International Journal of Reproductive BioMedicine
Volume:8 Issue: 2, Feb 2010

Premature ejaculation (PE) is the most common sexual dysfunction compliant in about 35-40% of men younger than 40 years; therefore a study for survey and diagnosis of this disorder is very important.

In this study, the efficacy of 2 drugs (fluoxetine and citalopram) for treatment of patients suffering from PE is compared. We studied the effectiveness of both drugs in PE with different protocols to find out the most effective drug with least side effects.

In total 77 patients referred to the Urology Clinic of Emam Reza Hospital, Tehran from 2006 to 2008 for the treatment of PE, including 25 patients with anxiety disorder, were randomly divided into 2 study groups. Patients belonging to first group (N= 43) received 40 mg (2 capsules of 20 mg) fluoxetine daily for 4 weeks and patients of the group II (N=34) received 40 mg citalopram daily for 4 weeks.

The mean Intra Vaginal Ejaculation Latency Time (IVELT) before treatment in patients of group I was 58.26±41.83 seconds while after treatment it raised to 466.2±10.85 seconds. In group II, the mean IVELT before treatment was 51.76±34.39 seconds while after treatment it elevated to 403.8±7.58 seconds.

Difference was significant in mean IVELT before and after treatment with fluoxetine and citalopram (each drug separately). In this study, both drugs improved ejaculation duration while difference between 2 drugs was not significant (p>0.05)

The trace element copper has been identified as a highly toxic element for sperm. It is known to affect sperm motility in humans, and experimental implantation of copper in the epididymis, vas deferens, and scrotum of mammals has been demonstrated to affect fertility detrimentally.

Sperm concentration, motility, vitality and morphology are parameters used to evaluate potential male fertility. Since, copper is believed to be important for spermatogenesis; we conducted a study to investigate the correlation between seminal plasma copper concentration and human semen parameters in 232 males.

We selected 232 subfertile or infertile men who referred to Omid Fertility Clinic, randomly. Samples were categorized into normospermic (n=32), oligozospermic (n=73), asthenozospermic (n=111) and azospermic (n=16) groups according to their spermiogrames. Total seminal plasma copper concentration was determined by furnace atomic absorption spectrophotometer.

The results showed that seminal plasma copper concentrations in oligozospermic, asthenozospermic and azospermic groups are significantly higher than normozospermic group (p<0.01). Also, negative correlations were found between seminal plasma copper concentration and sperm count (p<0.05), sperm motility (p<0.01), sperm vitality (p<0.01), normal morphology (p<0.01) and pH (p<0.01) in all groups.

It was suggested that excess copper in seminal plasma was detrimental for male reproductive capacity by reducing sperm count, motility, vitality and morphology.

Anemia in pregnancy is associated with increased rates of maternal and perinatal mortality.

To study the prevalence and risk factors of women with anemia during pregnancy in Kerman, Iran.

A retrospective cross-sectional study was performed based on 2213 pregnancies delivered during the years 2005-2007 in Kerman, Iran. Women with hemoglobinopathies such as thalassemia were excluded from analysis. Anemia was defined as hemoglobin (Hg) lower than 11 g/dl during pregnancy. Categorical variables were compared using the chi-square or Fisher’s exact test.

Overall, 104 (4.7%) women were anemic (Hg<11g/dl), out of which 4.8% had severe anemia (Hg<7g/dl), 15.4 % had moderate anemia (Hg=7-8.9 g/dl) and 79.8% had mild anemia (Hg=9-10.9 g/dl). The frequency of anemia were 5%, 3.4% and 5.7% in the first, second and third trimester, respectively. Multiparity was associated with lower hemoglobin concentration during the second/third trimester of pregnancy (p=0.03 and p<0.001, respectively). Prevalence of anemia was significantly higher in smokers and opium users (p=0.01 and p=0.003, respectively).

Our study showed that prevalence of anemia was not high in this study. Factors associated with anemia during pregnancy were parity, smoking, opium use and not using Iron supplement.

Active immunization with gonadotropin releasing hormone conjugate (GnRH-BSA) manipulates the fertility axis and thus alters the reproductive cyclicity, serum estradiol and progesterone levels. While the application of Kamdhenu ark increases the efficacy of GnRH-BSA.

This experimental investigation is aimed to evaluate the modulatory effects on estrous cycle, serum estradiol and progesterone levels in female mice after Kamdhenu ark and GnRH-BSA immunization.

Sixty sexually mature female mice were divided into three groups of twenty each. Group I served as control, while group II was immunized with GnRH-BSA conjugate (50µg/animal) for 120 days. However, group III was supplemented with Kamdhenu ark (100 ppm) orally along with GnRH-BSA conjugate immunizations and their vaginal estrous cyclicity, serum estradiol and progesterone levels were estimated after 30, 60, 90 and 120 days of intervals.

GnRH-BSA immunized females showed regular estrous cycle initially but after 13th day animals started showing irregular and prolonged estrous cycle with a complete diestrus stage after 65th day onwards. In connection to this, GnRH-BSA + Kamdhenu ark supplemented animals also showed regular cyclicity initially but later they showed more interrupted cycle with complete diestrus stage after 55th day. Besides this, the serum estradiol and progesterone levels lowered significantly in all the experimental groups as compared to control animals. The more severe decrease in hormonal levels was noticed in later part of the experiment especially in the group supplemented with Kamdhenu ark along with GnRH-BSA immunizations.

All these observations suggest that the GnRH-BSA conjugate has a deleterious effect on the reproductive hormones and estrous cycle of female mice; and Kamdhenu ark acts as a bioenhancer in immunization efficacy to modulate these effects.

Hyperhomocysteinemia (hhcy) has been considered as a risk factor for several obstetrical complications such as early pregnancy loss, pre-eclampsia and IUGR. Recently its association with infertility has been underscored in IVF failures; however limited information is available about the relationship of hhcy and subfertility.

To find out the association between unexplained subfertility and hhcy in Pakistani women.

This observational study was conducted in Department of Obstetrics and Gynaecology, Liaquat University Hospital Hyderabad from 1st April 2008 to 31st March 2009. Study group consisted of all those women who were subfertile for more then one year, have body mass index less than 25, regular menstrual cycle, normal pelvic examination findings and no past history of pelvic inflammatory disease. Exclusion criteria was male factor subfertility, endocrine and ovulatory dysfunction and tubal blockage. Evaluation was done by semen analysis, pelvic ultrasound scan, hystero-salpingography and hormonal assays. Fasting serum levels of homocysteine were determined using a fluorescence polarization immunoassay.

In total, 61 subjects were enrolled in the study including 49 subfertile women and 12 healthy women. Among subfertile women, 39 (80%) were suffering from primary subfertility while 10 (20%) were complaining of secondary subfertility. Majority of the subjects were young, house wives and residents of Hyderabad city. Mean serum fasting homocysteine levels were significantly higher in women suffering from unexplained subfertility as compared to controls (12.8+5.1 versus 9.7+1.7, p-value= 0.04).

Hyperhomocysteinemia was observed in women suffering from unexplained subfertility. However large scale clinical studies are required to confirm the association.

Women 35-39 years old have a 2–3 fold higher risk of pregnancy-related death than women in their twenties, and the risk is even more dramatic for women 40 years and older.

The aim of this study was to investigate the association of maternal age with risk of adverse pregnancy and mother outcomes in our setting, Tehran, Iran.

In this retrospective observational hospital-based study, 538 nulliparous women were assessed. The association between maternal age and various pregnancy and neonatal outcomes were reported. Data were extracted from the database of Akbar Abadi hospital in Tehran from 2001-2006 records. Univariate and multiple logistic regression analyses were preformed to investigate the association between maternal age and various relevant outcomes.

Women aged 35 years or older had an increased percentages of gestational hypertension (18.8% vs 9.6%; p=0.02) and diabetes in pregnancy (3.7% vs 1.4%; p=0.08) compared with women younger than 35 years. There were no differences between the two age groups in Apgar score at 1 min, antepartum hemorrhage, preterm labor, PROM, fetal distress, perinatal death, and postpartum hemorrhage.

Advanced maternal age was shown to be independently associated with low birth weight, preterm labor and rate of cesarean delivery.

Polycystic ovary syndrome (PCOS) is a heterogeneous, complex genetic disorder characterized by hyperandrogenemia, hyperinsulinemia, insulin resistance, and chronic anovulation. It is the most common endocrine disorder in women of reproductive age with an enigmatic pathophysiologic and molecular basis. Obesity, hyperandrogenism, and infertility occur frequently in PCOS, which mostly have a genetic predisposition, and are features known to be associated with the development of breast cancer risk.

In present study, frequency of PCOS in patients with premenopausal breast cancer was compared with the frequency in women without breast cancer.

This is a case-control study, which compared PCOS frequency in 166 patients with premenopausal breast cancer and 166 healthy controls with normal mammography in last 6 months.

Eleven patients (6.62%) in case group and 16 patients (9.63%) in control group had polycystic ovary syndrome according to their questionnaire. The difference was not significant (p=0.645).

There was no relationship between frequency of polycystic ovary syndrome and breast cancer in this study. This might be due to the age of patients with breast cancer in this study, which was mostly over 40. It could be significant if the patients were chosen in lower age for showing more effect of genetic than environment. The adjustment or matching of other risk factors could help to find the better results.

Endometriosis is a chronic inflammatory gynecologic disease. Problems associated with endometriosis include dysmenorrhea, dyspareunia, and infertility. While endometriosis does not generally cause complications during pregnancy, endometriosis clearly causes complications before pregnancy.

Cases: 

We report four patients with endometriosis who developed a hemoperitoneum during pregnancy, suggesting that endometriosis may be involved in the development of a hemoperitoneum. The patients were diagnosed with endometriosis during surgery or underwent laparoscopic resection of endometriosis. There were one hemoperitoneum that occurred in the second trimester and one hemoperitoneum occurred in the third trimester. Two hemoperitoneums occurred at the time of vaginal delivery.

A spontaneous hemoperitoneum during pregnancy is a rare and life-threatening condition because of the high maternal and fetal mortality rates. The presence of surgical scar tissue and deep infiltrated endometriotic lesions located under dense adhesions in the cul-de-sac could have been avulsed by uterine contractions and pushing in labor.