Journal of Family and Reproductive Health
Volume:2 Issue: 1, Mar 2008

The capability to preserve human oocytes, blastocysts, ovarian tissue and spermatozoa is an important tool in human assisted reproductive techniques. This preservation allows patients undergoing chemotherapy or radiotherapy to preserve their fertility, and helps to attain all benefits from the costly ovarian superovulation therapies prior to ART. The primary goal in establishing an appropriate freezing protocol is to do as little damage as possible while exposing specimens to nonphysiologic ultra low temperatures. Nowadays two techniques are used in cryopreservation: the slow cooling method and the more recent rapid procedure of vitrification. Vitrification is simple, requires no expensive programmable freezing equipment, efficient and cost effective way to improve cumulative pregnancy rates per cycle. Oocytes, blastocysts, ovarian tissue and spermatozoa could be suitable for vitrification and thus cryopreservation. Vitrification proved to be the future of cryopreservation and important progresses are achieved everyday in this active domain in a trial to set the optimal protocol for cryopreservation of different types of gametes, embryos and tissue.

Urogynecologists are constantly looking for simple, safe and effective ways to cure vaginal apex prolapse. The aim of this study was to evaluate the results of posterior intravaginal slingplasty (PIVS). A total of 38 patients with advanced vaginal apical prolapse underwent posterior intravaginal slingplasty in Vali-e-Asr hospital in Tehran. In this clinical trial (before-after study), demographic, pre-operative, operative details and post-operative follow-up data were collected for all patients. The data were analyzed using SPSS software and Mac Nemar test. P<0.05 was considered for statistical significance. The mean for patient's age was 67 (50-81) years, for operation time was 35 (25-45) minutes and for blood loss was 125 (70-300) ml. No intraoperative rectal perforation was observed and there was a significant difference in patient's symptoms such as pelvic pain, nocturia, urgency and urinary tract infection before and after the surgery (p < 0.001). PIVS had similar efficacy with other studies in the treatment of vaginal vault prolapse. The procedure reduces the complication rate and shortens the rehabilitation period with a satisfying result.

The study aimed to evaluate the effectiveness of laparoscopic ovarian drilling (LOD) on ovulation and restoration of menstrual cycles and pregnancy. This cross sectional study was conducted on 81 consecutive Polycystic Ovarian Syndrome (PCO) patients whom were referred to Avesina Infertility clinic during 2003-2006. Exclusion criteria were tubal and male factor infertility, hyperprolactinemia, thyroid disease and diabetes mellitus. Patients with the age range of 20-35, body mass index of less than 35 kg/m2, failure to ovulate during at least three cycles of Clomiphene Citrate (CC) consumption and more than 12 months of ovulatory factor infertility entered the study. Metformin was used for at least 8 weeks in combination with CC. Forty four PCO women who had not ovulated after medical therapy with combination of CC and Metformin were selected for LOD. The data was analyzed with SPSS software using t- test and logistic regression analysis. P<0.05 was considered statistically significant. Patients aged 28.9±2.3 years with infertility duration of 4.8±2.3years and BMI of 28±3.3 kg/m2. Effectiveness of medical therapy significantly was related to BMI (P<0.001). After LOD, ovulation occurred in 14 cases (31.8%), restoration of menstrual cycle in 18 women (40.9%), and spontaneous pregnancy in 5 cases (11.3%). LOD is a good method for restoration of ovulatory cycles in anovulatory PCOS women who were resistant to the combination of CC and Metformin. LOD may avoid or reduce the need to gonadotropins for ovulation induction.

The objective of this research was to study the sexual perception and practices among people aged 45 years and above and the associated socio-demographic factors. A cross sectional study was done on 473 middle aged and elderly people living in Klang Valley in 2005. They were married and literate. Data were collected by means of face to face interview using structured questionnaires and were analyzed using SPSS software. Logistic regression was used and p<0.05 was considered for statistical significance. The mean age of the respondents was 54.36 ± 7.91 years and majority of them were in age group of 50-59yrs (41.25%) and 53.5 % were male. The ethnic distribution was 50.1% Malay, 23.3% Chinese and 26.6% Indians. Most of them (61 %) reported that they were healthy as compared to 39% who suffered at least from a major medical problem. Only 17.1% of respondents admitted that they had sexual problems and out of these 32% sought various types of treatment. There was a significant difference between satisfaction with sexual intercourse and gender, ethnicity, age, who initiated the sexual intercourse and presence of sexual problem. The findings indicate that older people present as wide a variety of sexual problem areas as younger individuals. Accurate information about sexuality in later life will enable professionals to better provide a desirable environment.

This study aimed to assess the value of Chlamydia trachomatis (C.trachomatis) antibody titer test in prediction of tubal damage. In this case-control study we enrolled 50 women with tubal factor infertility (proven by laparoscopy after hysterosalpingography) and 110 women without infertility history. ELISA was performed for all participants, seeking C.trachomatis IgG antibodies. ELISA for IgM was then performed for women with positive test. Statistical package for social science version 11 was used for data entry. Statistical evaluation was performed using student t test, Fisher exact and chi-square tests. Statistical significance was defi ned as P<0.05. In 8(5%) of all women the C.trachomatis IgG antibody was positive. Five (10%) of the infertile patients and 3 (2.7%) of pregnant women had positive tests (P < 0.03). All of them had negative results for IgM antibodies. Twenty five percent of women with normal hysterosalpingography and 5.3% of women with abnormal hysterosalpingography had positive antibody test. There was not any correlation between antibody titer and abnormal HSG. Endometriosis was diagnosed in seven women with negative antibody results. The result of C.trachomatis antibody titer was significantly different in women with and without infertility Laparoscopic. Tubal assessment is recommended in infertile women with a positive result of the C. trachomatis antibody titer.

To investigate the hematologic indices of mothers in non-immune hydrops fetalis pregnancies and identify the possible causative role of Alpha-Thalassemia among them. From 2005 to 2007, 11386 hydrops fetalis casesin three major obstetric hospitals affiliated to Tehran University of Medical Sciences were recorded. Indirect coombs test and hematologic indices of maternal samples were assessed. Among 11386 deliveries, 67 hydrops fetalis cases were detected. Forty-one (62%) cases were immune type and 26 (38%) cases were non-immune hydrops. All the mothers had MCV more than 80 fl and 25 mothers had MCH more than 27 pg, so none of them had Alpha-Thalassemia carrier criteria. Alpha- Thalassemia is not the major cause of hydrops fetalis in this study and cost-effectiveness of population scaled biochemical and/or molecular screening programs of α-globin gene mutations in Tehran population is under question.

The aim of this study was to assess the accuracy of ovarian reserve tests, mainly basal and clomiphene stimulated follicle stimulating hormone (FSH) concentrations. A prospective cohort study was conducted on 120 infertile patients referring to Mirza Koochak Khan Hospital for IVF from 2004 to 2006. All the patients underwent clomiphene citrate challenge test (CCCT) and then in vitro fertilization (IVF) was performed. We evaluated predictive power of CCCT to find IVF outcome in women with decreased ovarian reserve in comparison to those who have appropriate ovarian reserve. SPSS 12 was used to analyze the data of this study via student t test, Fisher exact, Chi -square tests and logistic regression analysis. IVF success rate was 11.7% and CCCT sensitivity and specificity were 30.2% and 92.9% while its positive and negative predictive values were 14.9% and 97% respectively. CCCT is a good test in estimating ovarian reserve. Due to its high negative predictive value, lower chance of pregnancy is expected in the cases with abnormal results.

This study was performed to determine the level of satisfaction among women attending the prenatal clinics in the city of Zanjan, Iran. This descriptive cross-sectional study was performed from 2005 to 2006 in Zanjan. A total of 701 pregnant women with gestational age of 20 weeks or more who had undergone at least two prenatal visits in prenatal care centers were enrolled into the study. A questionnaire was filled by face to face interview with each mother including questions about the general physical environment of the clinic, whether the pregnancy was solicited, the communication skills of the personnel, the quality, feasibility and cost of prenatal care, as well as questions pertaining to demography and type of insurance. Data were entered into SPSS 11 software and subsequently analyzed using descriptive statistical tests including ANOVA. Mean age of mothers was 26.23 ± 5.6 years. Among them 55.8%, 37.3% and 6.9% had up to primary, secondary, and high school level of education, respectively. Overall satisfaction rate was more than 99% in all aspects and dissatisfaction was mainly related to type of insurance. The dissatisfaction was also related to the trainings given in health center. Women with private insurance (free and military) showed the least dissatisfaction while the highest dissatisfaction was in women with social security or health services insurance. Overall dissatisfaction rate was 1%. The dissatisfaction was related to the type of insurance. The dissatisfaction was also related to the level of the trainings given in health center.

To assess follicular development and endometrial growth using transvaginal sonography in spontaneous and clomiphene citrate induced (CC) cycles. One hundred consecutive couples with unexplained infertility were recruited for this cross sectional study from 2003 to 2005. Patients were monitored for the first cycle with no medication while the laboratory routine test results were being prepared. Clomiphene citrate (150 mg) was administered on days 5 to 9 of cycle in 60 women. The pattern of the follicular development and endometrial growth was evaluated between clomiphene citrate-induced cycles and spontaneous cycles. SPSS software and student t test were used for analyzing the results. P value less than 0.05 was considered for statistical significance. The patterns of follicular development and endometrial growth were similar in both study cycles. Clomiphene citrate-induced cycles did not show different follicular and endometrial growth patterns compared with spontaneous cycles, so this must be regarded in treatment decision making.

Adenocarcinoma in situ is one of the premalignant lesions of the cervix and its incidence is believed to be increasing while the pathogenesis of the disease is not clearly understood. Management of Adenocarcinoma in situ (AIS) unlike carcinoma in situ (CIS) has not been clearly described in the current literature. Here we describe conservative management and serial colposcopy of two pregnant women with adenocarcinoma in situ of the cervix. Both of the cases were diagnosed initially with abnormal Pap smears and were confirmed by colposcopic directed biopsy. None of the patients agreed with any invasive procedure during pregnancy and both of them were followed with serial colposcopy. None of the lesions showed any evidence of progression. All cases underwent cold knife cone biopsies in their postpartum period. Hysterectomy as the final treatment has been done in both cases with no evidence of progression of the disease during pregnancy. We concluded that adenocarcinoma in situ of the cervix during pregnancy could be managed conservatively with definite treatment postponed till after delivery.