مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 4 (تیر 1402)

Nowadays, there are different methods to treat infertility. One of the oldest methods of treating infertility is artificial insemination of sperm into the uterus (Intrauterine Insemination or IUI) and fallopian tube sperm perfusion (FSP). The results obtained in internal and external trials are different and the need for more studies is felt regarding the comparison of these two methods and the outcomes of successful pregnancy resulting from them; so the present study was performed with aim to determine and compare the pregnancy rate between IUI and FSP in infertile couples.

This randomized controlled trial study was performed in 2019 on 120 eligible patients referred to Moloud Infertility center in Zahedan. Patients were assigned to FSP and IUI groups based on the day of visit. Based on the day of refer to the center, patients on even days were included in the FSP group and patients on odd days were included in the standard IUI group. Treatment cycles of IUI and FSP were performed for the patients of each group by the treatment team of the infertility center. Data were analyzed by SPSS statistical software (version 19) and independent t and chi-square tests. P<0.05 was considered statistically significant.

In the IUI group, 53 women (88.3%) had a negative pregnancy test and 7 women (11.7%) had a positive result. In the FSP group, 49 (81.7%) had a negative pregnancy test and 11 (18.3%) had a positive result. According to the Chi-square test, there was no statistically significant difference between women with a positive pregnancy result in the IUI and FSP groups (p = 0.306).

In the present study, although the pregnancy rate was higher in FSP method, but the difference in pregnancy rates was not significant between IUI and FSP methods.

Along with the expansion of embryo freezing methods, there have been studies comparing the fertility outcomes in two methods of fresh and frozen embryo transfer, which had conflicting results, so the present study was conducted with aim to compare the fertility outcomes between these two techniques.

This retrospective study was performed in 2020 on 1247 infertile couples referring to Dezful Om-Albanin infertility center. A total of 716 couples were studied in the fresh embryo transfer group and 531 couples in the frozen embryo transfer group within ten years. The two groups were compared in terms of age of women and men, history of fertility failure, endometrium thickness, duration of infertility, age of transferred embryos, number of transferred embryos, cause of infertility and fertility outcomes. Data analysis was done by SPSS software (version 21) and chi-square, Fisher’s exact and Mann-Whitney tests. P<0.05 was considered statistically significant.

In demographic findings, age of women and men, duration of infertility, number of transferred embryos and cause of infertility were not significantly different in two groups (P< 0.05), but history of fertility failure, endometrium thickness and age of transferred embryos showed a significant difference in the two groups (P<0.05). Pregnancy outcomes including chemical and clinical pregnancy, ectopic pregnancy, chemical and clinical abortion, live birth and multiple  did not show significant difference in the two groups (P<0.05).

The results of this study showed that in terms of pregnancy outcomes, there is no significant difference between the two groups of frozen and fresh embryo transfer.

Preeclampsia is a disorder of pregnancy characterized by high blood pressure. Regarding vascular and red blood cell (RBC) damages in preeclampsia patients, the present study was performed with aim to investigate the relationship between the level of RBC indicators with the incidence and severity of preeclampsia.

This case-control study was conducted within one year (July 2021 to July 2022) on 22 pregnant women with mild preeclampsia, 38 pregnant women with severe preeclampsia, and 38 healthy pregnant women who referred to Amiral Momenin Hospital in Zabol city. Evaluation of the number of red blood cells and the amount of hemoglobin, hematocrit, MCV, MCH, and MCHC was obtained by analyzing 2 ml of blood containing anticoagulant. Data analysis was done using SPSS statistical software (version 26) and independent t-test, chi-square, Pearson, and logistic regression analysis. P<0.05 was considered statistically significant.

Among the basic variables, having a history of preeclampsia (P=0.005), body mass index (P=0.030), systolic blood pressure (P<0.001) and diastolic blood pressure (P<0.001) had significant differences between the three studied groups. Among the RBC indices, MCV was significantly different between the studied groups (P=0.043). Hemoglobin (r= -0.248, P=0.034), MCV (r= -0.335, P=0.004), and MCH (r= -0.315, P=0.007) had a significant correlation with systolic blood pressure. Hemoglobin [OR (95% CI)= 0.545 (0.335, 0.912), P=0.021], hematocrit [OR (95% CI)= 0.789, (0.644, 0.967), P=0.022], and MCV [OR (95% CI)= 0.891 (0.808, 0.983), P=0.022] were related to the severity of preeclampsia.

Considering the significant reduction of MCV index in the preeclampsia group and the correlation of this decrease with the increase of systolic blood pressure and the severity of preeclampsia, it is suggested that this non-invasive index be measured during pregnancy for screening of preeclampsia.

Although physical activity improves the quality of life of the elderly, the effect of different volumes of resistance training is not well understood. Therefore, the present study was performed with aim to investigate the effects of high- and low-volume resistance training on endurance and quality of life in the inactive elderly women.

This semi-experimental study was conducted in 2020 on 30 elderly women in Mashhad. Subjects were randomly assigned into three equal groups of low-volume resistance training, high-volume resistance training and control groups. Subjects performed low-volume resistance training (one-set) and high-volume resistance training (three-set) protocols twice weekly for 12 weeks. Quality of life, six-minute walk distance (6MWD), and lower- (LBME) and upper body muscular endurance (UBME) were evaluated before and at the end of the protocols. Data were analyzed by SPSS (version 16) using dependent t test and analysis of covariance test. P<0.05 was considered statistically significant.

In comparison to the control group, both low- and high-volume resistance trainings resulted in significant increase in UBME, LBME, 6MWD and the subscales of physical functioning, general health, physical health and mental health (P<0.05). However, there were no significant differences between the UBME, LBME, 6MWD and quality of life subscales in the low- and high-volume resistance training groups at the end of the exercise protocols (P>0.05).

Both low- and high-volume resistance trainings by increasing endurance could improve the quality of life in the inactive elderly women, but there was no significant difference between different volumes of resistance training with respect to quality of life.

Regarding to the importance of the main role of ultrasonography in screening of chromosomal disorders, the present study was performed with aim to evaluate the relationship between NFT and PT in fetuses of second trimester of pregnancy; if these two ultrasonographic markers are correlated, PT can be used in fetuses in which NFT cannot be measured due to fetal position in the uterine.

In this descriptive-analytical and cross-sectional study, 500 pregnant women at second trimester of pregnancy underwent routine ultrasound scan of anomalies. First, pregnancy ultrasound along with determination of gestational age and general pregnancy information, as well as scan of anomalies including all fetal organs were done and fetal sex, maternal age and gestational age were recorded. Data analysis was done using SPSS (version 22) and Statistica (version 10) statistical software. P<0.05 was considered statistically significant.

The mean gestational age was 19 weeks and mean maternal age was 30.26 years. The mean of PT in pregnant women with gestational age of less than 19 weeks was 1.8±0.212 mm, and in pregnant women with gestational age of ≥19 weeks was 5.6±0.161 mm (p<0,001). The mean of NFT in pregnant women with gestational age of less than 19 weeks was 2.9 ±0.194 mm, and in pregnant women with gestational age of ≥19 weeks was 5.9±0.187 mm (p<0,001). The mean of PT according to maternal age was 4.4±0.32 mm, which increased from 2.7 mm under 20 years to 5.65 mm over 40 years (p<0.001). Also, the mean of NFT according to maternal age was 4.2±0.211 mm, which increased from 3.2 mm under 20 years to 5.3 mm over 40 years (p<0.001), so there was a significant relationship between PT and NFT with gestational age and maternal age; Thus, both increased with increasing gestational age and maternal age (p<0.001). PT/NFT ratio was stable according to gestational age (p=0.205), maternal age (p=0.111) and fetal gender (p=0.752). No significant relationship was observed between maternal age, gestational age and fetal gender with PT/NFT ratio (p>0.05).

It was found that NFT and PT as the ultrasonographic markers of aneuploidies are correlated with each other. It can be concluded that PT can be used in cases which NFT cannot be measured due to fetal position in the uterine.

Ultrasound is performed to check the growth of endometrial cells outside the uterus and the pathology is performed to confirm endometriosis. A combination of diagnostic methods is important for summarizing and starting treatment of endometriosis. The present study was performed with aim to investigate and compare clinical and ultrasound diagnoses in patients with histopathological diagnoses of endometriosis.

This retrospective study was conducted in 2010-2021 on 140 women aged 18-65 years old suffering from endometriosis referred to Ayatollah Rouhani Hospital in Babol city. Confirmation of endometriosis was done based on tissue pathology and then comparing clinical history with ultrasound findings. The data collection tools were the patients' files and the researcher made checklist. Collected data included clinical manifestations, presence or absence of pain during menstruation, abdominal pain, pain during intercourse, pelvic pain, abnormal menstrual bleeding, backache, pain during defecation, and dysuria. Data were analyzed by SPSS software (version 22) and chi-square and independent t-tests. P<0.05 was considered statistically significant.

Dysmenorrhea (55.63%), abdominal pain (48.59%), and dyspareunia (31.69%) were the most common clinical symptoms. The state of uterine echogenicity was reported to be homogeneous in 99 patients (69.7%) and heterogeneous in 43 (30.3%). Echogenic status had a significant relationship with abdominal pain (p=0.004) and abnormal menstrual bleeding (p=0.032), adenomyosis with abdominal pain (p=0.004), ovarian adhesion with complaints of pain during intercourse (p=0.002) and status of fallopian tubes with complaints of pain during intercourse (p=0.015) and dysuria (p=0.049).

Dysmenorrhea, abdominal pain, dyspareunia, abnormal menstrual bleeding, and dysuria had significant difference with ultrasound findings. For definitive diagnosis and appropriate treatment, clinical manifestations, pathology, and ultrasound should be considered and treatment should be carried out based on that.

Polycystic Ovary Syndrome (PCOS) is associated with hyperandrogenism and obesity. The present study was performed with aim to compare testosterone and dehydroepiandrosterone sulfate serum levels and anthropometric indices between patients with PCOS taking metformin and cyproterone compounds.

This cross-sectional analytical study was conducted in 2022 was performed by reviewing the medical documents including age, body mass index (BMI), waist circumference (WC), waist-to-hip-ratio (WHR), waist-to-height ratio (WHtR), testosterone serum levels, and dehydroepiandrosterone sulfate before and after taking the drugs for 3 months. Two-hundred and twenty participants were divided in 4 groups (n=55 in each group) as follows: 1) taking metformin 500 mg daily, 2) taking cyproterone compound 2 mg daily, 3) taking metformin and cyproterone compound simultaneously, and 4) participants without PCOS as control. Data were analyzed by SPSS software (version 25) and paired T-test and ANOVA. P<0.05 was consider statistically significant.

Before the intervention, the mean serum levels of testosterone and dihydroxyepiandrosterone sulfate were significantly higher in the intervention groups compared to the control group without PCOS (p<0.001 and p=0.005, respectively). This difference was not significant after the intervention (p=0.111 and p=0.423, respectively). However, taking metformin alone increased BMI (p= 0.001) and WC (p= 0.001) and decreased WHtR (p= 0.026) compared to the control group. Taking metformin and cyproterone compounds simultaneously were associated with a decrease in WC compared to the control group (p= 0.001).

Taking metformin and cyproterone compounds alone or simultaneously has no effect on the androgens serum level. Co-administration of metformin and cyproterone compounds may reduce abdominal obesity in PCOS patients.

Trichomonas vaginalis, which is a pathogen of the human reproductive system, is the cause of trichomoniasis. Metronidazole is the drug of choice for the treatment of this disease, which has side effects such as dizziness, carcinogenesis, and drug resistance. Therefore, it seems necessary to find an alternative medicine. Therefore, the present study was performed with aim to evaluate the effects of aqueous and alcoholic extracts of Malva sylvestris and Tribulus terrestris on two subtypes of Trichomonas vaginalis in laboratory conditions.

In this study, aqueous and alcoholic extracts of Malva sylvestris and Tribulus terrestris in dilutions of 1.25, 2.5, 5, 10, 20 mg/ml and metronidazole with dilutions of 0.78, 1.56, 3.125, 6.25, 12.5, 25 μg/ml were administered to Trichomonas vaginalis type i and g at 24 and 48 hours. Live parasites were counted with Neobar slide and then cytotoxicity of Metronidazole and extracts was evaluated by MTT method on Hela cell line. Data were analyzed with two way ANNOVA graphpad method.

Ic50, CC50 and SI indexes were calculated and the decrease in the percentage of parasite survival was significant in all concentrations and in both 24 and 48 hours compared to the control group (p=0.0001). Ethanol extracts of Tribulus terrestris and Malva sylvestris have a higher SI than water extract of Tribulus terrestris and Malva sylvestris, but they are very different from the SI index of metronidazole. These two extracts have a good inhibitory effect on parasites, but their toxicity was high. Because the cell-killing effect of these extracts on the hella cell line was high, it is suggested to conduct a study on the effect of these extracts in the treatment of cancer cells.

The ethanolic extract of Tribulus terrestris has a good inhibitory effect on both types of Trichomonas vaginalis, especially type g, while the ethanolic extract of Malva sylvestris has a very good inhibitory effect on type i of the parasite in 48 hours. Aqueous and alcoholic extracts of Malva sylvestris and Tribulus terrestris have lower SI than metronidazole, so the effects of the extracts are less than metronidazole.

Sexual satisfaction is a person's positive evaluation of the sexual relationship. Decrease in sexual satisfaction is one of the common complaints of the postmenopausal period. Flaxseed is a phytoestrogen and contains lignan. The present study was conducted with aim to investigate the effect of vaginal cream of flaxseed and conjugated estrogen on sexual satisfaction in postmenopausal women.

This single-blind randomized clinical trial study was conducted in 2018-2019 on 60 married postmenopausal women aged 40 to 65 years referred to the clinics of Qaem and Imam Reza hospitals in Mashhad, Villa Shahr Health Center and the health center of Khalilabad city of Kashmar. The research units were randomly assigned in two groups of 30 people, vaginal cream of flaxseed and conjugated estrogen for 8 weeks. The intervention group received 4% vaginal gel in the form of one gram per day, and the flaxseed group received one gram per day for up to 8 weeks. Sexual satisfaction was calculated based on Larson's questionnaire before, 4 and 8 weeks after the study. Data analysis was done using SPSS statistical software (version 22) and Independent t-test, Friedman and Mann-Whitney tests. P<0.05 was considered statistically significant.

The mean sexual satisfaction 4 weeks after the intervention was 24.2 ± 10.4 in the flaxseed group and 23.4 ± 12.1 in the conjugated estrogen group (P=0.576), and after 8 weeks, it was 37.7 ± 18.2 in the flaxseed group and 37.8 ± 18.3 in the conjugated estrogen group, which did not show a significant difference between the two groups (P=0.638).

Vaginal cream of flaxseed without any side effects compared to the side effects of hormone therapy can be as effective as conjugated estrogen vaginal cream in increasing sexual satisfaction.

Breast cancer is one of the most important cancers in women. Research has been done in many parts of the world to investigate the presence of bovine leukemia virus (BLV) and its correlation with breast cancer on breast paraffin tissue and human blood samples. The present study was performed with aim to trace this virus in paraffin tissue and blood samples and to investigate the relationship between this virus and breast cancer in the studied population.

In this case-control study conducted in 2022, the presence of Gag gen of BLV was investigated in 220 samples (100 breast paraffin tissue samples and 120 DNA samples extracted from the blood of cancerous and healthy individuals) by using Nested-PCR method. Data were analyzed by SPSS software (version 26) and chi-square test. P<0.05 was considered statistically significant.

Among 120 blood samples (13%) and among 100 breast paraffin tissue (8%) showed BLV infection that indicate better detection of this virus in the blood, but in comparison between patient and healthy samples, just paraffin tissue samples showed a significant relationship with breast cancer(p<0.05).

  Although there was a significant relationship between BLV infection and cancer in breast paraffin tissue samples of the investigated population (P<0.05(, but the number of positive samples for this virus is more in the blood samples, which indicates that the blood samples are more desire to trace this virus in patients.

Gestational diabetes is one of the most common pregnancy complications, which has negative consequences for both mother and fetus. A crucial treatment strategy is modifying the mother's diet. The present study was performed with aim to determine the effects of low carbohydrate (LC) diets on the outcomes of gestational diabetes.

In this systematic review, search was done with the keywords including low carbohydrate diet, carbohydrate restriction, ketogenic diet, gestational diabetes, hyperglycemia, glucose intolerance, insulin resistance, and clinical trials in Persian and English languages in databases of Medline, PubMed, Embase, Science Direct, Magiran, ISD, ISC, and Cochrane until March 2023.

This systematic review examined seven studies. Some studies showed that carbohydrate restriction can have beneficial effects on metabolic outcomes, glycemic control, less insulin therapy needs, delivery method, and fetal weight. The LC diet did not lead to ketonemia in pregnant women. However, in other studies, adherence to the LC regimen did not reduce the number of women requiring insulin. There were no significant differences between the groups in terms of insulin dose or time of insulin treatment initiation, and both groups had similar pregnancy outcomes.

Adherence to the low carbohydrate diet (about 40%) in pregnant mothers with gestational diabetes could have beneficial effects on some metabolic outcomes, delivery method, weight and health of the fetus. It did not lead to ketonemia in pregnant mothers. However, there are contradictions in the findings of the studies due to the amount and type of carbohydrates. It is recommended to conduct more clinical trials with different percentages of carbohydrates and a higher sample size.