shorter in the bupivacaine group (11± 5h vs. 16 ± 4h) (P< 0.01). Bupivacaine wound infusion was a simple and safe technique that provides effective analgesia and reduces morphine requirements after cesarean delivery.

This study compared the Tension-free vaginal tape (TVT) and Transobturator tape (TOT) procedures for surgical treatment of stress urinary incontinence in women. This prospective non randomized clinical trial was conducted in Vali-e-asr hospital from March 2001 to March 2005. A total of 71 patients with clinical and urodynamic diagnosis of Stress urinary incontinence (SUI) were enrolled in the study. Patients were divided into two groups and underwent TVT or TOT procedures. Mean operation time, cure rate, post operative urinary retention, bleeding and infection were compared between two groups. SPSS software was used for statistical analysis. Chi square and fisher exact test calculated the effects of the nominal variables. Mean difference of quantitative variables were compared by student's T- test. P ≤0.05 was considered statistically significant. There was no significant difference in mean time of operation and peri-operative complications among groups. Urinary retention was 13.8% (n=5) in the TVT group versus 2.8% (n=1) in TOT group (NS). The rates of cure (91.6% vs 91.4%), improvement (5.6% vs 8.6%) and failure (2.8% vs 0) were similar for the TVT and TOT groups. The rate of hemorrhagic complications was 5.5% in TVT and 2.8% in TOT group (NS). TOT appears to be equally efficient to TVT for surgical treatment of stress urinary incontinence after 30 months follow-up.

This study aimed to determine prevalence and predisposing factors of personality disorders among infertile in comparison to fertile women. By a descriptive- analytic study in Vali-e-asr Reproductive Health Research Center, 300 women entered the research. Eysenck personality (EPQ) and structured researcher questionnaires were applied for all patients. Demographic characteristics and predisposing personality factors were recorded and personality symptoms were scaled. For data analysis, SPSS-11-5 software system, chi-square and T-test were used. P-value <0.05 was considered significant. Based on EPQ, personality instability was significantly more frequent in infertile women in comparison to fertile women (P<0.001). Housewives are at higher risk of developing personality instability as compared to working women. This finding was also statistically significant (P<0.001). Considering the high prevalence of personality disorders among infertile women, it seems that more serious attention is required from gynecologists, psychiatrists and psychologists for better treatment of these disorders. The use of psychotherapy, especially supportive methods, should be considered as part of the general therapeutic framework of infertility.

This study aimed to review Papanicolaou (Pap) smears in patients of Shohada hospital in Tehran. A cross-sectional descriptive study was carried out and a database search of all Pap smear reports from 1995 to 2005 at cytopathology department was reviewed. The abnormal Pap smear reports based on the Bethesda System were assessed. A total of 13315 Pap smear reports were reviewed from patients aging 20 to 79 years old. Totally 6065 (45.55%) cases had diagnosis of ‘negative', 293(2.21%) smears were labeled as ‘inadequate', and 6799 (51.06%) reports had ‘Benign cellular changes'. There were 158(1.18%) abnormal Pap smears consisting of 84 (53.18%) SIL with undetermined grade (ASC-US), 28(17.73%) low grade SIL (LSIL), 17(10.75%) high grade SIL (HSIL), 27(17.08%) carcinoma and 2(1.26%) atypical glandular cells of undetermined significance (AGUS). Overall incidence of the cervical cancer among these samples was 0.2%. Benign cellular changes numbered 6799(51.06%), of which 5365 (78.9%) smears demonstrated infectious processes. The number of abnormal pap smears in this study is less than western countries, but is comparable with Middle East and Islamic regions. More prospective studies are recommended.

This study assessed the influence of maternal request on elective cesarean rate and related factors in maternity hospitals in Tehran. This cross sectional descriptive analytic study was performed via a two-step random sampling technique, using data from 824 pregnant women who attended the maternity hospitals in Tehran in 2001. A questionnaire covering past and present obstetrical history and demographic characteristics was completed for each mother. SPSS software was used for data analysis. Descriptive analysis and inference tests, including chi-square and t-tests were used. Logistic regression test was also used to find the correlation between variables. P value less than 0.05 was considered for statistical significance. Totally 66.5% of mothers underwent cesarean and 33.5% had normal vaginal delivery. From cesarean cases 72% were elective and of these 22% were done upon maternal request. It was shown that 71% of mothers who selected cesarean had no scientific reason. Also, 65% of doctors suggested cesarean for their patients without any true medical indication. The majority of elective cesareans performed on maternal request were done in private hospitals (86% in private vs. 14% in public hospitals) (P<0.0001). High educational, employment status and first pregnancy significantly increase the demand for cesarean section. Increasing the level of awareness and attitude of mothers and providing painless normal vaginal delivery as well as vaginal delivery after previous cesarean, the frequency of unnecessary cesareans and related complications can be decreased.

Preeclampsia is one of the most important complications of pregnancy that is associated with increased morbidity and mortality. The aim of this study was to investigate the relation between serum iron status and ferritin with pre-eclampsia. This case control study evaluated 33 preeclamptic patients and 33 normal pregnant women before parturition in Imam Hossein hospital, from March 2003 till March 2004. Anemia, diabetes and multiple pregnancies were excluded from the study. Blood samples were taken before delivery and patients with HELLP syndrome were considered separately. Data were analyzed using the SPSS software and P value <0.05 was considered statistically significant. T-test, chi-square and Fisher exact test were used. The mean of serum iron level in case and control group was 79.9±32.4µg/dl and 88.6±40.8 µg/dl, respectively (NS). TIBC was 443.4±55.0 µmol/l and 383.7±63.6 µmol/l in normal patients and preeclamptics respectively (P = 0.002). Mean serum ferritin was 32.1±16.2 ng/dl in control group and 123.8±46.1 ng/dl in preeclamptics (P<0.001). No meaningful relation was observed between hematocrit, ferritin and iron. Ferritin increases and TIBC decreases in preeclampsia regardless of hepatic function. It seems that elevated serum ferritin (as an oxidative stress) can accelerate vascular damage. So, routine iron supplementation in preeclamptic women is questationable.

This study was designed to investigate RBC indices and HbA2 levels in parents of major beta-thalassemia patients to detect possible silent beta- thalassemia carriers and examine its potential impact on the premarital genetic counseling. This cross sectional study was performed at Children Medical Center from 2004 to 2006. After genetic counseling and getting informed consent, peripheral blood sampling was carried out on 185 carrier parents of regularly blood transfused thalassemia children. Then RBC indices and HbA2 concentration were measured. Samples with MCV and MCH higher than and/or HbA2 lower than cut off values were rechecked. In one case, MCV and MCH indices were within the limits defined for non beta- thalassemia carriers. Furthermore, four other cases were found to have decreased values of MCV and MCH but normal HbA2 levels. About 3% of beta-thalassemia carriers in our country may potentially be missed using current screening methods. Further studies are required to assess the need for presenting a new threshold for thalassemia carrier screening. Defining the causative mutations using molecular methods would pave the way for establishing a protocol for a premarital screening program in conditions when one of couples is a confirmed carrier.

This study evaluated the efficacy and safety of the bulbourethral sling in male urinary incontinence. This case series was conducted in Imam Khomeini hospital-Tehran, between April 2001 to December 2006. Bulbourethral sling was implanted in 7 patients with stress urinary incontinence after prostate surgery. The patients were monitored and evaluated in a prospective manner. The average follow up period was 24 months. Treatment was considered to be successful if the patient stopped wearing any kind of pad and improved if the patient was wearing only one pad daily. Five patients were completely dry. One patient weared one pad daily and the last patient suffered from treatment failure. All patients who were completely dry or had improvement were satisfied and presented no obstructive or irritative urinary symptoms. Urethral erosion was not reported. The overall success rate was 85%. The bulbourethral sling in men has satisfying results to treat urinary incontinence.

Heterotopic pregnancy is a rare event in natural conception cycles. The prevalence of heterotopic pregnancy is known to be increasing in part due to more precise diagnostic techniques and widespread use of of assisted reproductive technology.A case of an incidental heterotopic pregnancy diagnosed at 10 weeks of gestational age is reported here in which laparotomy was scheduled and right salpingectomy was performed immediately after diagnosis. The intra uterine pregnancy proceeded without any problem until term and a healthy male infant weighing 3680 grams was born. As this case demonstrates, early diagnosis is the key of successful treatment. Early detection and appropriate intervention in order to save the intra uterine pregnancy and the prevention of associated maternal morbidity and mortality are emphasized.