Showing papers in "Iranian Journal of Reproductive Medicine in 2010"

Incidence of gestational diabetes mellitus in pregnant women

Abstract: Background: Gestational Diabetes Mellitus (GDM) is the most common metabolic complications of pregnancy and causes fetal mortality and morbidity. Therefore early diagnosis of GDM is necessary to reduce maternal and fetal morbidity and to help prevent or delay the onset of type 2 diabetes Objective: This prospective study was carried out to determine the incidence of GDM in Yazd and to assess the effect of various contributing factors. Materials and Methods: One thousand and seventy one pregnant women were screened for GDM at 24-28 weeks. Initial screening was done by a glucose challenge test with 50 g glucose. If the 1-hour blood glucose level exceeded 130 mg/dl then a 3-hour oral glucose tolerance test (OGTT) with 100g glucose was performed and diagnosis was established according to American Diabetes Association criteria. Results: Three hundred and forty two (31.9%) women had an abnormal screening test and proceeded to oral glucose tolerance testing. The overall incidence of GDM was 10.2% (n=110). Seventy six of subjects (7.1%) have one abnormal OGTT. There was a significant association between incidence of GDM and age familial history of diabetes BMI before pregnancy parity history of GDM macrosomic baby still birth during previous pregnancies and systolic and diastolic blood pressure. Conclusion: According to high incidence of GDM in our area we recommend screening for GDM in all pregnant women and modification of contributing factors in high risk women.

Prevalence of anemia risk factors in pregnant women in Kerman, Iran

Abstract: Background: Anemia in pregnancy is associated with increased rates of maternal and perinatal mortality. Objective: To study the prevalence and risk factors of women with anemia during pregnancy in Kerman, Iran. Materials and Methods: 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. Results: 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). Conclusion: 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.

Seminal plasma levels of copper and its relationship with seminal parameters

Abstract: Background: 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. Objective: 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. Materials and Methods: 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. Results: 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. Conclusion: It was suggested that excess copper in seminal plasma was detrimental for male reproductive capacity by reducing sperm count, motility, vitality and morphology.

The effects of diazinon on pituitary-gonad axis and ovarian histological changes in rats

Abstract: Background: Diazinon is a widely used Organophosphate insecticide, which is applied against plant pests This compound has various side effects because it acts as an acetyl cholinesterase enzyme inhibitor Objective: The aim of present study was to investigate the effects of diazinon on pituitary–gonad axis and ovarian histological changes in rats Materials and Methods: In total, 50 female wistar rats were divided into 5 groups of 10, including control, sham and experimental groups I, II and III which orally received 50, 100 and 150 mg/kg/bw diazinon for 14 days respectively Diazinon was administered orally, and 24 hours after the last treatment, blood samples were taken from the heart, centrifuged and sera were evaluated for the concentrations of estrogen, progesterone and gonadotropins via RIA method In addition, ovaries were removed, fixed and studied with steriological methods Results: The results show no significant changes in body weight among various groups; while, ovarian weight in experimental group III decreased significantly (p<005) Also, no significant changes in the levels of LH, FSH and estradiol hormones were observed In contrast, the concentration of progesterone showed a significant decrease in all experimental groups compared with the control group The results showed no significance difference in the mean number of primary, secondary and graffian follicles but there was a significant decline in the mean number of corpus luteum in experimental group receiving 150 mg/kg diazinon (p<005 ) Conclusion: One can conclude that oral administration of diazinon could have adverse effect on progesterone hormone level as well as hazardous effects on ovarian tissues and reproductive processes

Symptoms of natural menopause among iranian women living in tehran, iran

Abstract: Background: Menopause is a step of a woman’s life when hormonal changes cause menstruation to stop permanently. Menopausal symptoms can affect women's health and differ between different races and societies. Objective: The aim of this study was to survey the symptoms associated with menopause among Iranian women living in Tehran, Iran. Materials and Methods: In this cross sectional study which has been done between 2004 and 2005, women aged equal or more than 35 years old living in districts of Tehran were selected by multistage randomized cluster sampling. For each woman a questionnaire was completed. The data gained from each questionnaire was analyzed by using SPSS version 13. Results: At time of study, 2462 women were naturally menopause. The mean age of natural menopause onset was 47.71 (SE=0.11) years. In 52.9% of cases, the onset of menopause was sudden. The symptoms associated with menopause were night sweats (61.2%), joint and muscle pain (59.9%), hot flashes (53.1%), fatigue (45.6%), decreased libido (33.9%), insomnia (33.7%), weight gain (30.1%), forgetfulness (24.9%) and urinary symptoms (17.4%). Conclusion: This study showed that night sweats, joint and muscle pain and hot flashes are the most common symptoms associated with menopause.

Effects of cryopreservation on plasma membrane glycoconjugates of human spermatozoa

Abstract: Background: ‍ryopreservation has some detrimental impacts on sperms surface molecules. Modification of the sperm surface molecules can affect on fertility rate. One of the important surface molecules are glycoconjugates. Objective: The objective of this study was to evaluate the changes of content of the glycocalyx after standard cryopreservation procedure. Materials and Methods: Forty five healthy semen samples were frozen in 0.5ml plastic straws and kept in liquid nitrogen and thaw after 48 hours. Sperm smears were prepared before and after freezing and thawing. The smears were stained with the lectins and also with acridin orange. The smears were studied by fluorescents microscopy and the intensities of the reactions to lectins were measured by image analyses software. Results: The reactions of the sperm samples to Peanut agglutinin (PNA), Wheat germ agglutinin (WGA) and Dolichos biflorus (DBA) changed after cryopreservation and the percentage of samples that showed modifications were 46.67%, 34.09% and 73.34%, respectively. The crypreservation led to both increase and decrease the intensities of the reactions. It means that there are various mechanisms that impact on the carbohydrate contents of the sperm surface. There is no correlation between DNA denaturation of sperms and their lectin binding patterns. Conclusion: Cryopreservation affected the surface glycoconjugates at least in a subset of spermatozoa. These results might cause to modify the future application of sperm banking techniques.

Effects of vitamin E on ovarian tissue of rats following treatment with p-nonylphenol: A stereological study

Abstract: Background: Para-Nonylphenol (p-NP) is one of the environmental pollutants which cause reproductive system disorders. Objective: The effects of vitamin E on ovary structure during its development in rats treated with p-NP. Materials and Methods: 32 Wistar female rats after mating were divided into 4 groups; control, vitamin E (100mg/kg/day), p-NP (250mg/kg/day) and p-NP + vitamin E. The rats were treated from the day 7 of pregnancy till 21 st day of postnatal through sucking period. After weaning, the female pups were treated by gavages for 120 days. The total volume of ovary, number of follicles, volume of oocyte, follicular cells and their nuclei and the thickness of zona pellucida were estimated stereologically. The results were analyzed using one way ANOVA and p<0.05 was considered significant. Results: The ovary weight, mean total volume of ovary and cortex, number of antral and graafian follicles and body weight were decreased significantly (p<0.05) in the pNP treated rats compared to control and other groups, while the number of atretic follicles was increased significantly (p<0.05). A significant reduction (p<0.05) in volume of oocyte, follicular cells and their nuclei in antral and graafian follicles was found in p-NP group. In addition, treatment with only vitamin E showed an improving effect on folliculogenesis due to a highly significant increase (p<0.01) in the number of primordial follicles. Conclusion: Vitamin E could compensate the adverse effects of p-NP on the ovary structure during its development.

Effects of gonadotropin releasing hormone conjugate immunization and bioenhancing role of Kamdhenu ark on estrous cycle serum estradiol and progesterone levels in female Mus musculus

Abstract: Background: 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. Objective: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

Delayed childbearing: pregnancy and maternal outcomes

Abstract: Background: 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. Objective: 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. Materials and Methods: 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. Results: 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. Conclusion: Advanced maternal age was shown to be independently associated with low birth weight, preterm labor and rate of cesarean delivery.

Evaluating the experiences of surrogate and intended mothers in terms of surrogacy in Isfahan

Abstract: Background: Using the method “surrogacy”, in which a woman accepts to bear and deliver a child for a married couple, is considered as a subsidiary method in infertility therapy. This method is relatively new in Iran. Objective: The purpose of this study was to evaluate the experiences of the women involved in surrogacy and to reveal some issues related to this method. Materials and Methods: The method of research was analytic–descriptive and causative – comparative type. The 5-item neo - questionnaire and structured interview were used simultaneously. The sample consisted of 15 surrogate mothers, 15 intended mothers, and 30 normal mothers (each with one or more children). The studied data was gathered in the fall and winter of 2009 in Isfahan by the researcher (Monir Pashmi) and data analysis was executed through the use of descriptive data (such as the median, standard deviation) and interpretive data (T- test). Results: The research revealed that, in terms of social – cultural status, the surrogate and intended mothers were completely different but their psychological characteristics were not significantly varied. Results indicate the satisfaction and consent of both sides involved in the surrogacy. They had a good relationship during the pregnancy period but after delivery the intended mother wanted no further relationship, they found out this method an altruistic experience. Conclusion: Most surrogate and intended mothers do not consider surrogacy a problematic issue. A number of mothers, however, did mention that they had not been given the appropriate counseling beforehand. It seems plausible, therefore, to endeavour a general rise in the socio – cultural awareness of surrogacy in Iranian society.

Gonadal histo-morphologies and serum hormonal milieu in female rats treated with azadirachta indica leaf extract

Abstract: Background: Azadirachta indica is a tree with most of the parts having various medicinal values. It is however popular because of its high potencies, as antimalarial and anti-fertility agents, which the locals still exploit. Objective: We investigated the effect of the methanol leaf extract on the serum levels of the pituitary-gonad hormones and the histo-morphology of the ovary and uterus of adult female rats. Materials and Methods: Eighteen adult female Wistar rats were divided into three groups (A, B and C) of six animals each. Group A was the control group that received distilled water orally, while groups B and C were the experimental groups that received 200mg/kg and 400mg/kg of the extract respectively by oral intubation for fourteen days. The animals were sacrificed on the fifteenth day, and blood was collected from the left ventricles of the hearts and subsequently spurned in heparinized bottles for serum hormonal assay. The ovaries and the uteri were then dissected out and preserved in Bouin’s fluid. Routine haematoxylin and eosin method was used to stain them. Results: There were significant (pl0.0001) lower serum levels of luteinizing hormone (LH) in the treatment groups, especially in the 400mg/kg group, while there were significant (pl0.0001) higher progesterone (PH) levels in the treatment groups. The follicle stimulating hormone (FSH) levels were however not different (p=0.0502) from the control. The histo-morphologic studies revealed no obvious pathological changes in the ovaries and uteri of the treatment groups. Conclusion: 200mg/kg and 400mg/kg of methanol extract of the leaf of A. indica does not have any obvious effect on the histo-morphologies of the ovary and uterus, but showed significant changes in the serum levels of LH and PH of female Wistar rat, implying that the effect of the extract may have been at a level other than these organs of study.

Frequency of poly cystic ovary syndrome in patients with premenopausal breast cancer

Abstract: Background: 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. Objective: In present study frequency of PCOS in patients with premenopausal breast cancer was compared with the frequency in women without breast cancer. Materials and Methods: 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. Results: 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). Conclusion: 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.

The effect of morphine administration on structure and ultrastructure of uterus in pregnant mice

Abstract: Background: Maternally administered opiates such as morphine represent a serious human health problem. Opioid abuse may have unfavorable effects on reproductive organs. Objective: The present study evaluates on the effects of morphine on structure and ultrastructure of uterus in BALB/c mice. Materials and Methods: Forty BALB/c pregnant mice were divided into four groups: two experimental (I and II), one sham and one control group. 5 mg/kg and 10 mg/kg morphine were injected via intra-peritoneal (IP) route, daily (during 15 days) in group I and II animals, respectively. The same volume of saline was administrated in sham group. Control group did not receive any treatment. At 15th day of gestation (E15), the pregnant mice were sacrificed and their uterus was removed. Following histochemical staining, the samples were studied using light and transmission electron microcopies. Results: In experimental groups, some apoptic sites with polymorphic inflammatory infiltration and congestion of vessels were observed. The rate of polymorphic inflammatory infiltration and apoptic sites were 60% and 70% in experimental groups I and II, respectively. Also, the rate of vessel congestion in the experimental groups (I and II) was 70%. The ultrastructural study showed the nuclear membranes of endometrial epithelial cell was torn, convoluted, and a distance between nuclei and irregular chromatin was observed in both experimental groups. There were no signs of structural abnormalities in other groups. Conclusion: Morphine administration causes histological and cytological lesions that may be responsible for endometrial alterations in laboratory animals.

The Leptin concentrations in seminal plasma of men and its relationship to semen parameters

Abstract: Background: Leptin is a polypeptide hormone secreted by white adipose tissue in proportion to body energy. Although the participation of leptin in female reproduction is well established, any role in male reproductive function is at best tenuous. Objective: The objective of this study was to compare the leptin concentration in human seminal plasma and then the relationships between seminal leptin and semen parameters were evaluated. Materials and Methods: Semen samples were provided from 71 men; normozoospermic (n=22), asthenozoospermic (n=31) and oligoasthenozoospermic (n=18) referring to Jichi Medical University Hospital for in vitro fertilization-embryo transfer (IVF-ET) treatment. After liquefaction, all sperm specimens were evaluated for sperm parameters and motility characteristics by computer-assisted semen analysis (CASA) system. After semen analysis, concentrations of leptin in seminal plasma of all groups were measured by ELISA. Results: The mean concentrations of leptin in seminal plasma of normozoospermic, asthenozoospermic and oligoasthenozoospermic men were 0.75+/-0.09 ng/ml, 0.8+/0.14 ng/ml and 0.8+/-0.15 ng/ml, respectively. A trend was observed for a lower leptin concentration in seminal plasma of normozoospermic men compared with asthenozoospermic and oligoasthenozoospermic men. There was a significant negative correlation between seminal plasma leptin concentration with sperm motility (p<0.05) and Curvilinear Velocity of the sperm kinetic parameter (p<0.01). Conclusion: It was demonstrated that there was a significant correlation between seminal leptin with the sperm motility.

Efficacy of selective serotonin reuptake inhibitor (SSRI) in patient with premature ejaculation

Abstract: Background: 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. Objective: 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. Materials and Methods: 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. Results: 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. Conclusion: 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 correlation between follicular fluid anti-mullerian hormone levels and fertilization and embryo quality in ART cycles

Abstract: Background: Determination of oocyte and embryo quality are one of the most important goals in IVF. Anti-mullerian hormone (AMH) is secreted by the ovarian granulosa cells into blood flow and follicular fluid. Follicular fluid anti-mullerian hormone level is probably a marker of activity of granulose cells. Objective: To evaluate whether high level of follicular fluid anti-mullerian hormone level is related to success of fertilization and better embryo quality. Materials and Methods: 62 women, whose follicular fluid sample was obtained from a single follicle in each patient, underwent IVF with GnRH-agonist long protocol. Based on oocyte fertilization, the patients were divided into fertilized group (n=42) and non-fertilized group (n=20). FF AMH levels were measured in both groups and the quality of embryos was determined in fertilized group. Results: Median of FF AMH level in fertilized group was higher than that in non-fertilized group (5.7ng/ml v.s. 2.7ng/ml) and a statistically significant difference was observed between the two groups. There was a significant difference between FF AMH level and scores of embryos (pl0.001). The medians levels of FF AMH were 6.7ng/ml in good quality embryos and 3.80ng/ml in fair quality embryos. Conclusion: Our results indicate that FF AMH level has positive correlation with fertilization and embryo quality; therefore, it can be considered as a marker of IVF outcome.

Follistatin concentrations in women from Kerala with polycystic ovary syndrome

Abstract: Background: Polycystic ovary syndrome (PCOS) is a disorder in which there are numerous benign cysts that form on ovaries under a thick white covering that is one of the causes of infertility. Follistatin is a single chain glycosylated polypeptide that can bind to activin. When follistatin binds to activin it suppresses the role of activin to stimulate the secretion of Follicle Stimulating Hormone (FSH). FSH plays an important role in folliculogenesis and decrease in FSH level may arrest follicular development. Objective: The aim is this study was to determine the circulating follistatin concentrations in PCOS patients compared to regularly menstruating women. Materials and Methods: The PCOS study group consisted of 88 oligo/amenorrheic women with PCOS. The control group consisted of 60 healthy women with regular menstrual cycles (26–30 days) and with no signs of hyperandrogenism. Body mass index (BMI, Kg/m 2 ) was calculated. Serum follistatin, Serum Leutenizing hormone (LH), and FSH were determined. Student‟s t-test, and Pearson correlation coefficients were used carried out statistical analysis of the data. Results: Serum follistatin levels were 0.11±0.04 and 0.31±0.08 ng/ml in control subjects and PCOS patients respectively (mean ± SD), and mean follistatin concentration in PCOS was high. The relationship between serum follistatin and FSH for control study was negatively correlated (r= -0.107, p=0.415) and was not significant, whereas for PCOS patients, the correlation was negative (r= -0.011, p=0.027) and however significant. Conclusion: Follistatin concentrations were high in PCOS patients compared to control subjects in this study. The high concentration of follistatin in PCOS decreased the FSH level and thus follistatin and FSH levels were negatively correlated in this study.

The effects of Cassia italica leaves aqueous extract on non-pregnant uterus contraction in rats

Abstract: Background: Cassia italica or Senna is a wild plant distributed in south of Iran. It increased water consumption and has a laxative effect. In traditional medicine this plant has been used for the dysmenorrheal. Objective: In this study we investigated the effect of aqueous extract of Cassia italica on uterus contraction. Materials and Methods: Virgin Wistar rats 200-300g were purchased. After laparatomy, a piece of uterus (1.5cm) was excised and mounted in an organ bath (10ml) containing De Jalon (29°C) and isometric contractions were recorded under 1g tension. KCl (60mM) was used to produce contractions. Cassia italica extracts after washing were added at 0.5, 1, 2 and 4 mg/ml cumulatively to the organ bath and the contractions were recorded. Uterus was separately incubated with atropine sulfate (10mM), metoclopramide (10mM) and oxytocin (10mU/ml) and the tissue spasmodic effect of the extract were recorded. Results: Cumulative concentrations of the extract (0.5-4 mg/ml) increased the basal, peak and frequency of uterus contractions, dose-dependently (pl0.001). Incubation of the tissue with atropine sulfate and metoclopramide did not reduce the spasmodic effect of the extract. Cassia italica extract was shown the oxytocic activity on the uterine smooth muscle which most concentrations of the extract (4mg/ml) were more potent than of oxytocin (10mU/ml). Conclusion: Cassia italica stimulated the uterus contractions without involving dopaminergic (D2), and muscarinic receptors. This extract has oxytocin mimetic effects on uterus. Since the extract has uterus contraction, therefore we suggest that more study will be necessary about abortive or contraceptive effects of this plant on pregnant uterus.

Hemoperitoneum during pregnancy with endometriosis; report of four cases

Abstract: Background: 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. Conclusion: A spontaneous hemoperitoneum during pregnancy is a rare and lifethreatening 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.

Thyroid autoantibodies in euthyroid women with recurrent abortions and infertility

Abstract: Background: Evidences suggest an association between the prevalence of thyroid peroxidase (anti-TPO) and anti thyroglobulin (anti-Tg) with recurrent abortions and infertility. Iodine deficiency was once endemic in Iran and little data is available about the prevalence of these antibodies in different groups of fertile or infertile individuals. Objective: This case control study was designed to compare the presence of anti-TPO and anti-Tg in four groups of women to reveal their role in the etiology of recurrent abortion and infertility. Materials and Methods: Four groups of euthyroid women referring to Avicenna Infertility Clinic in Tehran were selected; 95 cases as fertile controls and 70, 78 and 137 cases with male and female factor infertility and recurrent abortion respectively. TSH, anti-TPO and anti-Tg were evaluated by chemiluminescent immunoassay. Results: The prevalence of the above mentioned autoantibodies in euthyroid controls was about 25% and the percentage of people with an anti-Tg >500 was two times bigger in the abortion group compared to the control group (p 500 in younger cases in the abortion group was significantly higher than the rest of the cases (p<0.05). Anti-TPO distribution had no significant differences. Conclusion: There were no statistically significant differences among four groups. It seems that more comprehensive studies are needed to reach a common conclusion about thyroid autoantibodies in women with recurrent abortions in different groups and different parts of Iran. In addition, dividing the recurrent abortion and infertility groups on the basis of their etiologies could be effective.

Effect of bilateral uterine artery ligation on follicular atresia in ovaries of mature female rabbits; histomorphometric and histochemical study

Abstract: Background: Nowadays it is proofed that the uterine artery plays essential role in follicular growth and/or post parturition hemorrhagic. Objective: This study was conducted to evaluate the effect of Bilateral Uterine Artery Ligation (BUAL) on follicular fate and the probable histochemical changes of the carbohydrate and lipids in the ovaries of rabbits. Materials and Methods: 24 mature female rabbits randomized into two test and control-sham groups. Test group subdivided to three groups, based on time. Animals in the test group under went to BUAL. The ovaries were processed to histochemical and histomorphometric analyses to evaluate the ratio of lipid, carbohydrate and lipase enzyme in follicular cells. Results: The ovaries from test groups exhibited many atretic follicles in various sizes. BUAL significantly (p≤0.05) increased the rate of atresia in the test groups in comparison to the control-sham cases. This situation was progressed by the time. In the test groups, lipid reactions were observed more remarkable in the small atretic follicles in comparison to the large atretic follicles. BUAL elevated the reaction sites for lipase enzyme in the early stages of the atresia in the test group. Conclusion: Referring to our results, BUAL caused significant (p≤0.05) hypo-ovulation by increasing the atresia. Also increasing lipid foci in the first stages of the apoptotic process caused cytoplasmic lipase enzyme evaluation, while the lipase enzyme level was decreased by the advancement of the atresia and decreasing of the biological activities in follicular cells.

Relationship between anti-mullerian hormone and assisted reproductive technique outcome in patients with polycystic ovary syndrome

Abstract: Background: Anti-mullerian hormone (AMH) levels may represent the ovarian follicular pool and could be a useful marker of ovarian reserve. The clinical application of AMH measurement has been proposed in the prediction of quantitative and qualitative aspects in assisted reproductive technologies. Objective: This study aimed to assess the relationship between the serum levels of AMH and results of assisted reproductive technique (ART) outcome in polycystic ovary syndrome (PCOS) patients versus control group. Materials and Methods: This cohort study was conducted on 61 (PCOS) patients and 28 patients without PCOS (controls) candidates for assisted reproductive technique. Serum levels of AMH were measured on the 3 rd day of menstrual cycle and all the patients underwent controlled ovarian hyper stimulation and ART. The relationship between AMH serum level with retrieved oocytes, mature oocytes and pregnancy rate were assessed. Results: There was significant correlation between the AMH level with number of total retrieved oocytes and mature oocytes in patients with PCOS and controls (p=0.001). In PCOS and control groups AMH level in pregnant patients was higher, but it was not statistically significant (p=0.65, p=0.46, respectively). The major outcome of the study (pregnancy) did not differ significantly between two groups. Conclusion: This study revealed that AMH level was higher in pregnant patients undergoing ART; but AMH may not be an accurate predictor for pregnancy in PCOS patients.

CO-EXPRESSION OF GALECTIN-3 AND αVβ3 INTEGRIN AT PINOPODES OF HUMAN ENDOMETRIUM

Abstract: Background: Pinopodes are suggested as biological markers of uterine receptivity, but their molecular components are unknown. Objective: Co-expression of galectin-3 and ?v?3 integrin at human pinopodes has been examined in this study to propose a role for them during adhesion phase of embryo implantation. Materials and Methods: Biopsies were obtained from early and mid luteal phase endometrium of 12 fertile women with regular menstrual periods (25-35 days) and the mean age of 37 years (range 25–45). Then, they were examined under light and scanning electron microscopy for detection and dating of pinopodes. Using immunofluorescent staining and immunogold electron microscopy, the expression of galectin-3 and ?v?3 integrin in human endometrium and pinopodes was detected. Further, statistical analysis was performed using immunogold electron microscopy to investigate the expression and subcellular distribution of these, before and during the frame of implantation window. Results: The results demonstrated that pinopodes of luminal epithelial cells exhibited immunoreactivity for both galectin-3 and ?v?3 integrin, which was increased statistically significant (pl 0.05) at the time of implantation window. Furthermore, area-related distribution of these proteins was found higher in pinopodes compared to the neighboring apical membrane without pinopode. Conclusion: Temporal and spatial expression of galectin-3 and ?v?3 integrin at pinopodes proposes a role for pinopodes in the adhesion of embryo and the involvement of galectin-3 as a binding partner of integrins in the human utero-fetal complex.

The point mutations of mitochondrial trna threonine and proline in idiopathic repeated pregnancy loss

Abstract: Background: Mitochondrial transfer RNAs (tRNA) genes are essential components of protein biosynthesis. These genes are hotspots for mutations. These mutations are associated with a wide spectrum of human disease. Many genetic factors are known in assessment of repeated pregnancy loss (RPL). Objective: The aim of this study was analysis of tRNA Thr and tRNA Pro in women with RPL. Materials and Methods: The nucleotide variations of threonine and proline were investigated in 96 women with idiopathic repeated pregnancy loss. The related mitochondrial area was amplified using a polymerase chain reaction (PCR). The PCR products were demonstrated by 2% agarose gel electrophoresis, and all the positive samples were purified and verified by an automated DNA sequencing method. Results: The sequence analysis revealed 4 mutations in tRNA Thr . These mutations were A15907G in 2 cases (2.08%), A15924G in 3 cases (3.12%), G15928A in 10 cases (10.42%) as the most common mutations and G15930A in 3 cases (3.12%) as a novel mutation. Also, the result of tRNA pro sequencing showed the T15972C mutation in 1 woman (1.04%) as a novel mutation. Conclusion: These tRNAs mutations can alter their steady state level and affect the structure of tRNAs. It results in protein synthesis defects and, in turn, mitochondrial dysfunction. The mutations of these genes may help in the assessment of RPL. Further study of an expanded series of these tRNA mutants is recommended to describe their etiologic role in idiopathic RPL.

Hyperhomocysteinemia in Pakistani women suffering from unexplained subfertility

Abstract: Background: 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. Objective: To find out the association between unexplained subfertility and hhcy in Pakistani women. Materials and methods: This observational study was conducted in Department of Obstetrics and Gynaecology, Liaquat University Hospital Hyderabad from 1 st April 2008 to 31 st 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, hysterosalpingography and hormonal assays. Fasting serum levels of homocysteine were determined using a fluorescence polarization immunoassay. Results: 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, pvalue= 0.04). Conclusion: Hyperhomocysteinemia was observed in women suffering from unexplained subfertility. However large scale clinical studies are required to confirm the association.

The effect of sperm morphology on IUI outcome in cases with unexplained and male factor infertility

Abstract: Background: Although intrauterine insemination (IUI) is one of the most common methods which is used for male factor and unexplained infertility, the relative influence of various semen parameters on the likelihood of a successful outcome is controversial. Several semen parameters have been evaluated as predictors of a successful outcome with intrauterine insemination. Objective: To evaluate the effects of sperm morphology on the success rate of IUI. Materials and Methods: This was a prospective study of 200 couples who underwent IUI cycles of ovarian stimulation in Shiraz University of Medical Sciences. The patients were chosen in 2 groups, group A: 100 patients with ≤20% normal sperm morphology and group B: 100 patients with >20% normal sperm morphology (unexplained infertility). The other semen parameters were normal in both groups. Results: Total clinical pregnancies were 10.5% (pregnancy rate / cycle). There was not any difference between two groups in rate of pregnancy and also pregnancy outcome. Conclusion: Intrauterine insemination used for treating male factor infertility has not shown excessive advantage when normal sperm morphology in semen analysis is more than 20% in comparison with ≤ 20%.

Screening utility of umbilical artery Doppler indices in patients with preeclampsia

Abstract: Background: Doppler indices of umbilical artery are used as indicator of fetal well being. Objective: To compare Doppler parameters of umbilical artery including pulsatility index (PI) and resistance index (RI) in patients with preeclampsia with those of normal pregnancies and to evaluate the diagnostic characteristics of these parameters in preeclampsia. Materials and Methods: In a case control study, umbilical artery pulsatility and resistance indices were calculated at a free loop of umbilical cord in 25 preeclamptic patients and 75 uneventful pregnancies. Measurements were compared and diagnostic characteristics of the indices were determined. Results: Mean of pulsatility and resistance index were significantly higher in preeclampsia patients than the control group. Besides, patients with severe preeclampsia showed significantly higher values of PI and RI in comparison to those with mild preeclampsia. For PI, the cut-off of ≥0.98 yielded the highest sensitivity and specificity. Also, RI of 0.64 acquired a sensitivity of 100% and specificity of 44%. Conclusion: Umbilical artery pulsatility index and resistance index increase in preeclampsia and these changes tend to be greater in severe preeclampsia. Umbilical artery PI and RI seem to be more appropriate in excluding preeclampsia rather than confirming it, and we propose the cut-off values of 0.98 for PI and/or 0.64 for RI, to rule-out the disease.

C-reactive protein level and pregnancy rate in patients undergoing IVF/ICSI

Abstract: Background: C-reactive protein (CRP) can be increased after hormonal stimulations. The changes of CRP might affect the success of in-vitro fertilization (IVF). Objective: The aim of this study was to determine the possible relationship between the serum CRP level and outcome of controlled ovarian stimulation, and pregnancy rate in patients undergoing IVF or intra cytoplasmic sperm injection (ICSI). Materials and Methods: This prospective cross sectional study was performed in Avicenna Infertility Clinic on 70 consecutive infertile patients (Jan 2008-Aug 2009) who were candidate for IVF/ICSI, using standard long GnRH agonist protocol. Blood was drawn 4 times during the cycle, on first day of stimulation, the day of HCG injection, the day of ovum pick up, and the day of embryo transfer. Results: In 82.2% of cases, the serum CRP level was higher in day of HCG injection than first day of stimulation and also the day of ovum pick up than the day of HCG injection. The ratio of CRP level in the day of transfer to the day of ovum pick up, was significantly higher (ratio ?1.23) in patients who became pregnant after ICSI (p =0001). All patients with less than this Ratio have not been pregnant. Conclusion: Controlled ovarian hyper stimulation and puncture of ovaries can potentiate systemic stimulation. Increasing serum CRP level in day of embryo transfer rather than ovum pick up can predict the success in patients undergoing IVF/ICSI.

The effects of different luteal support hormones on endometrial alkaline phosphatase activity and endometrial thickness in superovulated mice

Abstract: Background: There are some controversial data on application of progesterone and progesterone plus estrogen at luteal phase. Objective: To investigate the effects of different luteal support hormones on the Alkaline Phosphates (ALP) activity in the endometrial epithelium and endometrial thickness during superovulation process for obtaining the optimized endometrial receptivity in animal model. Materials and Methods: Pseudopregnant female Balb/c mice were induced for pseudopregnany through superovulation then the mice were divided into two groups. Experimental group included five groups: the pseudopregnant mice were given four consecutive, daily injections of progesterone (P group), estrogen (E group), estrogen + progesterone (E+P group), antiprogesterone + estrogen (RU 486 + E), and sham group. In the control group, pseudopregnancy was induced in the natural cycle. The uterus was collected after day 4.5 of pseudopregnancy. The samples were prepared for the morphological and morphometrical evaluation of the endometrial ALP activity and endometrial thickness. Results: ALP activity was observed in all groups except P group. ALP activity of P + E group was similar to E and RU 486 + E groups. Sham group showed high ALP activity compared to the P group. The endometrial thickness was low in the P group and high in the sham group in comparison with other groups. Conclusion: In conclusion, super ovulation decreased the ALP activity. Estrogen along with progesterone at the luteal phase increased the enzyme activity and the endometrial thickness, compared with the progesterone administration, and thus, progesterone plus estrogen could improve embryo receptivity.

Acceptability and side effects of Cyclofem© once-a-month injectable contraceptive in Kerman, Iran

Abstract: Background: When family planning programmes offer a wide variety of contraceptives, contraceptive prevalence would be higher overall. Objective: To determine the acceptability of Cyclofem© and to evaluate its side effects and continuation rate in Iran. Materials and Methods: An introductory study of Cyclofem© was conducted in seven districts of Kerman Province, the largest province of Iran, in three phases. At first, 14394 women attending randomly selected urban and rural health centers representing different socioeconomic classes were invited to choose Cyclofem© after a standard schedule of counselling. At the second phase 418 of those who accepted Cyclofem© and 354 of those who refused to use the method were randomly selected to participate in an interview. At the third phase the first group was followed up for one year at regular one-month intervals. Results: Nearly 12.6% (n=1809) of 14394 women counselled to choose Cyclofem© accepted the contraceptive method. They had a mean (±SD) age of 28.5 (±6.5) years. Fear of side effects was the most common cause of refusal to use Cyclofem©. The one-year continuation rate was 21.2%. The three main side effects leading to early discontinuation of Cyclofem© were nausea (18%), prolonged menses (15.8%), and amenorrhea (14.7%), respectively. Conclusion: The one-year continuation rate of Cyclofem© use in Iran has been lower than other countries. Further research is necessary to improve continuation rates.