مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 10 (دی 1402)

Polycystic ovary syndrome is one of the common diseases during the reproductive period that the common treatments are mostly symptomatic and their long-term use has many complications. According to previous studies that showed the effect of wet cupping on calf muscles on oligomenorrhea pattern, this study was performed with aim to investigate the effect of wet cupping on calf muscles on clinical and laboratory symptoms and quality of life in patients with this syndrome.

In this randomized clinical trial study which was performed in 2019-2021, 60 PCOS women with minimum 60 days menstrual cycle entered the study and randomly divided to cupping and control groups (n=30 per group). At the 26th day menstrual cycle, after blood sampling for two groups, wet-cupping on calf muscles was done for intervention group. Menstrual period, insulin resistance and quality of life were measured using Cronin PCOS Questionnaire. Data analysis was done using SPSS statistical software (version 20) and student t and chi-square tests. P<0.05 was considered significant.

In this study, 21 members of cupping group and 6 members of control group menstruated after the intervention, the difference was statistically significant (p<0.001). Insulin resistance changed significantly in the intervention group (p=0.03). Quality of life was significantly improved in the cupping group (p=0.01), but no significant statistical difference was observed in the control group.

Calf muscles wet-cupping can be considered as one of the options for causing bleeding in people with PCOS. Obviously, more studies are necessary to compare different protocols and investigate its mechanism.

IUI or injection of washed sperm into the uterine cavity is one of the assisted reproductive techniques that has been widely used in the treatment of infertility. This study was performed with aim to evaluate the effect of intrauterine injection of granulocyte stimulating factor (G-CSF) on the success rate of IUI in patients referred to the infertility center of Ardabil University of Medical Sciences.

This clinical trial study was performed in 2019-2020 on 100 women with primary infertility referred to the Infertility Center of Ardabil University of Medical Sciences for IUI. The subjects were randomly divided into intervention and control groups each with 50 women. To stimulate ovulation for the women in two groups, clomiphene citrate was administered from the third to the fifth day of menstruation at a dose of 50-100 mg daily for five days and gonadotropin ampoules were administered with dose 150 mg at days 7 and 9 and after reaching to at least one follicle with 20 ml diameter, HCG was injected for the final maturation of the oocyte. In the intervention group, in addition to previous procedures on the day of HCG injection, 100 micrograms of G-CSF was injected intrauterine with IUI catheter, and then IUI was performed 36 hours later. Collected data were analyzed by SPSS (version 25). P<0.05 was considered significant.

The success rate of IUI based on βHCG test was 20% in the case group and 4% in the control group, which showed a statistically significant difference in the success rate of pregnancy (p=0.028).

The results of the present study showed that G-CSF administration improves the chance of pregnancy compared to no treatment.

Since conflicting results have been reported about the relationship between the level of vitamin D in people with polycystic ovary syndrome and related metabolic disorders, the present study was performed with aim to determine the effect of vitamin D administration on the clinical and laboratory symptoms of adolescents with polycystic ovary syndrome with vitamin D deficiency.

This double-blind randomized controlled clinical trial study was performed on 50 patients with sonographic evidence of polycystic ovary syndrome with vitamin D deficiency in two control and intervention groups. The intervention group was given vitamin D and the control group was given placebo. Clinical, laboratory and sonographic symptoms before and after the intervention were compared in two groups. Data were analyzed by SPSS software (version 16), Man-Whitney U and Wilcoxon test. P<0.05 was considered statistically significant.

The intervention improved the level of vitamin D in the case group (P<0.001). There was significant difference between the case and control groups in terms of fasting insulin level (P=0.001), serum testosterone level (P<0.001), free testosterone level (P=0.042), LH to FSH ratio (P<0.001), LH level (P<0.001), diastolic blood pressure (P=0.027), and severity of hirsutism (P=0.016). Polycystic ovary syndrome and Oligomenorrhea was more in the control group (P <0.01); However, there was no significant difference between the two groups in terms of fasting blood sugar, triglycerides, HDL, systolic blood pressure, acne severity, and ovarian volume (P>0.05).

Considering the role of vitamin D in ovum development and its relationship with the reduction and regulation of insulin, the use of this supplement is recommended to improve the clinical and laboratory symptoms of polycystic ovary syndrome and subsequently correct menstrual disorders and hyperandrogenism. Also, in this study, vitamin D consumption did not cause a significant difference in insulin resistance between the two groups after the intervention.

Fetal birth weight, as one of the most important indicators for evaluating the health of newborns, is influenced by various factors such as maternal diabetes. Fetal weight estimating is necessary for planning the type and time of delivery. The present study was performed with aim to compare the estimated fetal weight before birth with the actual weight of the baby after birth in diabetic mothers.

This descriptive-cross-sectional study was done from April 2022 to April 2023 on 71 diabetic mothers in the obstetrics and gynecology department of Imam Reza and Qaem hospitals in Mashhad. All the characteristics of the mother were recorded in the researcher-made checklist. The fetal weight before termination of pregnancy was estimated by ultrasound and also by Johnson's clinical formula, and then the actual weight of the baby was measured after delivery. Data were analyzed by SPSS software (version 22). To compare the fetal estimated weight with the actual weight after birth, Pearson's test was used to evaluate the type of correlation (p<0.001) and Bland Altman's diagram was used to check the pattern of agreement.

In the Pearson correlation analysis, there was a positive and statistically significant correlation between the estimated weight by Johnson's method and ultrasound with the actual fetal birth weight, and in the presence of different variables, this correlation was still positive and significant (r=0.9, p<0.001). In the investigation of any agreement pattern between different methods of fetal weight estimation using Bland Altman method, which was based on the distance between the upper and lower limit of agreement between different methods, it was shown that this distance between Johnson's estimated fetal weight and the actual fetal weight was 1230.44 gr, between the Ultrasound and real weight was 1111.84 gr and between ultrasound and Johnson was 1136.8 gr, which did not have an acceptable level of agreement.

Despite the positive and significant correlation between Johnson's clinical fetal weight estimation and ultrasound, these methods cannot be replaced for each other in estimating the fetal weight, and considering the reported difference, ultrasound estimated fetal weight compared to Johnson's method is closer to actual fetal weight.

Female infertility is a universal medical condition that can be caused by various disorders of the reproductive system, including premature ovarian failure. The present study was performed with aim to investigate the effect of 8 weeks of swimming training and stem cell injection on VEGF, TGF and HGF genes in the ovarian tissue of premature ovarian failure model rats.

In this experimental research, 30 female rats 6- to 8-week-old were selected. In order to create a model of premature ovarian failure, cyclophosphamide and biosulfan were used in the amount of 100 and 50 mg/kg, respectively, as an intraperitoneal injection. After model induction, rats were randomly divided into 6 groups (5 heads in each group) including: 1) healthy control, 2) patient+ sham, 3) patient+ saline, 4) patient+ cell, 5) patient +exercise and 6) patient+ cell+ exercise. The rats of the training group swam for 8 weeks. Cell groups, 2 weeks after creating the model stem cells were transplanted in the ovary at the rate of one million cells for each mouse. Data analysis was done using SPSS statistical software (version 22) and one-way ANOVA and Tukey's post hoc tests. P≤0.05 was considered significant.

Induction of premature ovarian failure led to a significant increase in VEGF, TGF and HGF genes in the ovarian tissue of rats compared to the control-healthy group (P≤0.05) that the exercise, cell and exercise+ cell groups decreased the expression of these genes compared to the patient and patient-saline groups (P≤0.05).

The synergistic effect of aerobic exercise and bone marrow-derived mesenchymal stem cells improve angiogenic factors in experimental premature ovarian failure model rats.

Currently, the advancement of knowledge and technology in assisted reproductive technologies (ARTs) has caused infertile couples to look at it less as a crisis; however, there is still a need for awareness and counseling in the field of assisted reproductive treatments. Considering the people's interest in receiving health information from online content, the present study was conducted with aim to investigate the websites of infertility treatment centers in the country as a source of information for providing services in order to evaluate and analyze the amount of complementary counseling.

This research is a web-based content analysis that was searched using Google's advanced search tool between August and September 2023 with the keywords of infertility treatment center, clinic, specialized service center and similar words. The content analysis was done using the observation checklist for the objective evaluation of the variables and as a census from the official website of the infertility treatment centers of the country.

In this study, 37 websites of infertility treatment centers and clinics were first surveyed, of which 25 met the inclusion criteria. Of these, 18 cases (72%) provided initial explanations of counseling, 15 websites (60%) explained how to provide counseling services, and 16 cases (64%) had stated the types of counseling provided by the center. Also, 17 websites (68%) provided educational materials in the field of infertility treatment and 18 (72%) provided communication facilities for their contacts. The websites that had their own success rate, disclaimer for providing consulting services and facilities for viewing users' views were less than 35%.

Since the official websites of the centers are a capacity to introduce services and provide awareness, despite the importance of counseling in the decision-making of clients, the full capacity of websites in this field has not been used yet.

According to the high prevalence of primary dysmenorrhea and its consequences on the quality of life and the effects of nonsteroidal anti- inflammatory drugs consumption, the present study was performed with aim to investigate the effect of the capsella bursa-pastoris on the severity of primary dysmenorrhea.

This triple-blind clinical trial study was conducted in 2022 on 80 girls referred to the comprehensive health service centers of Kermanshah University of Medical Sciences with a history of primary dysmenorrhea. The participants were divided into two groups of 40 people, intervention and control. The intervention group received capsules containing 400 mg of hydroalcoholic extract of the "Capsella bursa pastoris" plant and the control group received 250 mg capsules of mefenamic acid every 8 hours for 3 days for 2 consecutive periods. The research tools were demographic profile questionnaire, menstrual status and physical activity questionnaire, and visual analog scale. Data were analyzed by SPSS software (version 19) and independent t-tests, chi-square, Bonferroni and analysis of variance with repeated measures. P<0.05 was considered statistically significant.

Before the intervention, the two groups were similar in terms of pain intensity (p=0.689). The two-factor variance test showed that the two groups had a significant difference in terms of pain intensity after the intervention (p=0.001), but the reduction of pain was more in the capsella bursa-pastoris group.

The Capsella bursa-pastoris plant can reduce the severity of primary dysmenorrhoea; Therefore, it is recommended to conduct more researches to confirm the effectiveness and safety of the Capsella bursa pastoris plant.

Immunological dysfunctions and imbalance of Th1 and Th2 cells in pregnant women can lead to adverse pregnancy outcomes. The effect of exercise training in changing immune-cell distribution during pregnancy is unclear. Therefore, this study was performed with aim to investigate the effect of 12 weeks moderate-intensity aerobic exercise training (AET) on Th1/Th2 (IFN-γ/IL-4) balance in the second trimester of pregnancy.

This semi-experimental study was conducted in 2022 on 30 pregnant women aged 20 to 35 years, with gestational age 12 to 15 weeks in Tabriz city. The subjects were randomly divided into two exercise and control groups. AET were performed according to the recommendations of the American College of Obstetricians and Gynecologists with moderate intensity (12-14 Borg RPE) for 12 weeks, 3 sessions per week and each session 45 min. The variables of weight, blood pressure, heart rate and serum levels of IL-4, IFN-γ were evaluated before and after the exercise protocol. The data were evaluated by SPSS software (version 25) and ANCOVA test. P<0.05 was considered statistically significant.

According to the results, the weight gain of the exercise group was significantly lower compared to the control group (P=0.027). Mean arterial blood pressure (P=0.019) and IFN-γ (P=0.025) were significantly decreased in the exercise group compared to the control group, but IL-4 and Th1/Th2 ratio did not show any significant difference (P>0.05).

In general, moderate intensity AET may be a safe way to improve the health of mothers in the second trimester of pregnancy, but considering limited studies and conflicting results, it seems that the effect of exercise training on Th1/Th2 balance in three different periods of pregnancy needs more investigations.

Pregnancy-related back pain is one of the most common musculoskeletal disorders during pregnancy. In some women, pregnancy-related back pain can be the beginning of chronic back pain for the rest of life and the cause of subsequent problems and disabilities. This study was performed with aim to systematically review the effectiveness of conservative management and physical therapy modalities in pregnancy-related low back pain and pelvic girdle pain.

A search was done in Persian language databases, including the Scientific Information Database (SID), MagIran, Iran Medex and the English-language EMBASE, including Web of Science, ClinicalTrials.gov, Scopus, Physiotherapy Evidence Database (PEDro), Allied and Complementary Medicine Database (AMED) and MEDLINE (Pubmed) without time limitation until September 2022 using the keywords included (“Pregnancy” OR “Postnatal Care”) AND (“Pelvic Girdle Pain” OR “low back pain” OR “Lower Back Pain” OR “Low Back Ache”) AND (“Conservative Management” OR “Self-management” OR “Complementary Medicine” OR “Alternative Medicine” OR “Alternative Therapy” OR “Physical Therapy” OR “Kinesio Tape” OR “Acupuncture” OR “Manual Therapy” OR “Muscle Training” OR “Cupping Treatment” OR “Cupping Therapy” OR “Cupping Treatment” OR “Acupressure” OR “Massage Therapy” OR “Belt” OR “Physical Activity” OR “Aquatic Therapy” OR “Hydrotherapy” OR “Exercise Therapy” ). The Cochrane Risk of Bias tool was applied to evaluate the quality of the studies.

Eighty-six articles entered the final results. Ergonomic training and low and moderate-intensity exercises lead to pain relief and functional improvement in pregnancy-related back or pelvic girdle pain sufferers. Local and auricular acupuncture, Kinesio taping, and modified belts separately or in combination with other methods lead to pain relief and improved performance.

Clinicians can recommend conservative multidisciplinary management combining ergonomic training and exercise with acupuncture, Kinesio taping, and belts to manage pregnancy-related back and pelvic girdle pain. Care should be taken in choosing other interventions due to the lack of evidence.

Considering the increasing prevalence of obesity and the importance of examining the relationship between sexual dysfunction and obesity in women and the need for systematic reviews that summarize the results of similar studies, the present study was systematically conducted with aim to determine sexual performance in women with obesity using the questionnaire of the female sexual function index (FSFI). 

In this systematic review, based on the PRISMA checklist, a literature review was conducted with a systematic approach in the field of examining sexual function in obese women using the FSFI questionnaire. In this regard, a systematic review was conducted in Web of Science, PubMed, MEDLINE, etc. databases. The keywords that were selected included sexual function, obesity, and women. In this systematic review, all English and Persian observational articles from the inception to 2022 were used.

In this study, 761 articles were initially extracted from the investigated databases and sources, and finally, five published articles met the criteria for entering this systematic review. Among the articles, four articles were in English and 1 article was in Persian. In these studies, the sexual performance scores obtained from the obese group were evaluated as a total score, sexual desire, sexual arousal, vaginal moisture, orgasm, sexual satisfaction, and pain. As this review was conducted with the aim of determining sexual function in obese women using the FSFI questionnaire, in most studies, a decrease in scores of the questionnaire and in different areas of sexual function was observed.

According to the results of most studies examined in this systematic review, sexual dysfunctional in obese women is high. Therefore, it is recommended to evaluate the sexual function in obese people in order to identify and treat people who need intervention.