Journal of Family and Reproductive Health
Volume:2 Issue: 2, Jun 2008

Female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Age related infertility is due to oocyte abnormalities and decreased ovarian reserve. Treatment of infertility when the cause is limited to decreased ovarian reserve is empirical at present except for oocyte donation. This mini review of the literature covers all available English biomedical journals that have been published from 1995 to 2008. The search based on combination of the words age, fertility, infertility, and oocyte abnormalities. The important findings from this search strategy are summarized and presented in the sub headings including female age and fertility, miscarriage and in vitro fertilization. Regarding infertility prevention, this mini review suggested that early marriage is a primordial, effective, inexpensive and easy way to prevent infertility.

The abdominal sacrocolpopexy is the standard method of vaginal prolapse correction and posterior intravaginal slingplasty (PIVS) is a newer procedure with minimal invasiveness. This study compares the effectiveness and complications of these two surgical methods. In this non randomized clinical trial study, which was conducted in Imam Khomeini Hospital, Tehran, 51 patients with severe uterovaginal or vaginal vault prolapse were evaluated. From 2001 to 2004 twenty six patients were operated by PIVS method and sacrocolpopexy was performed for the remainders. Data were primarily gathered from patient's folders and further information was achieved by two years follow-up and inviting patients to interview or exam. Eighty percent of women with abdominal sacrocolpopexy were cured compared to 96.2 percent with PIVS. Short-term surgical complications like hemorrhage, perforation, fever and abdominal distention were positive just in 36% of sacrocolpopexy group (p=0.001). Long- term complications like tape or mesh dysfunction were seen in 8% of PIVS group while none of sacrocolpopexy patients presented these complications. According to shorter operating time, lower complications and efficient response to therapy in PIVS method, it can be an alternative procedure for prolapse surgeries. It is preferred in elderly patients with medical problems.

The aim of this study was to determine the associates of marital relationship in mustard exposed veterans. Two hundred ninety two married Iranian mustard exposed veterans, who had been exposed to single high dose mustard gas in Iraq-Iran war, were assessed for marital adjustment with Revised Dyadic Adjustment Scale (RDAS). Census sampling was done. The patient's quality of life (SF-36), spirometric measures and war related data were also extracted. A total of 189 subjects (65%) completed our study. The mean (±SD) of the RDAS Total score, RDAS Dyadic Consensus, RDAS Affectional Expression, RDAS Dyadic Satisfaction, and RDAS Dyadic Cohesion were 50.61 (8.16), 16.67 (2.77), 7.62 (1.84), 14.76 (3.39), and 11.54 (3.79), respectively. RDAS Dyadic satisfaction was correlated with SF-36 and all its sub-scores (p<0.05). RDAS total score showed significant correlation with SF-36 total score and most of its sub-scores (p<0.05). RDAS affective expression was significantly correlated with role limitation, social function, general mental health, vitality, General health perceptions, physical composite score (PCS) and mental composite score (MCS) (p<0.05). RDAS dyadic consensus was not correlated with any SF-36 sub-scores. Veterans health team including physicians, psychologists and/or psychiatrists should know that poorer marital satisfaction is linked with lower quality of life scores, late after mustard exposure, although marital relationship is independent of spirometric findings, age, duration from exposure and comorbidity score.

To evaluate the prevalence of gestational diabetes mellitus (GDM) and its risk factors in Tehran. From March 2002 to October 2004, screening for GDM was performed on 1804 women in Tehran. All pregnant women were referred for a 50 g oral glucose challenge test (OGCT) between 24th and 28th week of gestation. All subjects with an abnormal GCT (blood glucose level ≥130 mg/dl) underwent an oral glucose tolerance test (OGTT) within 1 week after the abnormal screening test. The prevalence of GDM was estimated. The glucose challenge test was positive in 38.1% of cases. The prevalence of GDM for the whole cohort was 6.8%. About 78.6% of our population were at medium or high risk for GDM and, therefore, would have been screened. The rate of GDM was significantly higher in women with a positive family history of diabetes, positive history of GDM, older age, multiparity, pre-pregnancy obesity, greater weight gain during pregnancy, history of infertility, chronic hypertension, history of stillbirth pregnancies and abortion. After logistic regression analysis, GDM diagnosis was significantly correlated with age (P<0.001), pre-pregnancy BMI (P=0.005), family history of diabetes (P<0.001), history of GDM (P=0. 002), chronic hypertension (P<0.001) and glucosuria during current pregnancy (P<0.001). In populations with medium/high risks for GDM (like the Iranian) universal screening is recommended to identify women with diabetes mellitus.

Zinc deficiency is an important health problem in developing countries. The aim of this study was diagnosis of zinc deficiency among young female students of Tehran University of Medical Sciences. This cross sectional study evaluated 420 medical and paramedical students of Tehran University in 2005. All of them were female and in the first year of their education. Serum concentrations of zinc were measured by enzymatic method students in whom had sufficient criteria to enroll in the study. Zinc concentration more than 85 µ/dl was considered as normal value. Concentration less than 50 µ/dl was defined as severe zinc deficiency. Mild and moderate deficiencies were described as zinc levels between 50 to 85 µ/dl. Analysis was performed by t-test, chi-square and ANOVA using SPSS software. Zinc deficiency was found in 7.1% of the participants. In women with body weights between 50.1-60 kg, zinc deficiency was less than patients with body weight of ≤ 50 Kg (p=0.04). In zinc deficient group acne was observed more frequently (p=0.01). Also anemic participants (Hb<12) had lower zinc level than non anemic women (Hb≥12) (p=0.001). This study found severe and mild to moderate zinc deficiency in 1.4% and 5.7% of female students, respectively. Zinc deficiency is common in anemic students. Zinc supplementation is recommended in anemic patients and in cases of confirmed zinc deficiency.

To compare the efficacy of ceftriaxone plus Ofloxacin or Azithromycin for cases of pelvic inflammatory disease (PID). This clinical terial was performed on 180 women with PID from March 2005 to March 2007 in Parastarane-Shahed Hospital. Patients with PID were randomly divided to receive injection of Ceftriaxone 250 mg plus Ofloxacin 200 mg per day or Azithromycin 1 g per week for two weeks (90 cases in each group). The degree of pain was assessed on days 7, 14, 30 and clinical cure was assessed on days 14 and 30. Statistical analysis was done based on Fisher exact test, Mann-Whitny and student t-test. From 180 patients eligible for the study, 138 cases were enrolled for protocol analysis. Significant differences were observed regarding the degree of pain between two groups. Clinical cure was 90% (70 of 78) for Azithromycin and 83.3% (50 of 60) for Ofloxacin. Combination of Ceftriaxone plus weekly Azithromycin for two weeks is not only equivalent to Ceftriaxone plus daily Ofloxacin for two weeks but also seems to be better for the treatment of mild PID.

The study evaluated the efficacy of oral calcium carbonate supplement on leg pain in pregnancy and nursing period. A total number of 176 women at third trimester of pregnancy or nursing period till to one year after delivery with complaint of leg pain, low back pain (LBP), and posterior pelvic pain (PPP) were evaluated for distinct primary causes and were excluded, then 58 patients randomized into calcium group (n=27) treated with 500 mg calcium carbonate orally per day just for one week, and control group (n=31) received no drug. Incidence of days with leg, low back, and posterior pelvic pain per week were evaluated and compared between the two groups at 3 different weeks before, during, and after discontinuation of drug. Statistical significance was defined as P<0.05. Mean number of days with leg pain per week during calcium carbonate intake was significantly different between the study and control groups (P<0.05). Mean number of days with LBP and PPP was not significantly different between two groups. The use of oral calcium supplement was associated with lower episodes of leg pain but failed to reduce the incidence of LBP and PPP in pregnancy and nursery period.

This research was designed to compare the effectiveness of intramuscular progesterone and vaginal progesterone to support luteal phase in IVF cycles. In this randomized clinical trial 182 infertile patients between 20-40 years old were selected for rapid ZIFT cycles. In order to support luteal phase Cyclogest suppository (400 mg BID) was used for 77 cases and the rest used intramuscular progesterone (100 mg daily). Pregnancy and abortion rates were compared between two groups. Chemical pregnancy rate (positive ß-HCG) was %27.3 in Cyclogest group and %30.6 in intramuscular progestrone group (P = 0.7). Clinical pregnancy (gestational sac visible by transvaginal ultrasound) was observed in %22.1 of cases in Cyclogest group and %27.1 of cases in intramuscular progestrone group (P = 0.4). Ongoing pregnancy rate (fetal heart action visible by transvaginal ultrasound) was %15.6 in Cyclogest group and %18.8 in intramuscular progesterone group (P = 0.6). Chemical pregnancy, clinical pregnancy and ongoing pregnancy rates were similar in vaginal and intramuscular progestrone groups.

This study aimed to compare newborns anthropometric indices of housewives and employed women. This case control study compared newborns’ anthropometric indices (weight, length, head circumference) and first minute APGAR between working women and housewives. Two hundred consecutive term pregnant women during active phase of labor without any pregnancy complications were evaluated. For each participant a questionnaire was filled by the researcher. Employed women according to their standing position during work time were divided into three groups: heavy, light and moderate jobs. The mean weight, length and head circumference of the newborns were higher in employed women (p=0.018, p<0.001, p=0.010, respectively). After eliminating effect of the interfering variables by using a general linear model, it was observed that the mother’s job has a direct influence on newborn's length and head circumference. But infant's weight was similar in two groups (p=0.340). The newborn's anthropometric indices and first minute APGAR had not significant difference in subgroups of job difficulty. Maternal job has a direct positive influence on newborn's length and head circumference. But infant's weight is not related to maternal job.

Endometriosis is described as the presence of functioning endometrial tissue (glands and stroma) outside the uterine cavity. The most common location is within the pelvis. However, extra pelvic endometriosis is a fairly uncommon disorder and difficult to diagnose. It can sometimes occur in a surgical scar. Scar endometriosis is a rare condition and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. It presents as a painful, slowly growing mass in or near a surgical scar. We report two cases of abdominal wall endometriosis following hysterotomy and cesarean section. Consequently the pathogenesis, diagnosis and treatment are discussed.