فهرست مطالب batool rashidi

COVID-19 pandemic has affected all aspects of human life including social, economic, healthy behaviors and even individual relationships. This study aimed to investigate the effect of corona virus outbreak on assisted reproductive technology (ART) outcome.

In this retrospective and prospective cohort, 260 ART cycles of ovum pick up (OPU), fresh embryo transfer (ET) and frozen embryo transfer (FET) were evaluated in 223 women (from December 2019 to February 2020) and during COVID-19 outbreak (February and July 2020) in an infertility center. Primary and secondary outcomes of ART cycles including chemical and clinical pregnancy rate were evaluated.

The mean±SD (standard deviation) age of women was 34.17±6.56 years. Chemical and clinical pregnancy rates were 23.91% (33/138) per embryo transfer and 75.8% (25/33) per positive pregnancy test, respectively while ongoing pregnancy was seen only in 69.7% (23/33) of those with positive pregnancy test. Spontaneous abortion rate was 15.15% (5/33) per laboratory pregnancy. COVID-19 symptoms were reported in 2.83% and 15.38% of women during and after ART cycles, respectively.

It seems that COVID-19 pandemic has not negative effect on outcome of ART cycles except for cancelation rate due to COVID-19 that increased at the beginning of COVID-19 outbreak as it was unknown at that time and awareness was limited.

To compare the effect of dydrogesterone and Gonadotropin releasing hormone (GnRH) antagonists on prevention of premature luteinizing hormone (LH) surge and pregnancy outcomes in infertile women undergoing Invitro fertilization/ Intra cytoplasmic sperm injection (IVF/ICSI).

In a Randomized controlled trial (RCT), two-hundred eligible women undergoing in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) treatment were randomly assigned into two groups. Human menopausal gonadotropin (HMG) was administered for controlled ovarian stimulation (COS) in both groups. Intervention group (group 1) received 20 mg dydrogesterone from day 2 of menstrual cycle till trigger day and control group (group2) received GnRH antagonist from the day that leading follicle reached 13 mm in diameter till trigger day. Serum levels of LH, estradiol and progesterone were measured on the trigger day. The primary outcome measure was the incidence of a premature LH surge, and the secondary outcomes investigated were the chemical and clinical pregnancy rates in the first FET cycles.

There were no significant differences in patients' age, BMI, AMH levels, previous IVF cycle, and cause of infertility between the two groups. None of the patients in two groups experienced a premature luteinizing hormone surge. The numbers of retrieved oocytes, the MII oocytes and good quality embryos, were significantly higher in the intervention group than antagonist group (p < 0.05). The overall chemical pregnancy rate in intervention group (43/91: 46.2%) and control group (45/91: 49.5%) (p = 0.820) was similar. Meanwhile, the clinical pregnancy rate was similar between groups too.

Regarding the cost, efficacy and easy usage of dydrogestrone, it may be reasonable to use it as an alternative to GnRH antagonist for the prevention of premature LH surge.

To investigate the relationship between insulin resistance and hepcidin levels in patients with PCOS. In this case–control study fifty- six patients with PCOS and forty – one healthy control subjects were included. Plasma levels of hepcidin, IL-6, Serum Insulin and ferritin using ELISA method, serum iron levels using a spectrophotometric method, and Insulin resistance by using HOMA  were measured in the two groups of PCOS (case group) and  healthy subjects (control group). The results were analyzed by student’s t-test, General Linear Model, Binary logistic and linear regression tests. The mean hepcidin level was 1.97 ± 0.53 pg/ml and 2.40 ± 0.25pg/ml in the case and control groups, respectively. The t-test results showed a significant difference between the two groups (p = 0.0001). The mean of insulin level in case and control group was 30.65 ± 15.02g/dl and  14.71 ± 10.46g/dl, respectively. The t-test analysis indicated a significant difference between the two groups (p = 0.0001). There was an inverse relationship between the level of hepcidin with HOMA-IR (β = -0.629, p = 0.04), and IL-6 (β = -0.243, p = 0.015) in both groups. The adjusted OR proved a statistically significant association between serum hepcidin (OR = 0.063; 95 % CI: 0.01-0.385, p-value  =  0. 003) and HOMA (OR  =  1.569; 95 % CI: 1.254–1.964, p-value  =  0.001) with PolycysticOvarian Syndrome. There was an inverse relationship between hepcidin levels and insulin resistance in both groups meaning decrease in hepcidin levels and increase in insulin resistance may increase the risk of PCOS.

Since infertility affects quality of life and even couples' relationships, it is important to identify the variables affecting fertility. One of these cases is obesity in men and its relationship with infertility. Regarding the contradictory results of various studies, this study was conducted with aim to determine the relationship between body mass index and quality of sperm parameters. This cross-sectional study was performed on 200 women's husbands with inclusion criteria who referred to Infertility Clinic of Vali-e-Asr Tehran in 2015-2016. Individual data, height, weight and sperm results of the subjects were entered to the researcher-made questionnaire. Data were analyzed using SPSS (version 18) and Chi-square test. P<0.05 was considered statistically significant. More than 38.5% (n=77) of participant were in the normal BMI group. 47% (n=94) were overweight and 14.5% (n=29) were in the obese group. Based on the results, there was no significant relationship between sperm counts, sperm motility and sperm shape and BMI in the three groups of men based on BMI (p> 0.05). There is no significant relationship between BMI in three groups of men (based on BMI), with sperm analyses factors including sperm counts, sperm motility and sperm shape.

This study was conducted with the aim to investigate and compare Iranian produced and foreign oxytocin for use in induction of labor. This random clinical trial was conducted on a population of 198 pregnant women with live fetus and cephalic presentation and conditions conducive to induction of labor, monitored by obstetricians and gynecologists. They were randomly divided into group A (n=99) received 10 units of Syntocinon (Novartis Pharma Canada) in 500 cc Ringer lactate, and group B (n=99) received 10 units of Oxytip (Caspian Tamin Company Iran) in 500 cc serum, who entered the study to commence induction, by signing written consent. Study variables such as induction indications (post-term, ruptured membranes, diabetes, and. .), induction duration, duration of the 1st and the 2nd stages of labor, and delivery method; as well as labor outcomes like hyper-stimulation of uterine, postpartum bleeding, 5-minute Apgar score, and infant’s birth weight; and neonatal outcomes (admission to NICU, oxygen and intubation) were assessed for the two groups by a trained midwife and registered in the patient’s questionnaire. Data were analyzed in SPSS software using statistical tests: t-test, Chi-square, and Mann-Whitney. Two groups were similar in demographic variables such as; age, BMI, parity, education. There was no significant difference regarding to obstetric and gynecologic characteristics such as: gestational age, dilatation, effacement, and fetal positioning, as well as the indication for labor induction when the study began. After intervention, variables including: induction duration, duration of the 1st and the 2nd stages of labor, delivery method; and labor outcomes such as: hyper-stimulation of uterine, postpartum bleeding, 5-minute Apgar score, and infant’s birth weight; and neonatal outcomes (admission to NICU, oxygen and intubation), in the two groups, were found to be the same (P<0.05). Mean oxytip dosage needed was less than that of oxytocin to reach for appropriate pain (P=0.042). The two drugs in terms of labor induction and neonatal complications had similar outcomes and the locally made drug with a lower dosage appears to produce the desired outcome.

The purpose of this study was to investigate the role and contribution of infertility stress, coping styles with stress, personality traits and social support in the marital adjustment of infertile women. In this study, causal comparative or "exposit facto" research method was used. Population of the study included 201 women who were selected through availability sampling method from those visiting VALI-e-ASR Reproductive Health Research Center. Research tools of the study included the Gadroon's Big Five Factor, The Fertility Problem Inventory, Revised Dyadic Adjustment Scale, Multidimensional Scale of Perceived Social Support, and Coping Inventory for Stressful Situations. In order to analyze the data, Pearson Correlation and Stepwise Regression analysis were used. The results indicated that there were significant relationships between the variables of this study. It was also revealed that social concern, important others, extroversion, emotional coping style, need for parenthood and sexual concern were suitable predictors of the marital adjustment. In sum, the results of the study put an emphasis on the importance of the psychological-Social factors in marital adjustment.

Obejective (s): infertile couples receiving IVF / ICSI treatment may be at higher risk of developing psychological or health-related problems. Identification of these groups at risk may enable better allocation for appropriate counseling. a total of 1028 (516 women and 512 men) were invited to complete health survey short form (SF-36) questionnaire prior to initiating IVF / ICSI treatment in Vali.e.Asr hospital and Rooyan infertility center.The patient’s demographic and clinical characteristics were also recorded. male SF-36 scores were higher than those reported by women. Quality of life increased with advancing age, level of education, economic status, in working women and infertality due to male factor. Infertile couples are at risk of a sub- optimal quality of life. Psychological counselling, especially support psychotherapy, must be regarded for patients in order to increase their quality of life.

The aim of our study was to investigate the effect of coping strategies, personality trait and social support as the main social and psychological factors on infertility stress. This study was conducted on 201 infertile Iranian women referred to the Vali-e-Asr Reproductive health Research Center, and completed the following questionnaires: The fertility problem inventory, measuring perceived infertility related stress (Newton CR, 1999), big five factor personality questionnaire (Farahani, 2009), multidimensional scale of perceived social support MSPS (Zimmet 1988), and multidimensional assessment of coping (Endler, 1990).The results were then analyzed using the Pearson Correlation and stepwise regression. Infertility stress has negative and significant relation with emotion-oriented coping method, perceived social support and bring extrovert. It has a positive, significant relation with emotion-oriented coping method, obsessive compulsive disorder (OCD). The results of the stepwise regression showed that emotion-oriented coping method, OCD and being extrovert are suitable predictors of infertility stress. About 22% of the infertility stress variance was explained by coping strategies and personality trait. Therefore our result demonstrates the importance of social and psychological factors on experiencing the infertility stress.

The differential efficacy between long GnRH agonist with antagonist can partly be due to the preexisting differences in the early antral follicles before ovarian stimulation. To compare the effect of pretreatment by estradiol with GnRH antagonist on antral follicular size coordination and basal hormone levels in GNRH antagonist protocol. On cycle day 3 (control/day 3), women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones then were randomized to receive oral estradiol 4mg/day (n=15) or 3mg cetrorelix acetate (n=15) in luteal phase before subsequent antagonist protocol. Participants were re-evaluated as on control/day 3. There was a significant reduction of mean follicular sizes in each group after medical intervention (7.63±2.11 Vs. 4.30±0.92 in group A and 8.73±1.96 Vs. 4.13±1.11 in group B) (p=0.0001). The magnitude of follicular size reduction was significantly higher in group B (-4.60±2.04 Vs. -3.33±2.28) (0.027). There was a non significant attenuation of follicular size discrepancies in two groups. FSH and inhibin B levels in the day 3 of the next cycle in both groups were significantly decreased but did not have significant difference between two groups. Both luteal E2 and premenstrual GnRH antagonist administration reduces the follicular sizes significantly and GnRH antagonist acts more potently than E2 in this way but attenuation of follicular size discrepancies in both treatment is not significant.

General concern is that the pregnancy rate is higher with GnRH-agonist as a protocol of pituitary suppression. GnRH-antagonist protocol provides a shorter period of administration and an easy flexible protocol. In this study, the outcomes of GnRH agonist and antagonist in ICSI cycles are compared in normo responder patients. In this randomized clinical trial, 300 normoresponders undergoing ICSI were randomly divided to GnRh agonist (n=150) and GnRh antagonist (n=150) groups. The main outcome measurements were chemical, clinical and ongoing pregnancy rates (PR). The mean duration of stimulation were 9.6±1.6 and 8.2±1.6 days in agonist and antagonist groups respectively (p=0.001). The mean number of MII oocyte retrieved in agonist and antagonist groups were 7.7±4.0 and 6.9±4.3 respectively (p=0.03). There was no significant difference between two groups regarding mean number of gonadotrophin ampoules, follicles, occytes, total embryos and good quality embryos, OHSS incidence, and abortion rate. Chemical pregnancy rate was 35.3% in agonist and 39.3% in antagonist group. Clinical pregnancy rate was 35.3% in agonist and 34% in antagonist group. Ongoing pregnancy rate was 45 (31.3%) in agonist and 44 (29.3%) in antagonist group. There was no significant difference between two groups in pregnancy rates. In this study antagonist protocol was shown to be an easy, safe and friendly protocol in Iranian normoresponder patients, having similar outcomes with standard agonist protocol but shorter period of stimulation.

The study assessed the efficacy of low dose ketoconazole in addition to clomiphene citrate (CC) and hMG on ovulation induction.A double blind, randomized, clinical trial was performed on fifty infertile patients with PCOS who had failed to respond to a daily dose of hMG and 100 mg CC for controlled ovarian hyperstimulation in Vali-e-Asr Reproductive Health Research Center.These patients were randomly divided into two equal groups receiving ketoconazole or placebo.All patients received CC and hMG for controlled ovarian hyperstimulation.Number of mature follicles, estradiol and progesterone levels at the time of hCG adminstration, endometrial thickness, ovarian hyperstimulation syndrome(OHSS), pregnancy rate, abortion, multiple pregnancies were measured. SPSS 11 software was used for statistical analysis. Statistical significance was defined as P < 0.05. No significant statistical differences existed in the number of mature follicles, estradiol and progesterone levels prior to hCG administration, endometrial thickness, OHSS and pregnancy rate between two groups. Estradiol level was lower among those receiving ketoconazole. No abortion and multiple pregnancy were found. Ketoconazole may suppress steroid production in resistant PCOS patients undergoing CC and hMG induction. But it has no effects on follicular maturation and OHSS prevention

The study aimed to determine the relationship between presence of antiphospholipid antibodies (APLs) and clinical pregnancy rate in patients undergoing IVF/ICSI procedures. This descriptive-analytic study performed on two hundred consecutive women referred for IVF/ICSI in Vali-e-Asr Reproductive Health Research Center. Serum levels of APLs, anticardiolipin [aCL], antiphosphatidic acid [aPA], antiphosphatidyl choline [aPC] and antiphosphatidylserine [aPS] were checked for all patients before starting IVF cycles. APLs seropositivity and clinical pregnancy rate were determined. T-test and Mann-Whitney were used to compare two groups. P value <0.05 was considered significant. 23 women (11.5%) were APL positive. Twenty nine women of 177 APL seronegative patients (16.4%) became pregnant while only one of 23 seropositive patients (4.3%) was pregnant. Clinical pregnancy rate was not significantly different in two groups. Although APLs were common, these antibodies did not affect the outcome of IVF/ICSI procedures. Thus screening for APLs is not recommended in women undergoing these procedures.

To compare a flexible, multi-dose GnRH antagonist protocol with a long GnRH agonist protocol in poor responders. A randomized clinical trial of 70 poor responder patients (35 patients in GnRH antagonist protocol and 35 patients in long GnRH agonist protocol) was performed at Royan Institute, Tehran, Iran. Both groups were given a fixed dose of human menopausal gonadotropin (HMG) for stimulation and oral contraceptive pre-treatment. Data analyzed by student’s group t-test or Chi square test. Stimulation duration, total gonadotrophins consumption, mean numbers of oocytes retrieved, formed embryos, cycle cancellation rate, and clinical pregnancy rate were similar between both groups. Although the miscarriage rate was higher in the agonist protocol group, the rate of miscarriage was not statistically significant between both groups. A flexible, multi-dose GnRH antagonist protocol appears as effective as the long GnRH agonist protocol in poor responders. More (larger) randomized controlled trials for better statistical analysis are recommended.

The etiology of infertility has direct influence on the plan and outcome of its management. In this paper we showed the effect of history of tuberculosis (TB) on female infertility among infertile couples admitted to Royan infertility management center. This case control study was performed on cases that were diagnosed with female infertility (308 women). Controls were women whose husbands were infertile due to some male factor (314 women). Those who had both female and male infertility were excluded from the study. The observed variables were BMI>25 kg/m2, positive history of smoking, tuberculosis, sexually transmitted disease and pelvic inflammatory diseases. The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI: 1.31-29.56).The attributable risk in exposed group was about 1%. According to our study, positive history of tuberculosis may be responsible for female infertility.