Journal of Family and Reproductive Health
Volume:1 Issue: 1, Mar 2007

Although pregnancy was once thought to protect against psychiatric disorders, gravid and non gravid women have similar risks for major depression, at 10% to 15%. Both depression and antidepressant treatment during pregnancy have been associated with risks. Few medications have been proved unequivocally safe during pregnancy. Although certain antidepressants have not been linked with an increased risk of birth defects or impaired development including bupropion, citalopram, escitalopram and venlafaxine, the latest studies arent necessarily reassuring. As researchers continue to learn more about antidepressants, the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis. This review discusses about the use of new generation of antidepressants in pregnancy

This study aimed to determine prevalence and predisposing factors of psychiatric disorders among infertile in comparison to fertile women. By a descriptive- analytic study in Vali-e-asr Reproductive Health Research Center, 300 women entered the research. Symptom Checklist -90 -Revised (SCL-90-R) test and structured researcher questionnaires were applied for all patients. Demographic characteristics and predisposing psychological and personality factors were recorded and psychological symptoms were scaled. For data analysis, SPSS-11-5 software system, chi-square and T-test were used. P-value <0.05 was considered significant. Results showed that 44% of infertile and 28.7% of fertile women had psychiatric disorders. Using SCL-90-R test, the highest mean scores among infertile women were found for paranoid ideation, depression and interpersonal sensitivity scales and the lowest scores were related to psychoticism and phobic anxiety scales. Interpersonal sensitivity, depression, phobic anxiety, paranoid ideas and psychoticism scales were significantly different between infertile and fertile women (p<0.05). Housewives were at a statistically significant higher risk for psychiatric disorders as compared to working women (p<0.001). The significantly higher prevalence of psychiatric disorders among infertile women mandates a more serious attention from gynecologists, psychiatrists and psychologists regarding to diagnosis and treatment of these disorders.

The study evaluated the efficacy and safety of vaginal progesterone on prevention of recurrent preterm labor. Total number of 70 patients with preterm labor treated with intravenous magnesium sulfate in perinatology department of valiasr hospital entered to a randomized clinical trial. Treatment group after inhibition of preterm labor with magnesium sulfate received progesterone suppository (400 mg) daily until delivery and control group received no treatment. Latency until delivery, recurrence of preterm labor and neonatal outcomes were studied. Statistical significance was defined as p< 0.05. Mean latency until delivery (p< 0.05), low birth weight (p< 0.05), birth weight (p< 0.01) were significantly different between the two groups. Recurrence of preterm labor was not significantly different between the groups. The use of vaginal progesterone suppository after successful parenteral tocolysis associated with a longer latency preceding delivery but failed to reduce the incidence of recurrent preterm labor

This study determined the chromosomal constitution of recurrent spontaneous abortions by Comparative genomic hybridization (CGH) analysis of fetal samples. Forty pregnant women with early recurrent pregnancy losses aged 21 to 42 years old from Tehran University of Medical Sciences affiliated hospitals entered in this descriptive study. Hibridization analysis of fetal samples whose standard karyotyping were not possible due to poor sample quality was performed. Number of successful chromosome analysis using CGH comparing with all samples analyzed was determined. CGH was able to determine the chromosomal constitution of all samples. Overall, CGH detected chromosomal abnormalities including trisomies and monosomies in 18 samples (46%). CGH can be used to reveal the chromosomal constitution of fetal samples when the sample quality does not permit an accurate chromosome analysis. CGH can also play a role as a complementary method, to the traditional cytogenetic techniques used in the investigation of recurrent spontaneous abortions.

This study aimed to evaluate the correlation between plasma lipid levels at first trimester of pregnancy and results of Oral Glucose Challenge Test (OGCT). In a cross - sectional descriptive analytic study, two hundred eligible primigravida women without history of Diabetes Mellitus referring to Vali-e-Asr Hospital were evaluated. Plasma levels of triglyceride and cholesterol were measured at first trimester of pregnancy and Oral Glucose Challenge Test was done for all women at 24th - 28th gestational week. Pre-pregnancy BMI, and plasma levels of triglyceride and cholesterol at first trimester of pregnancy were compared with the results of OGCT.Results were analyzed using SPSS version 14. p-values ≤ 0.05 was considered statistically significant. In 45 (22.5%) of the women OGCT was positive. Pre pregnancy BMI and the rate of positive result for OGCT were both correlated with the plasma levels of triglyceride and cholesterol at first trimester of pregnancy. Plasma lipid levels in first trimester can predict the result of OGCT at 24- 28 weeks of pregnancy.

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.

This study investigated the effect of body mass index (BMI) on the success rate of IVF for couples with different causes of infertility. In a cross sectional descriptive- analytic study conducted simultaneously in Mehr IVF center and Vali-e-Asr Reproductive Health Research Center, the success rate of IVF was examined in 396 consecutive women undergoing IVF cycles. Clinical pregnancy rate per first cycle of IVF was evaluated with regard to BMI. SPSS 11 software was used for statistical analyses. Significance level was identified as P< 0.05 in data analysis. Women with a BMI of 27 kg/m2 had a significantly lower pregnancy rate compared with normal weight women (BMI 20 and <27 kg/m2), OR = 0.67 (95% CI 0.48-0.94).For male infertility the rate of pregnancy per cycle was significantly lower than unexplained infertility, OR = 0.70 (95% CI 0.57-0.86.) For tubal pathology the rate was slightly lower than unexplained infertility, OR = 0.86 (95% CI 0.70-1.01). Overweight unfavorably affects the pregnancy rate after IVF. Infertile couples may improve the outcome of IVF treatment by lifestyle changes.

Seeking for fertility after previous vasectomy is increasing. Vasectomy may break the blood testis barrier and in this way the level of antisperm antibody increases. It is suggested that increase in antisperm antibody decreases spontaneous pregnancy even after successful vasovasostomy. In this study we evaluated antisperm antibody formation 3 months after vasectomy. This study was performed on 80 healthy men requesting vasectomy from eurology ward of Imam Khomeini hospital. Blood antisperm antibody was checked at the time of vasectomy and 3 months later, when they came to assure vasectomy results, using Kibrick and sensitized RBCs. Only 2 patients had antisperm antibody before surgery. Three months after vasectomy 56.49% of the patients had antisperm antibody in Kibrick Method, and 53.56% of them had antisperm antibody in sensitized RBCs. Vasectomy increases antisperm antibody level. We suggest evaluation of antisperm antibody before vasovasostomy to estimate the risk of infertility after successful procedure.

Volvulus of the small bowel, although being rare, carries a high risk of strangulation and ischemic necrosis. Preoperative diagnosis is difficult and may be complicated by pregnancy, labor and the post-cesarean-section state. Delay in diagnosis and surgical intervention increases morbidity and mortality rates.We present a 20- year- old primigravida woman (GA=10 weeks) with massive intestinal necrosis. Her initial symptoms were abdominal pain and nausea. Her complaints were attributed to pregnancy and she came with acute surgical abdomen. Emergent laparotomy was performed. Gangrenous, distended loops of small intestine passed through a defect in the mesentery were resected. Primary end to end anastomosis of jejunum and ileum was done and the defect causing volvulus was repaired. It is concluded that surgical acute abdomen must be considered in differential diagnosis of abdominal discomfort in pregnancy. In the case of small bowel volvulus early surgery is mandatory to reduce the risk of gangrene, which is known as doubling the mortality rate.