فهرست مطالب ساغر صالح پور

Breast cancer is one of the most common malignancies in women. Cytotoxic chemotherapy or drugs exert a negative effect on fertility potential. Techniques,such as ovarian suppression, oocyte and embryo freezing, InVitro Maturation, and ovarian tissue freezing, are necessary to preserve fertility.

To conduct this study, a query was conducted on Persian and English sources databases as Scoupus, Google Scholar, Pub Med, and Science Direct during the last 24 years using the following keywords: breast cancer, infertility, fertility preservation, oocyte freezing, and embryo freezing.

Based on the result15% to 25% of patients are young premenopausal women. Chemotherapy or radiation therapy can lead to infertility or early menopause. As suggested by evidence, the success rate of embryo freezing is much higher than oocyte freezing and In Vitro Maturation. Among the fertility preservation methods, ovarian tissue freezing and 3D bioprinting are in the laboratory research stage and have received much attention. Correct counseling and providing accurate information to patients and their timely referral have have a marked impact on improving their mental and physical condition and treating their underlying disease.

As evidence by the result of this study, early diagnosis of breast cancer and timely referral to a fertility specialist  enable , breast cancer patients to maintain their fertility and experience their biological child after aggressive cancer treatments.

Luteal phase support is an inevitable part of IVF programs, for this purpose, progestogenic therapies are used. Lutogel and Utrogestan are two progestogenic therapies that can be used as supportive drugs for the luteal phase. Utrogestan is a known drug to support the luteal phase. The aim of this study was to use Lutogel in case of effectiveness and tolerance as effective micronized progesterone to support the luteal phase in IVF patients due to the reduced availability in Iran.

This randomized clinical trial study (RCT) was performed on 200 patients referred to Infertility Clinic of Tehran Taleghani Hospital in 2019-2020. The subjects were divided into two equal groups and from the same day of getting oocyte one group was treated with 200 mg vaginal Lutogel and the other with 200 mg vaginal Utrogestan. Then the two groups were compared in terms of effectiveness, tolerability, safety, positive clinical pregnancy rate, successful pregnancy rate up to 12 weeks and abortion rates. Data were analyzed by SPSS statistical software (version 21) and Mann-Whitney, Chi-square and logistic tests. P <0.05 was considered statistically significant.

Positive BHCG levels were 22% in Lutogel and 23% in Utrogestan groups that had no significant difference (P=0.866). Rate of pregnancy based on positive FHR in sonography was 18% in Lutogel and 22% in Utrogestan groups that no significant difference was found between the two groups (P=0.480). Rate of successful pregnancy up to 12 weeks was 13% for Lutogel and 15% for Utrogestan groups which showed not significant relationship between the two groups (P=0.684). The incidence of pregnancy more than 20 weeks was 14% in both Lutogel and Utrogestan groups, with no statistically significant difference (p=1.000).

The rate of positive BHCG, pregnancy based on positive FHR in sonography, and successful pregnancy up to 12 weeks were the same in the use of two Lutogel and Utrogestan drugs. Also, there was no difference in the incidence of complications. For this reason, each of these drugs can be used to support the luteal phase in patients undergoing IVF.

While pregnancy and childbirth can be considered as a natural bodily function for women, it is still an experience that increases their vulnerability to a variety of physical and psychological problems. Therefore, it seems necessary to improve their quality of life and mental health.

The present study was conducted in order to evaluate the effectiveness of emotion regulation group training for improving the quality of life and mitigating emotion regulation difficulties of pregnant women.

The current study is a quasi-experimental random study with a pretest-posttest and follow-up design. The statistical population of the study includes all pregnant women in Tehran in 2018, and the sample includes 39 pregnant women, selected based on a targeted sampling method. The Short-Form Quality of Life questionnaire and the Difficulties of Emotion Regulation Scale were used. The emotion regulation group training was administered to the intervention group in 8 sessions. The results were analyzed using repeated measures ANOVA in SPSS-24 software application.

The data analysis indicated that the mean scores of quality of life in the intervention group (M = 58.13) increased compared to the control group (M = 38.25). Moreover, the mean scores of DERS in the intervention group in the post-test stage (M = 77.33) significantly decreased at the 0.001 level compared to the pre-test stage (M = 92.87) and the follow-up period (M = 72.27).

Emotion regulation group training can be effective for improving the quality of life of pregnant women and mitigating their emotion regulation difficulties.

Repeated implantation failure (RIF) is a major challenge in reproductive medicine and despite several methods that have been described for management, there is little consensus on the most effective one.

This study was conducted to evaluate the effectiveness of platelet-rich plasma in improvement of pregnancy rate in RIF patients.

Twenty women with a history of RIF who were candidates for frozen-thawed embryo transfer were recruited in this study. Intrauterine infusion of 0.5 ml of platelet-rich plasma that contained platelet 4-5 times more than peripheral blood sample was performed 48 hrs before blastocyst transfer.

Eighteen participants were pregnant with one early miscarriage and one molar pregnancy. Sixteen clinical pregnancies were recorded and their pregnancies are ongoing.

According to this study, it seems that platelet-rich plasma is effective in improvement of pregnancy outcome in RIF patients.

Recurrent implantation failure is one of the most issues in IVF cycles. Some researchers found that beneficial effects of endometrial Scratching in women with recurrent implantation failure, while some authors demonstrated contrary 

The present study aimed to investigate the effect of intrauterine. Saline infusion as a form of endometrial injury, during fresh in vitro fertilization-embryo transfer cycle, among patients with recurrent implantation failure.

In this clinical trial study 63 women undergoing assisted reproductive technology were divided into two groups either local endometrial injury by intrauterine saline infusion during day 3-5 of the ongoing controlled ovarian stimulation cycle, or IVF protocol performed without any other intervention in Taleghani Hospital, Tehran, Iran. The main outcome measure was clinical pregnancy rates.

Patients who received intra uterine saline infusion (n=20), had significantly lower clinical pregnancy numbers (1 vs. 9, p0.05) and multiple pregnancy numbers (1 vs. 3, p>0.05) between groups.

When intrauterine saline infusion as a form of endometrial injury is performed during the ongoing IVF cycles it has negative effect on reproductive outcomes among patients with recurrent implantation failure.

Premature luteinization during in vitro fertilization was commonly happened before the introduction of GnRh analogues. High level of unwanted progesterone is associated with adverse pregnancy outcome and is thought to be induced by inappropriate LH elevation.

To evaluate the progesterone level on the day of Human Chorionic Gonadotropin (HCG) triggering in GnRh agonist and antagonist protocols, and its correlation with clinical pregnancy rate and miscarriage rate.

One hundred and seven women underwent intracytoplasmic sperm injection with long agonist protocol (n=46) or antagonist protocol (n=61). Blood sample was obtained from each patient for progesterone level measurement in HCG administration day, then patients were divided into two groups according to their serum progesterone levels on the HCG triggering day: progesterone level <1.2 ng/ml, and progesterone level ≥1.2 ng/ml. Clinical pregnancy and miscarriage rates were evaluated as main outcomes and biochemical pregnancy rate and implantation rate were considered as secondary outcomes.

The increased prevalence rate of premature progesterone (progesterone level ≥1.2 ng/ml) in total patients was 13.1% (14/107) and in long agonist protocol group and antagonist protocol group was 15.2% (7/46) and 11.5% (7/61) respectively. Premature progesterone rise had no significant correlation with clinical pregnancy rate in total patients (p=0.174), agonist protocol (p=0.545), and antagonist protocol (p=0.129). Also premature progesterone rise had no significant association with miscarriage rate in total patients (p=0.077), agonist protocol group (p=0.383) and antagonist protocol group (p=0.087).

A significant rise in progesterone levels at the time of HCG triggering doesn’t lead to decrease in pregnancy rate and implantation rate and increase in miscarriage rate.

The beneficial role of cabergoline as a prophylactic agent to prevent ovarian hyper stimulation syndrome (OHSS) among high-risk patients has been demonstrated in previous studies. But data for its role as a treatment for established severe OHSS is still limited. We represent the treatment results of high dose oral cabergoline in management of six patients after the syndrome is established.

High-dose oral cabergoline (1 mg daily for eight days) was prescribed as an adjuvant to symptomatic treatment for six hospitalized patients with established severe OHSS following infertility treatment cycles. In two cases OHSS resolved rapidly despite the occurrence of ongoing pregnancy.

Considering the treatment outcomes of our patients, high dose cabergoline did not eliminate the need for traditional treatments, but it was a relatively effective and safe therapy in management of established severe OHSS, and prevented the increase in its severity following the occurrence of pregnancy

The appropriate combination and composition of hypocaloric diets for obese women with polycystic ovary syndrome (PCOS) is still unclear. The aim of this study was to investigate the effects of a high protein-low glycaemic load diet on reproductive hormones in obese women with PCOS.

In this single blind clinical trial, sixty overweight and obese women with PCOS, not using metformin, were randomly assigned in one of two groups, the modified with a 30% protein-low glycaemic load diet, and the conventional with 15% protein. Reproductive hormones, glucose and insulin were measured for 49 subjects at baseline and after 12 weeks.

Weight loss showed no significant difference in the two groups. Changes in means for testosterone in the modified and conventional groups (0 to 12 weeks), were 1.78±1.52 to 1.31±1.27 and 1.51±0.63 to 1.15±0.57 ng/ml, respectively (p<0.001). FSH, LH, estradiol, progesterone and prolactin did not change. Insulin and HOMA reduction was significant for modified diet (p<0.001).

Weight loss had a significant effect on reduction of androgens. The main effect of modified diet with high protein and low glycaemic load was observed on insulin and HOMA, a finding which should taken into consideration for women with PCOS.

Polycystic ovary syndrome (PCOS) is usually accompanied by cardiovascular disease risk factors in women especially obese subjects. The aim of this study was to investigate and compare the effects of two hypocaloric diets on weight loss and improvements of cardiovascular disease risk factors.

For this randomized clinical trial, weight reduction was attempted among sixty overweight and obese PCOS women who did not use any medication. They were randomly assigned into two groups; "conventional group" receiving 15% protein and 55% carbohydrate and "modified group" receiving 30% protein and 40% reduced glycemic load carbohydrates. They consumed hypocaloric diet for 12 weeks. In weeks 0 and 12, anthropometric data, 24-hour dietary recall for 3 days and fasting blood sample for measuring lipid profile, adiponectin and pro-inflammatory factors were obtained.

Subjects were aged 28.9±5.9 years old. There was no significant difference in percentages of weight loss between two groups. Reduction of total body fat in "modified group" was slightly higher, however, the difference did not reach a statistically significant level. Levels of LDL-C, TNF-α and IL-6 reduced and adiponectin increased significantly. CRP was significantly reduced in modified group.

Weight loss was associated with reduction in LDL-C level and improvement of cardiovascular disease risk factors. However, its effect is independent of the diet composition.