International Journal of Reproductive BioMedicine
Volume:9 Issue: 3, Mar 2011

Endometriosis is a common gynecological problem associated with chronic pelvic pain. To evaluate the effectiveness of current hormonal treatments of endometriosis associated pain. Randomized Controlled studies identified from databases of Medline and Cochrane Systemic Review groups were pooled. 7 RCTs were recruited for evaluation in this review. Data from these studies were pooled and meta-analysis was performed in three comparison groups: 1) Progestogen versus GnRHa; 2) Implanon versus Progestogen (injection); 3) Combined oral contraceptive pills versus placebo and progestogen. Response to treatment was measured as a reduction in pain score. Pain improvement was defined as improvement ≥1 at the end of treatment. There was no significant difference between treatment groups of progestogen and GnRHa (RR: 0.036; CI:-0.030-0.102) for relieving endometriosis associated pelvic pain. Long acting progestogen (Implanon) and Mirena are not inferior to GnRHa and depot medroxy progesterone acetate (DMPA) (RR: 0.006; CI:-0.142-0.162). Combined oral contraceptive pills demonstrated effective treatment of relieving endometriosis associated pelvic pain when compared with placebo groups (RR:0.321CI-0.066-0.707). Progestogen was more effective than combined oral contraceptive pills in controlling dysmenorrhea (RR:-0.160; CI:-0.386-0.066), however, progestogen is associated with more side effects like spotting and bloating than the combined contraceptive pills. Combined oral contraceptive pills (COCP), GnRHa and progestogens are equally effective in relieving endometriosis associated pelvic pain. COCP and progestogens are relatively cheap and more suitable for long-term use as compared to GnRHa. Long-term RCT of medicated contraceptive devices like Mirena and Implanon are required to evaluate their long-term effects on relieving the endometriosis associated pelvic pain.

General concern is that the pregnancy rate is higher with GnRH-agonist as a protocol of pituitary suppression. GnRH-antagonist protocol provides a shorter period of administration and an easy flexible protocol. In this study, the outcomes of GnRH agonist and antagonist in ICSI cycles are compared in normo responder patients. In this randomized clinical trial, 300 normoresponders undergoing ICSI were randomly divided to GnRh agonist (n=150) and GnRh antagonist (n=150) groups. The main outcome measurements were chemical, clinical and ongoing pregnancy rates (PR). The mean duration of stimulation were 9.6±1.6 and 8.2±1.6 days in agonist and antagonist groups respectively (p=0.001). The mean number of MII oocyte retrieved in agonist and antagonist groups were 7.7±4.0 and 6.9±4.3 respectively (p=0.03). There was no significant difference between two groups regarding mean number of gonadotrophin ampoules, follicles, occytes, total embryos and good quality embryos, OHSS incidence, and abortion rate. Chemical pregnancy rate was 35.3% in agonist and 39.3% in antagonist group. Clinical pregnancy rate was 35.3% in agonist and 34% in antagonist group. Ongoing pregnancy rate was 45 (31.3%) in agonist and 44 (29.3%) in antagonist group. There was no significant difference between two groups in pregnancy rates. In this study antagonist protocol was shown to be an easy, safe and friendly protocol in Iranian normoresponder patients, having similar outcomes with standard agonist protocol but shorter period of stimulation.

Recent studies have shown that benzene extract of Ocimum sanctum (O. sanctum) leaves induces the ultrastructural changes in the epithelial cells of the cauda epididymis, its subsequent recovery in the seminiferous epithelium and fertility of male albino rats. Our aim was to investigate the effect of benzene extract of O.sanctum leaves on the cauda epididymal sperm parameters, morphology and their organelles at the ultrastructural level in albino rats. Wistar male rats (n=20) were allocated into two groups of control (n=10) and test group (n=10). The test group received benzene extract of O.sanctum leaves (250mg/kg/day) for 48 consequence days. Five animals from each group were used for fertility test. Twenty-four hours after the last dose, the rest of the control (n=5) and treated (n=5) animals were sacrificed by cervical dislocation and then the cauda epididymal plasma was used for sperm analysis, scanning electron microscopy (SEM) and transmission electron microscopic (TEM) studies. Sperm analysis of test group exhibited significant (p≤0.001) decrease in the sperm count, motility, speed and increase in sperm anomalies when compare to control group. SEM and TEM observation in treated animals indicated the morphological changes in plasma membrane as well as in the acrosomal membrane of spermatozoa, formation of a balloon-like cytoplasmic droplet in the mid-region of abnormal tail and disorganization or degeneration of mitochondria of sperm mitochondrial sheaths. The effects observed in this study may have resulted from a general alteration in the cauda epididymal milieu, probably due to androgen deficiency consequent to the anti-androgenic property of O.sanctum leaves.

Adhesion is a common complication of gynecology surgery so different barrier agents and solutions have been used during these operations to separate and protect tissues from adhesion after surgery. Adept is one of these solutions that have been postulated to reduce the chance of adhesion following gynecolgy surgery. To evaluate the effect of 4% icodextrin in reducing adhesion formation in comparing with sterile water and human amniotic fluid in rabbits. In this prospective experimental study 30 white Newzealand female rabbits were selected and randomized in to three treatment groups. The rabbits were anesthetized and an abdominal incison was made, uterine horns were abrated with gauze until bleeding occurred. Before closing the abdomen, the traumatized area was irrigated either by 30cc of sterile water, 30cc of 4% Adept or 30cc of human amniotic fluid. The solutions were labeled only as solutions A (steriel water), B (icodextrin), or C (human amniotic fluid). On the seventh day after surgery, second laparotomy was performed to determine and compare adhesion formation in rabbits. There was significant difference between mean score of adhesions in 4% icodextrin group (2.1±0.70) in comparison to sterile water group (10.4±0.60) and amniotic fluid group (8.7±0.84). But the difference between mean score of adhesions in amniotic fluid group in comparison to sterile water group was not significant (8.7±0.84) versus (10.4±0.60). The use of 4% icodextrin solution was more effective than human amniotic fluid and sterile water in reducing adhesion formation in a gynecological surgery model in rabbits

Follicular fluid (FF) plays an important role in oocytes and embryo development, which may contribute to IVF/ICSI success rate. The aim of this study was to investigate the correlation between cholesteryl ester transfer protein (CETP) level in FF and the success rate of IVF/ICSI. In a cross-sectional study, FF samples, FF samples were obtained from 100 patients referred to Tabriz Alzahra Hospital. Seventy-nine subjects underwent IVF and the remaining 21 underwent ICSI. The levels of high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I and CETP were measured using enzymatic, turbidometric and ELISA methods respectively. Analysis of the subgroups with different levels of CETP showed a significant lower level of CETP in the subgroup with the lowest number of mature oocytes (p<0.05). The level of CETP was also considerably lower (18%, p=0.05) in subjects with<50% oocytes fertilization ratio than subjects with >70% of this ratio. While no association was found for pregnancy, the amount of CETP in FF was associated positively to the maturity and the percentage of oocyte fertilization.

Abnormal uterine bleeding is a common presentation of uterine abnormalities among premenopausal and postmenopausal women. To evaluate and compare the diagnostic accuracy of saline contrast sonohysterography and hysteroscopy for detecting the cause of abnormal uterine bleeding. A total of 65 women with abnormal uterine bleeding were enrolled in this study. A prior saline contrast sonohysetrography followed by a hysteroscopy was performed in all cases. Sensitivity, specificity, positive and negative predictive value and test accuracy were calculated. As the most common abnormality, SCSH showed hyperplasia in 19 patients while hysteroscopy diagnosed polyp in 15 cases. A sensitivity of 73.3%, 71.4% and 90.9% were reported for polyp, hyperplasia and submucous myoma respectively whereas the specificity was calculated 96% for polyps, 82.3% for hyperplasia and 90.7% for submucous myoma. Comparing with hysteroscopy, sonohysterography showed a high sensitivity and specificity for detecting submucous myoma but not for endometrial polyp and endometrial hyperplasia.

The selection of pre-embryos for transferred is based on morphological appearance. But some poor quality cleaved embryos also can be cultured to the blastocyst stage and implanted. To assess the clinical pregnancy outcomes of blastocyst transfer which developed from poor quality embryos. A total of 109 cleaved embryos with poor quality were cultured to day 5/day 6 and 27 (24.8%) blastocysts were collected from the 15 cycles/patients undergoing conventional IVF. All the blastocysts were cooling with fast-freezing. Then the blastocysts were warmed for transfer. All of 25 vitrified blastocysts (92.6%) survived after warming and were transferred to 15 patients. Five of the women became pregnant. Our results suggest that vitrified human day 5/day 6 blastocyst transfer which develop from poor quality embryo at day 3 can contribute to increasing cumulative pregnancy rates in assisted reproduction.

In general, 15% of oocytes collected in ART cycles are immature. These oocytes may be cryopreserved further for use in in-vitro maturation (IVM) program. The aim of this study was to determine maturation capacity, morphometric parameters and morphology of human immature oocytes in both fresh IVM (fIVM) and vitrified-IVM (vIVM) oocytes. 93 women who underwent controlled ovarian stimulation for ART were included. The immature oocytes (n=203) were divided into two groups: the first group (n=101) directly matured in vitro; and the second group (n=102) first vitrified, then matured in vitro. All oocytes underwent IVM in Ham’s F10 supplemented with LH+FSH and human follicular fluid. After 48h of incubation, the oocyte maturation rates, as well as morphometric and morphologic characteristics were assessed using cornus imaging and were compared. Oocyte maturation rates were reduced in vIVM, (40.4%), in comparison with fIVM (59.4%, p<0.001). Following morphometric assessment, there was no difference in the mean oocyte diameters (μm) between fIVM and vIVM, 156.3±6.8 and 154.07±9.9, respectively. Other parameters of perimeters, egg areas, as well as oocyte and ooplasm volumes were similar in two groups. In addition, more morphologic abnormalities, such as, vacuole, and dark oocyte were observed in vIVM oocytes. fIVM was more successful than vIVM groups. No statistical differences were noticed in morphometry assessment in two groups. This suggests that morphometric parameters can not be applied as prognosis factor in oocyte maturation outcome in IVM program.

Hymenocardia acida is traditionally used in African herbal medicine and has numerous therapeutic benefits. But little is known about its potentially negative effects on pregnant women. The aim of the present study was to evaluate the antifertility effect of aqueous ethanolic extract of Hymenocardia acida stem bark in female Wistar rats. Four groups of rats were administered orally aqueous ethanolic extract of Hymenocardia acida at doses of 100, 200 and 400 mg/kg body weight daily for 19 days. The control group received distilled water. On day 20 of gestation, each rat was laparatomised and number of corpora lutea of pregnancy, number of live fetuses as well as the postcoitum fertility index, weights of the foetuses and placentae were determined. Oral administration of the extract from days 1 to 19 of gestation showed reduction (p<0.05) in the number of corpora lutea of pregnancy and number of live fetuses. Weights of fetuses of extract treated female rats were also smaller (p<0.05) compared with the control. Anti-implantation activity of the treatment groups were 41.4%, 48.3% and 51.7% for groups II to IV respectively, whereas antifertility activity of the groups was found to be 40%, 60% and 60% in the same order. The results suggest that aqueous ethanolic extract of Hymenocardia acida stem bark could induce negative effects on reproductive functions in female albino rats.

Polycystic ovarian syndrome (PCOS) is a common disease among women in fertility ages and cause severe insulin resistance. Hyperhomocysteinaemia is said to be among the features of PCOS that could influence its outcome. This study aimed to investigate whether hyperhomocysteinaemia exists in PCOS and if it is related to insulin resistance in the affected patients. This prospective study was carried out in a university based fertility clinic. Sixty four PCOS patients and 50 normo ovulatory controls were reviewed for fasting glucose, insulin, homocysteine, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) plasma levels in the blood sample of the 3rd day of their menstrual cycle. Insulin resistance was determined with the fasting glucose (mmol/L) to insulin (mIU/L) ratio and HOMA-IR (Homeostasis model assessment-Insulin resistance). Independent-samples T-test and linear regression test were utilized to analyze the obtained data. Homocysteine levels compared between PCOS patients and control group showed a significant difference. PCOS group was divided into insulin resistant (IR) (LogHOMA-IR≥0.57) and non insulin resistant (NIR) patients. The IR group had significantly higher homocysteine (p-value=0.02), fasting insulin and glucose levels (p-value<0.001) rather than NIR group. PCOS patients have a leaning toward hyperhomocysteinaemia and insulin resistance. Insulin resistant patients are found to have higher homocysteine level.

Vanadium is an important environmental and industrial pollutant. It has a status of reproductive toxicant and is reported to cross placental barrier. The current study was performed to assess the therapeutic efficacy of Tiron and its combination with selenium against vanadium induced toxicity in lactating and suckling rats. Rats were exposed to vanadium at a dose of 7.5 mg/kg/day (p.o.) for 20 days from 0 day of post partom (p.p.). Tiron (606 mg/kg/day, i.p.) and selenium (0.5 mg/kg/day, p.o.) were administered for 5 days on 21-25 day PP. Vanadium exposure decreased blood sugar level while serum transaminases and serum alkaline phosphatase showed increased values significantly (p<0.01). Elevation in glycogen content of liver and kidney of suckling and kidney of lactating rats was found after toxicant administration. Toxicant intoxication increased the enzymatic activity of acid phosphatase in liver of suckling and lactating and kidney of suckling rats. On the contrary alkaline phosphatase and adenosine triphosphatase activities were inhibited significantly (p<0.01) in all the organs. Lipid peroxidation was enhanced whereas glutathione was reduced significantly in liver of suckling and lactating rats (p<0.01). Vanadium also caused histopathological lesions. Therapies of Tiron per se and Tiron along with selenium maintained almost all blood and tissue biochemical parameters towards normal. Tiron along with selenium reduced vanadium induced lesions in lactating and sucklings rats. Tiron along with selenium is more effective than Tiron alone against vanadium induced toxic effect on lactating and suckling rats.

Pregnancy rate with IVF cycle is almost 22%. Many investigations perform to increase this rate in IVF. Various factors affect the result of IVF cycles. One of these factors could be uterine contractions that expel transferred embryo. Ritodrine is a beta mimetic agent that can block and decrease uterine contractions. The objective of this study was to determine ritodrine effectiveness for increasing the implantation rate in IVF cycles, and its probable mechanisms in decreasing uterine contractions as well. A total of 100 patients of IVF-ET cycles were divided randomly in two groups in a university hospital, Hamadan, Iran. The case group were prescribed ritodrine 10 mg / bid orally after oocyte retrieval until 10 days. The control group didn’t received ridotrine. In ritodrine group 14% of patients and in control group 16% had positive β-hCG test (p-value>0.5). Ritodrine did not improve the implantation rate in IVF-ET cycles.

Uterine myomas are common pelvic masses during pregnancy. The pain and rapid growth of myomas are among the most common complications during pregnancy. We evaluate management of painful cystic degeneration of myomas during pregnancy.Case: A 27-year-old primigravida had a pelvic mass. We have managed a case in which the diagnosis of cystic degeneration of uterine myomas could not be easily differentiated from an ovarian torsion or carcinoma. Differentiation between degenerative pain of the myoma and an ovarian malignancy or torsion was necessary. A complete aspiration of the cystic changes of the uterine myoma was performed without performing a myomectomy. We report a good result of aspiration of a cystic uterine myoma during pregnancy with a review of the literature published for twenty years since 1 January 1988.

Tubo-ovarian abscess as a serious complication of pelvic inflammatory disease is very uncommon in sexually inactive girls.Case: We report a case of tubo-ovarian abscess in a 24-year-old sexually inactive girl with transverse vaginal septum who was presented with abdominal pain and a pelvic mass and without prior surgical history and no evidences of appendicitis, inflammatory bowel disease, or cancer. A huge unilateral tubo-ovarian abscess was recognized at laparotomy. Unilateral salpingoophorectomy, hysterectomy and postoperative antibiotic therapy cured the patient. Early diagnosis and treatment are essential to prevent further sequel including infertility, ectopic pregnancy, and chronic pelvic pain which cause morbidity.