Showing papers in "Iranian Journal of Reproductive Medicine in 2014"

The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study.

Abstract: Background: Infertility is a major life event that brings about social and psychological problems. The type and rate these problems in the context of socio-cultural of different geographical areas and sex of people is different. Objective: The aim of this qualitative study was to explain the psychological consequences of infertility in Iranian infertile women seeking treatment. Materials and Methods: This qualitative study was done using qualitative content analysis on 25 women affected by primary and secondary infertility with no surviving children in 2012. They were purposefully selected with maximum sample variation from a large Fertility Health Research Center in Tehran, Iran. Data were collected using 32 semi-structured interviews and analyzed by the conventional content analysis method. Results: The findings of this study include four main themes: 1. Cognitive reactions of infertility (mental engagement; psychological turmoil). 2. Cognitive reactions to therapy process (psychological turmoil; being difficult to control in some situations; reduced self-esteem; feelings of failure). 3. Emotional-affective reactions of infertility (fear, anxiety and worry; loneliness and guilt; grief and depression; regret). 4. Emotional-affective reactions to therapy process (fear, anxiety and worry; fatigue and helplessness; grief and depression; hopelessness). Conclusion: This study revealed that Iranian infertile women seeking treatment face several psychological-emotional problems with devastating effects on the mental health and well-being of the infertile individuals and couples, while the infertility is often treated as a biomedical issue in Iranian context with less attention on the mental-emotional, social and cultural aspects

Prevalence and risk factors associated with preterm birth in Ardabil, Iran.

Abstract: Background: Preterm birth is a leading cause of perinatal mortality and long-term morbidity as well as the long-term health consequences and cognitive outcomes. Objective: Present study was conducted to determine prevalence and risk factors associated with preterm birth in Ardabil, Iran. Materials and Methods: A case control study was conducted between Nov 2010 and July 2011 in all three maternal hospitals in Ardabil. All the live newborns during the study period were investigated. Of 6705 live births during the study period 346 births occurred in <37 weeks were taken as a case and 589 term neonates were taken as a control group. Data were obtained through review of prenatal and hospital delivery records. Univariate and multivariate logistic regression analysis were applied to obtain magnitude of association between independent variables and preterm birth. Results: The prevalence rate of preterm birth was 5.1%. History of previous preterm birth (OR=12.7,CI: 3.9-40.4, p<0.001), hypertension (OR=7.3, CI:2.1-25.4, p=0.002), Oligohydramnios (OR=3.9, CI:1.6-9.5, p=0.002), spouse abuse (OR=3.7, CI:1.1-11.8, p=0.024), preeclampsia (OR=3.6, CI:1.3-10.3, p=0.014), premature rupture of membrane (OR=3.1, CI:1.9-4.9, p=0.000), bleeding or spotting during pregnancy (OR=2.0, CI:1.0-3.8, p=0.037), Hyperemesis Gravid arum (OR=2.0, CI: 1.1-3.8, p=0.015), urinary tract infection in 26-30 weeks , (OR=1. 8 CI:1.0-3.2, p=0.04), diastolic blood pressure ≤60 mmg (OR=1.5, CI: 0.99-2.2, p=0.049) were determined as significant risk factors for preterm birth. Conclusion: Early detection and treatment of diseases or disorders among pregnant women especially hypertension, Oligohydramnios, preeclampsia, bleeding or spotting, Hyperemesis Gravid arum, urinary tract infection, and low diastolic blood pressure as well as the improving health care quality delivered to pregnant women may reduce preterm prevalence rate.

Transvaginal perfusion of G-CSF for infertile women with thin endometrium in frozen ET program: A non-randomized clinical trial

Abstract: Background: We often see patients with a thin endometrium in ART cycles, in spite of standard and adjuvant treatments. Improving endometrial growth in patients with a thin endometrium is very difficult. Without adequate endometrial thickness these patients, likely, would not have reached embryo transfer. Objective: We planned this study to investigate the efficacy of intrauterine granulocyte colony-stimulating factor (G-CSF) perfusion in improving endometrium, and possibly pregnancy rates in frozen-thawed embryo transfer cycles. Materials and Methods: This is a non-randomized intervention clinical trial. Among 68 infertile patients with thin endometrium (-7 mm) at the 12th-13th cycle day, 34 patients received G-CSF. G-CSF (300 microgram/1mL) to improve endometrial thickness was direct administered by slow intrauterine infusion using IUI catheter. If the endometrium had not reached at least a 7-mm within 48-72 h, a second infusion was given. Endometrial thickness was assessed by serial vaginal ultrasound at the most expanded area of the endometrial stripe. Results: The cycle was cancelled in the patients with thin endometrium (endometrial thickness below 7mm) until 19th cycle day ultimately The cycle cancelation rate owing to thin endometrium was similar in G-CSF group (15.20%), followed by (15.20%) in the control group (p=1.00). The endometrial growth was not different within 2 groups, an improvement was shown between controlled and G-CSF cotreated groups, with chemical (39.30% vs. 14.30%) and clinical pregnancy rates (32.10% vs. 12.00%) although were not significant. Conclusion: Our study fails to demonstrate that G-CSF has the potential to improve endometrial thickness but has the potential to improve chemical and clinical pregnancy rate of the infertile women with thin endometrium in frozen-thawed embryo transfer cycle.

Effects of date palm pollen (Phoenix dactylifera L.) and Astragalus ovinus on sperm parameters and sex hormones in adult male rats.

Abstract: Background: Date Palm Pollen (DPP) and Astragalus genus are used in some countries for the treatment of infertility. Objective: This study was designed to investigate effects of DPP and Astragalus ovinus (A.Ovinus) on fertility in healthy adult male rats. Materials and Methods: Thirty-six rats were divided into six groups (n=6) including control and five treatment groups. DPP (120, 240 and 360 mg/kg) and A.ovinus (100, 500 mg/ kg) were orally given to the treatment groups. After thirty-five days, blood samples were taken to determine serum levels of FSH, LH, testosterone and estradiol. Weight of testis and epididymis, sperm count, sperm motility, seminiferous tubules diameter (STD), germinal cell layer thickness (GCLT), sertoli, leydig and spermatogonia cells were also evaluated. Results: DPP at the of 120 and 240 mg/kg doses significantly raised the ratio of testis or epididymis to body weight, sperm count, sperm motility , and estradiol level compared to the control group (p<0.05). LH and testosterone levels only noticeably increased at 120 mg/kg of DPP (p<0.01 and p<0.001 respectively). STD increased in the three applied doses (p=0.001). A. ovinus extract at the indicated doses produced a significant reduction in the ratio of testis or epididymis to body weight and sperm motility (p<0.05). Sperm count, spermatogonia, leydig cells and FSH level decreased at dose of 500 mg/kg. Furthermore, GCLT, spermatogonia cells, and serum estradiol level increased at 100 mg/kg dose of A. ovinus. Conclusion: Our findings indicate that DPP could improve fertility factors, while A.ovinus can exhibit deleterious effects on gonad and sperm parameters in rats.

Effects of ascorbic acid on sperm motility, viability, acrosome reaction and dna integrity in teratozoospermic samples

Abstract: Background: Oxidative stress in teratozoospermic semen samples caused poor assisted reproductive techniques (ART) outcomes. Among antioxidants, ascorbic acid is a naturally occurring free radical scavenger and as such its presence assists various other mechanisms in decreasing numerous disruptive free radical processes. Objective: The main goal of this study was to evaluate potential protective effects of ascorbic acid supplementation during in vitro culture of teratozoospermic specimens. Materials and Methods: Teratozoospermic semen samples that collected from 15 volunteers were processed, centrifuged and incubated at 37 o C until sperm swimmedup. Supernatant was divided into four groups and incubated at 37 o C for one hour under different experimental conditions: Control, 10 µm A23187, 600µm ascorbic acid and 10 µm A23187+600 µm ascorbic acid. After incubation sperm motility, viability, acrosome reaction, DNA damage and malondialdehyde levels were evaluated. Results: Our results indicated that after one hour incubation, ascorbic acid significantly reduced malondialdehyde level in ascorbic acid group (1.4±0.11 nmol/ml) compared to control group (1.58±0.13 nmol/ml) (p<0.001). At the end of incubation, progressive motility and viability in ascorbic acid group (64.5±8.8% and 80.3±6.4%, respectively) were significantly (p<0.05 and p<0.001, respectively) higher than the control group (54.5±6.8% and 70.9±7.3%, respectively). A23187 significantly (p<0.0001) increased acrosome reaction in A23187 group (37.3±5.6%) compared to control group (8.5±3.2%) and this effect of A23187 attenuated by ascorbic acid in ascorbic acid+A23187 group (17.2±4.4%). DNA fragmentation in ascorbic acid group (20±4.1%) was significantly (p<0.001) lower than controls (28.9±4.6%). Conclusion: In vitro ascorbic acid supplementation during teratozoospermic semen processing for ART could protect teratozoospermic specimens against oxidative stress, and it could improve ART outcome.

Effects of silver nano-particles on sperm parameters, number of Leydig cells and sex hormones in rats.

Abstract: Background: Nano-particles are extensively employed in most industries. Several studies have been started to explore the probable detrimental effects of nanoparticles on human reproduction. However, there is insufficient and controversially evident of effects of silver nano-particles on sperm parameters and other reproductive indices. Objective: Investigation of the effects of silver nano-particles on sperm parameters, sex hormones and Leydig cells in rat as an experimental model. Materials and Methods: In this experimental study, 75 male prepubertal Wistar rats were categorized in five groups including control group and 4 experimental groups (n=15 in each group). The rats in the experimental groups were fed silver nano-particles (60 nm in dimension) with concentrations of 25, 50, 100, and 200 mg/kg/day. After 45 days (about one duration of spermatogenesis in rat), samples of blood were taken from the rats for testosterone, leuteinizing hormone (LH), and follicle stimulating hormone (FSH) assessments. Afterwards, the epididymis and the testis of each rat were dissected for analyzing sperm parameters and Leydig cells. Results: The results demonstrated a statistically significant reduction in number of Leydig cells in experimental groups compared to control one. In addition, the data showed a reduction in testosterone and a rise in LH level which was more obvious in high doses (p<0.05); however, FSH level showed a reduction but it was not statistically significant. A significant decrease was also found in sperm motility and normal sperm morphology in the experimental groups compared to the control one. Conclusion: Our results demonstrated that silver nano-particles, in addition to interruption in functions of sex hormones, can diminish the number of Leydig cells and sperm parameter indices. It should be noted that the effects of nano-particles on reproductive indices are dose-dependent.

Ovarian ectopic pregnancy: A 10 years' experience and review of literature.

Abstract: Background: Primary ovarian pregnancy is one of the rarest forms of ectopic pregnancy having incidence of 1/7000-1/40,000 in live births and 0.5-3% of all ectopic gestations. Intrauterine contraceptive device (IUCD), salpingitis, infertility, and assisted reproductive techniques are the important risk factors. Approximately, 75% terminate in first trimester and are often misdiagnosed as corpus luteum haemorrhage. Preoperative diagnosis by ultrasonography (USG) in early pregnancy can help in conservative medical/ surgical management. Objective: The aim of the present study was to find the incidence, risk factors, role of USG in pre-operative diagnosis, feasibility of conservative management with medical method or minimal invasive surgery in developing countries like India. Materials and Methods: We did a retrospective cross-sectional study of ovarian pregnancies managed at Government Medical College and Hospital Chandigarh between July 2000 to July 2010. We analyzed the incidence, risk factors, clinical presentation, management of ovarian pregnancy, and reviewed the literature. Results: Incidence of ovarian pregnancy was 4.9% of all ectopic pregnancies (14/523). Thirteen (93%) patients presented in first trimester with acute pain abdomen and of these ten patients had bleeding per vaginum. One (7%) patient referred from peripheral hospital at term gestation with ultrasonographic diagnosis of breech presention with plecenta previa. Pre-operative diagnosis was made only in two cases (11%). All cases were managed by laparotomy. Excision of the sac with conservation of the ovary was done in eleven cases (78%) and oophorectomy was done in two cases (14%). Conclusion: Incidence of ovarian pregnancy is on the rise. Although ultrasonography can detect ovarian gestations in unruptured cases but cannot easily differentiate ovarian from other tubal gestation in ruptured state. Medical management is usually not feasible it most of the patients present in ruptured state. Conservative surgical approach is the management of choice.

Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/ intracytoplasmic sperm injection: A randomized clinical trial

Abstract: Background: The direct effect of hCG on the human endometrium was studied several times Objective: The objectives of this study were to evaluate the effectiveness of intrauterine injection of recombinant human chorionic gonadotropin (rhCG) before embryo transfer (ET) Materials and Methods: In this randomized placebo-controlled clinical trial, a total number of 182 infertile patients undergoing their first in vitro fertilization/ intracytoplasmic sperm injection (IVF-ICSI) cycles were randomly assigned to receive 250μg intrauterine rhCG (n=84) or placebo (n=98) before ET The implantation and pregnancy rates were compared between groups Results: Patients who received intrauterine rhCG before ET had significantly higher implantation (369% vs 224%; p=0035), clinical pregnancy rates (345% vs 204%; p=0044) and ongoing pregnancy rate (321% vs 184%; p=0032) when compared to those who received placebo The abortion (24% vs 20%; p=0929) and ectopic pregnancy rates (12% vs 10%; p=0976) were comparable between groups of rhCG and placebo, respectively Conclusion: Intrauterine injection of 250μg of rhCG before ET significantly improves the implantation and pregnancy rates in IVF/ICSI cycles Registration ID in IRCT: IRCT2012121711790N1 This article extracted from fellowship course thesis (Masoumeh Younesi)

Subclinical hypothyroidism and insulin resistance in polycystic ovary syndrome: is there a relationship?

Abstract: Background: Polycystic ovary syndrome (PCOS) is the most common hyperandrogenic disorder among women and is often defined as hyperandrogenic syndrome. These patients are at risk for oligo/amenorrhea, chronic anovulation, infertility, obesity, spontaneous abortion, insulin resistance, hyperinsulinemia and metabolic syndrome. Thyroid disorders especially hypothyroidism is more common in these people. In PCOS patients, subclinical hypothyroidism may aggravate insulin resistance. Objective: The goal was to find any relationship between subclinical hypothyroidism and insulin resistance in PCOS patients. Materials and Methods: In this prospective cross sectional study we included all PCOS patients coming to infertility clinic of Taleghani Hospital in 2010-2012 who had the criteria of Rotterdam for PCOS. Then the clinical examination was done for them and height, weight, body mass index and lab data were measured including thyroid hormone and biochemical profile. The data were analyzed by SPSS software version 20. Results: Among 75 PCOS patients, 19 (25.5%) had subclinical hypothyroidism and 56 patients (74.4%) were euthyroid. The prevalence of insulin resistance was 22.7% and 77.3% of patients had no insulin resistance were normal. Conclusion: We could find no relationship between insulin resistance and subclinical hypothyroidism in PCOS patients.

Protective effect of urtica dioica l against nicotine-induced damage on sperm parameters, testosterone and testis tissue in mice

Abstract: Background: Nicotine consumption can decrease fertility drive in males by inducing oxidative stress and DNA damage. Urtica dioica L (U.dioica) is a multipurpose herb in traditional medicine for which some anti-oxidative and anti-inflammatory properties have been identified. Objective: The main goal is to investigate whether the U.dioica could inhibit nicotine adverse effects on sperm cells viability, count, motility, and testis histology and testosterone hormone. Materials and Methods: In this study, hydro-alcoholic extract of U.dioica was prepared and various doses of U.dioica (0, 10, 20, and 50 mg/kg) and U.dioica plus nicotine (0, 10, 20, and 50 mg/kg) were administered intraperitoneally to 56 male mice for 28 consequent days. These mice were randomly assigned to 8 groups (n=7) and sperm parameters (sperm cells viability, count, motility, and morphology), testis and prostate weight, testis histology and testosterone hormone were analyzed and compared. Results: The results indicated that nicotine administration (0.5 mg/kg) significantly decreased testosterone level, count and motility of sperm cells, and testis weight compared to control group (p=0.00). However, increasing the dose of U.dioica significantly boosted motility, count, normal morphology of sperm cells, seminiferous tubules diameter, and testosterone in all groups compared to control (p=0.00) and testis weight in 20 and 50 mg/kg doses in comparison with control group (p=0.00). Conclusion: It seems that U.dioica hydro-alcoholic extract administration could increase the quality of spermatozoa and inhibits nicotine-induced adverse effects on sperm parameters.

The effects of endometrial injury on intrauterine insemination outcome: A randomized clinical trial.

Abstract: Background: Implantation is considered as the rate-limiting step in success of assisted reproduction techniques, and intrauterine insemination cycles. It might be affected by ovarian superovulation and endometrial local scratching. Objective: This study aims to investigate the effect of local endometrial injury on the outcome of IUI cycles. Materials and Methods: In this randomized clinical trial 144 women with unexplained infertility, mild male factor, and mild endometriosis randomly divided into two study groups through block randomization. The patients were randomly assigned to undergo endometrial biopsy between days 6-8 of the previous menstrual cycle before IUI (n=72, IUI cycles =126) or receive no interventions (n=72, IUI cycles=105). Results: The pregnancy rate per patient was 17 (23.6%) and 14 (19.4%) in endometrial biopsy and control groups, respectively (p=0.686). The pregnancy rate per cycle was 17/126 (13.5%) and 14/105 (13.3%) in endometrial biopsy and control groups, respectively (p=0.389). The abortion rate was comparable between the two groups (6.9% vs. 9.7%; p=0.764). The ongoing pregnancy rate was found to be comparable between the two study groups, as well (16.7% vs. 9.7%; p=0.325). Endometrial thickness (p=0.609) was comparable between the groups; however E2 was significantly lower in the endometrial biopsy group (p<0.001). Conclusion: Application of local endometrial injury in the cycle before the IUI cycles is not associated with increased pregnancy rate per patient and per cycle, decreased abortion, and increased endometrial thickness.

The relationship between body mass index and sexual function in infertile women: A cross-sectional survey

Abstract: Background: Infertility as the bitterest life experience can affect sexual function. Many studies have shown agitation, depression, marital dissatisfaction, and sexual dysfunction as the psychological outcomes resulting from infertility. Many factors, including body mass index, influence the female sexual function. Objective: This study aimed to assess the prevalence of female sexual dysfunction and the relationship between sexual function and body mass index in the Iranian infertile women who had attended the infertility clinic. Materials and Methods: This cross sectional study was conducted on 502 infertile women who had attended Honoree clinic, Jahrom in Iran between April 2012 and December 2012. The infertile cases were classified into three groups according to the body mass index: 20-24.9 (Group I), 25-29.9 (Group II), and >29.9 and above (Group III). In addition, Female sexual function index (FSFI) questionnaire was used in order to assess the sexual problems. Finally, the data were analyzed by descriptive statistics, ANOVA and Student’s t-test. Results: The mean age of women was 30.95±6.80 years. The results showed that 430 subjects (87.1%) had sexual dysfunction. Furthermore, the rate of sexual dysfunction among the infertile women was reported as 23.30%, 31.47%, and 45.23% in groups I, II, and III, respectively. Considering body mass index, FSFI score was 21.65±1.70 in the women with normal weight, 18.08±1.52 in overweight women, and 12.21±3.62 in obese women and the difference was statistically significant (p<0.001). Conclusion: The prevalence of sexual dysfunction was quite high in infertile women, which might be due to the lack of knowledge about marital issues and lack of training in the society. If body mass index is too high, it can have a great effect on fertility. In this study, being overweight and obese based on body mass index had a negative effect on the infertile woman’s sexual function.

Effects of acrylamide on sperm parameters, chromatin quality, and the level of blood testosterone in mice.

Abstract: Background: Acrylamide (AA) is an important industrial chemical primarily. AA is also found in carbohydrate-rich foods that are prepared at high temperatures, such as French fries and potato chips. It is demonstrated that AA is a carcinogen and reproductive toxin and has ability to induce sperm damage. Objective: The aim of this study was to observe the effects of AA on sperm parameters and evaluation of sperm chromatin quality and testosterone hormone in mice. Materials and Methods: Totally, 16 adult male mice were divided into two groups. Mice of group A fed on basal diet; group B received basal diet and AA (10 mg/kg, water solution) for 35 days. The right cauda epididymis was incised and then placed in Ham’s F10 culture media at 37 o C for 15 min. Released spermatozoa were used to analyze count, motility, morphology and viability. To determine the sperm DNA integrity and chromatin condensation, the cytochemical techniques including Aniline blue, Acridine orange and Chromomycin A3 staining were used. Results: AA-treated mice had poor parameters in comparison with control animals. In sperm chromatin assessments, except TB (p=0.16), significant differences were found in all of the tests between two groups. It was also seen a significant decrease in concentration of blood testosterone in AA-treated animals when compared to controls (p<0.001). Conclusion: According to our results, AA can affect sperm parameters as well as sperm chromatin condensation and DNA integrity in mice. These abnormalities may be related to the reduction in blood testosterone.

Sexual dysfunction in patients with polycystic ovary syndrome and its affected domains.

Abstract: Background: Polycystic Ovary Syndrome (PCOS) is presented with characteristic complications such as chronic an ovulation, obesity, and hyperandrogenism which can affect sexual function in women of reproductive age. Objective: Herein we evaluated the frequency and predisposing factors of sexual dysfunction in infertile PCOS patients. Materials and Methods: In this cross-sectional study, 130 married women with a definite diagnosis of PCOS who were referred due to infertility were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire. Results: The frequency of sexual dysfunction was verified 57.7% in PCOS patients with the domains of desire and arousal being commonly affected in 99.2% and 98.5%of cases respectively. BMI had a significant effect on sexual desire and arousal (p=0.02) while the effect of hirsutism was significant on all domains (p<0.001 for total FSFI score) except for dyspareunia. Conclusion: PCOS patients markedly suffer from sexual dysfunction as comorbidity. It seems appropriate to screen all PCOS patients for sexual function with a simple short questionnaire such as FSFI. Targeted interventions could be considered to help improve their quality of life along with other treatments.

Effect of vitamin D insufficiency treatment on fertility outcomes in frozen-thawed embryo transfer cycles: A randomized clinical trial

Abstract: Background: Frozen- thawed embryo transfer is an essential part of ART treatment and outcomes of this procedure are associated with several clinical factors. Several studies have showed an increase level of IVF outcomes in women with sufficient vitamin D. Objective: whether treatment of vitamin D insufficiency can improve pregnancy rates in frozen-thawed embryo transfer cycles. Materials and Methods: This is an interventional, randomized clinical trial. Serum 25-(OH) vitamin D level of 128 women who had undergone IVF/ICSI with cryopreservation of embryos was checked. One hundred fourteen infertile women with insufficient serum vitamin D (less than 30 ng/ml) were included in the study. Fifty seven women were treated with supplementary vitamin D, 50000 IU weekly, for 6-8 weeks and fifty seven women were received no supplementation. One hundred six women completed frozen thawed embryo transfer cycles and included in the final analysis. Primary and secondary outcomes were chemical and clinical pregnancy respectively. Results: Our study did not show any significant difference between vitamin D insufficient and treated women in term of chemical (29.40% vs. 29.10% respectively, p=1.00) or clinical (25.50% vs. 21.80% respectively, p=0.81) pregnancy rates. Conclusion: Vitamin D insufficiency treatment is not associated with higher pregnancy rate in frozen-thawed embryo transfer cycles.

Prevalence of trichomonas vaginalis infection in kashan city, iran (2012-2013)

Abstract: Background: Trichomonas vaginalis infection is one of the most common sexually transmitted diseases in humans. T.vaginalis is a parasitic protozoan with a predilection for human urogenital tract and causative agent for vaginitis, cervicitis and urethritis in females. T.vaginalis infection is associated with risk of Human Immunodeficiency Virus infectivity and pregnancy complication. Objective: In this study, the prevalence of T.vaginalis in individuals who referred to public health units in Kashan city, Iran was investigated. Materials and Methods: This study was conducted on 970 women and 235 men who referred to 5 government health centers in Kashan, Iran during October 2012 to August 2013. Demographic information was collected as per the study protocol. Vaginal discharges and urine samples were obtained and examined by TrypticaseYeast Extract Maltose (TYM) culture medium and wet-mount methods. The prevalence of T. vaginalis was determined using culture based method and wetmount examinations. Results: The overall prevalence of trichomonal infection was 2% (95% CI, 2±0.08). The age of infected individual was 33.7±9.4 years. All of those infected, were married housewives and 58.3% of them had primary school education. No statistical correlation was observed between clinical manifestations and parasitological results (p=0.8). Conclusion: This study showed a relatively low prevalence of T.vaginalis infection in the study population. Since the clinical signs of trichomoniasis are the same of other Sexually Transmitted Diseases (STDs), confirmatory laboratory tests are necessary. Due to adverse outcomes of disease, there is a great need for public education regarding implementation of personal hygienic measures and prevention of inappropriate sexual contacts.

Protective effect of royal jelly on fertility and biochemical parameters in bleomycin-induced male rats.

Abstract: Background: Bleomycin (BL) is a glycopeptide antibiotic obtained from the bacterium Streptomyces verticillus which is routinely used for treatment of human cancers. Royal jelly (RJ) is a production from the hypo pharyngeal, mandibular and post cerebral glands of nurse bees. RJ consists of 66% water, 15% sugars, 5% lipids, and 13% proteins, essential amino acids and vitamins. Objective: The aim of present study was to evaluate protective effect of royal jelly on sperm parameters and malondialdehyde (MDA) production in rat. Materials and Methods: Forty adult male wistar rats (220±20gr) were randomly divided into 4 groups (n=10). Control group (CG) received normal saline 10 ml/kg twice a week with Intraperitoneal (I.P) for 48 days (0.3 ml/rat). Royal Jelly group (RJG) received jelly (100 mg/kg daily) for 48 days orally. Bleomycin group (BLG) received BL (10 mg/kg twice a week) with I.P for 48 days. Royal Jelly+ Bleomycin group (RJ+BLG) received royal Jelly (100 mg/kg /day) orally concomitant with BL administration. Sperm count, motility, and viability were investigated and chromatin quality and DNA integrity were also analyzed. Serum testosterone and MDA concentrations were measured as well. Results: BL caused decline significantly (p<0.05) sperm count, sperm viability, motility as well as testosterone concentration compared to control group while significant (p<0.05) increases in immature sperm, sperm with damaged DNA and MDA concentration were announced in BL in comparison with CG and RJ+BLG. Royal jelly improved Bleomycin-induced toxicity on sperm parameters and testosterone and MDA concentrations. Conclusion: The present results support the idea that BL adversely affects sperm parameters and MDA and the RJ with antioxidant properties has positive effects on these parameters.

Combination effect of pentoxifylline and l-carnitine on idiopathic oligoasthenoteratozoospermia

Abstract: Background: Pentoxifylline (PX) is a methyl xanthine derivative that influences the sperm motion characteristics and L-carnitine (L-C) is an amino acid that is naturally produced in the body. In general, separate administration of PX and L-C has been reported to be effective on preserving sperm motility in vitro, and also when is consumed orally by the Idiopathic oligoasthenoteratozoospermia (IOAT) patients. Objective: The aim of this study was to evaluate any possible effect of a combination of L-C and PX on sperm characteristics and improving the type of assisted reproductive techniques (ART) in a group of patients with unexplained oligoasthenoteratozoospermia. Materials and Methods: Two hundred twelve infertile men with IOAT in a double-blind, placebo-controlled, randomized clinical trial were allocated for this study. They randomized to four groups. Group I received PX/ and L-C (each one, twice daily), group II, PX and placebo, group III, L-C with the placebo, and group IV, received placebo tablets. Finally, we compared pre and post intervention sperm parameters and ART procedures between groups. Results: While the use of PX and L-C are only improved sperm motility, but their combined uses improved all sperm parameters, especially the sperm count. Also the combination of PX and L-C was effective on improving the ART procedures (p<0.01). Conclusion: Our results demonstrate that the combination use of PX and L-C is useful in improving of sperm parameters in IOAT patients and also, improve ART procedures in this group of patients

The differential expression of microRNA-143,145 in endometriosis

Abstract: Background: Recent studies showed that inappropriate expression of microRNAs (miRNAs) is strongly associated with tumor-related processes in humans (2-9,11-17). Objective: To understand the changes of miRNAs in endometriosis. Materials and Methods: With real-time RT-PCR, we investigated the miR-143 and miR-145 expression in eutopic (EU, n=2) and ectopic endometrium (EC, n=11) (from women with endometriosis) (as well as EU+EC, n=11), along with the normal endometrium (EN, n=22) (from women without endometriosis, but with leiomyoma). Results: We did not find that the expression of miR-143 and/or miR-145 in EN or EC changed with menstrual cycle. But our results showed the miR-143 was up-regulated in EC (p=0.000) compared to EN. The miR-143 was also up-regulated in EU, but the difference did not reach statistically significance (p=0.053). Compared to EU, the expression of miR-143 in EC was up-regulated (p=0.016). MiR-145 had the similar characteristic to miR-143. The miR-145 was up-regulated in both EU (p=0.004) and EC (p=0.000) in compared to EN group. When compared with EU, the miR-145 in EC was up-regulated (p=0.008). Conclusion: In conclusion, the miR-143 and miR-145 may play a certain role in the development and progression of endometriosis.

Prognostic factors of first birth interval using the parametric survival models

Abstract: Background: In recent years, the study of birth intervals has been a main determinant of the levels of fertility in the populations, as it is associated with rates of fertility and population growth. Objective: The purpose of this study was to firstly apply survival analysis for modeling of first birth interval and secondly to explore its determinants. Materials and Methods: In a cross sectional study, the fertility history of 858 women was collected in rural areas of Shiraz (southern Iran) in 2008. We used the survival analysis such as cox regression and alternative parametric models to evaluate the prognostic factors of first birth interval. Results: Among the explanatory variables of interest, age at marriage, level of women's education, and menstrual status had highly significant effects on the duration of birth interval after marriage (p<0.01). Conclusion: It is concluded that the suitable parametric models would be a useful tool for fitting to first birth interval, the fact that has been less paid attention to in researches.

The relationship between clinicobiochemical markers and depression in women with polycystic ovary syndrome

Abstract: Background: Previous studies have demonstrated that clinical features of 16TPolycystic ovary syndrome16T (PCOS) are associated with a lower degree of health, self, and sex satisfaction Objective: Our study aimed to investigate possible associations between depression and different clinicobiochemical markers of PCOS Materials and Methods: In a cross-sectional analytic study, 120 PCOS women aged 18-45 yr, were enrolled Beck Depression Inventory was used to assess depression Also, all participants underwent biochemical studies Individuals with 15 points and more in Beck test were referred to a psychiatrist to participate in a complementary interview for the diagnosis of depression based on Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV-TR) criteria Results: Among the study participants, 82 women (683%) were non-depressed, and 38 patients (317%) had some degrees of depression According to the psychiatric interview, 10 patients (83%) had major depression, 22 patients (183%) had minor depression and 6 patients (5%) had dysthymia We failed to show any significant difference in body mass index, hirsutism, infertility, serum total testosterone, lipid profile, and the homeostasis model assessment of insulin resistance (HOMA-IR) between depressed and non-depressed subjects (p>005) Using Spearman correlation, we did not find a positive correlation between BDI scores and clinicobiochemical markers for all PCOS subjects (-0139≤r≤+0121, p>005) Conclusion: In spite of high rate of depression in women with PCOS, there was no significant association between Clinicobiochemical Markers and depression

Emotional experiences in surrogate mothers: A qualitative study

Abstract: Background: Surrogacy is one of the new techniques of assisted reproduction technology in which a woman carries and bears a child for another woman. In Iran, many Shia clerics and jurists considered it permissible so there is no religious prohibition for it. In addition to the risk of physical complications for complete surrogate mothers, the possibility of psychological complications resulted from emotional attachment to a living creature in the surrogate mother as another injury requires counseling and assessment prior to acceptance by infertile couples and complete surrogate mothers. Objective: The purpose of this study was to assess the emotional experiences of surrogate mothers. Materials and Methods: This was a qualitative, phenomenological study. We selected eight complete surrogate mothers in Isfahan. We used convenient sampling method and in-depth interview to collect the information. The data analysis was fulfilled via Colaizzi’s seven-stage method. Reliability and validity study of the roots in the four-axis was done. Results: The findings of these interviews were classified into two main themes and four sub themes: acquired experiences in pregnancy (feelings toward pregnancy, relationship with family, relatives and commissioning couple) and consequences of surrogacy (complications of pregnancy, religious and financial problems of surrogacy). Conclusion: Surrogacy pregnancy should be considered as high-risk emotional experience because many of surrogate mothers may face negative experiences. Therefore, it is recommended that surrogates should receive professional counseling prior to, during and following pregnancy.

A population-based study on infertility and its influencing factors in four selected provinces in Iran (2008-2010).

Abstract: Background: Objective: We aimed to identify the burden of infertility and its influencing factors based on a population based study conducted in four provinces of Iran. Materials and Methods: A sample of 1126 women, aged 18-45 years, was selected using the multi stage, stratified probability sampling procedure; those met the eligibility criteria were invited for further comprehensive interview. This study used the definition of infertility proposed by World Health Organization "the woman has never conceived despite cohabitation and exposure to pregnancy for a period of 1 year". Results: The overall prevalence of lifetime infertility and current primary infertility were 21.1% (95% CI: 18.4- 23.8) and 6.4% (95% CI: 4.8-8) respectively. The probability of first pregnancy at the end of 2 years of marriage was 94% for all ever-married women. Infertility were observed as significantly higher among women age 31-35 (OR: 4.6; 95% CI: 1.9-11.5; p=0.001) and women with more than 9 years of education (OR: 2.8; 95% CI: 1.5-3.3; p<0.0001). Conclusion: The necessities of modern living have compelled many women to postpone childbearing to their late reproductive years; however they must be informed of being at risk of infertility with ageing Infertility has a varied impact on multiple dimensions of health and functioning of women.

Evaluation of clinical factors influencing pregnancy rate in frozen embryo transfer

Abstract: Background: Frozen embryo transfer (FET) is one of the most important supplementary procedures in the treatment of infertile couples. While general information concerning the outcome of fresh embryo transfer has been documented, paucity of investigations has addressed the clinical factors influenced on pregnancy rates in FET. Objective: In this study, we performed a retrospective analysis of clinical factors that potentially influence the outcome of FET. Materials and Methods: We reviewed the data from 372 women who were subjected to FET registered from April 2009-2011 at the Research and clinical center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Baseline data and pregnancy rate were collected. The data were analyzed statistically using the Kolmogorov-Smirnov, and Mann-Whitney tests. Results: The clinical pregnancy rate was 57.7 and 29.2% in women 35 years old, respectively (p 10 IU/ml were 56.3% and 17.5 %, respectively (p 0.05). Conclusion: Female age and basal FSH level are the most important factors influencing the clinical pregnancy rate following FET.

Effect of aqueous and hydro-alcoholic extracts of lettuce (Lactuca sativa) seed on testosterone level and spermatogenesis in NMRI mice.

Abstract: Background: One of the considerable uses of lettuce (Lactuca sativa) seed in traditional medicine has been to reduce semen, sperm and sexuality. Objective: The aim of this study was to investigate the effects of aqueous and hydro-alcoholic extracts of lettuce seed on testosterone level and spermatogenesis. Materials and Methods: In this experimental study 24 adult male NMRI mice weighing 20-25gr were purchased. Animals were randomly divided into 4 groups: controls, hydro-alcoholic (200 mg/kg) and aqueous extracts (50, 100mg/kg). The extracts were injected intraperitoneally once a day for 10 consecutive days. 2 weeks after the last injection, the mice were anaesthetized by ether and after laparatomy blood was collected from the heart to determine testosterone by ELISA assay kit. Then testis and cauda epididymis of all animals were removed for analyzing testis morphology and sperm count and viability. Results: Testis weight in hydro-alcoholic and aqueous extracts 100 mg/kg (p=0.001) and aqueous extract 50 mg/kg (p=0.008) groups was increased. Sperm viability in hydro-alcoholic (p=0.001) and aqueous extracts 50 (p=0.026), 100 mg/kg (p=0.045) groups was decreased, Also the results showed a significant decrease in sperm count in hydro-alcoholic (p=0.035) and aqueous extracts 50 mg/kg (p=0.006) groups in comparison with control group. Also there was a significant increase in serum level of testosterone in aqueous extract 50 mg/kg group in comparison with control (p=0.002) hydro-alcoholic (p=0.001) and aqueous extracts 100 mg/kg (p=0.003) groups. Conclusion: Present results demonstrated that hydro-alcoholic and aqueous 50 mg/kg extracts of lettuce seed have antispermatogenic effects, also aqueous extract 50 mg/kg increased serum level of testosterone in mice. Therefore we can suggest that lettuce seed could be a potential contraceptive agent. This article extracted from M.Sc. student research project. (Ali Akbar Oroojan)

Protective effects of celery (Apium Graveolens) on testis and cauda epididymal spermatozoa in rat.

Abstract: Infertility is one of the health problems that will have a negative impact on the individual, social and economic and is seen in 10-15% of couples (1). About 40 % of the issues involved with infertility are due to the man. Male sperm cells count nowadays has decreased dramatically in comparison with those who lived 50 years ago (2). Causes of infertility in men are included: oligozoospermia, immaturity of sperm, sperm deformity, and sperm non-motility. Spermatogenesis takes place within the testes under control of testosterone secreted by the testes and secretory activity of the testes controlled by the hypothalamic-pituitary-testicle axis. Due to adverse effects and side effects of chemical drugs today, the use of traditional medicine, especially herbal therapy is taken into consideration. In traditional medicine, it has been pointed to therapeutic properties of celery. Celery has anti-fungal, anti-bacterial, and anti-cancer properties (3). Also this plant is an appetite stimulant and sexual booster (4). Previous studies have shown that sperm cells are largely vulnerable to oxidative stress but celery is rich in antioxidant compounds such as flavonoids (apiin and apigenin), vitamins E and C that can reduce oxidative stress (5, 6). So, in the present study the protective effect of celery was investigated on the cauda epididymal spermatozoa and testis in rat. A total number of 32 male Wistar rats (weighting 170-220 g) were prepared from animal house central of Ahvaz Jundishapur University of Medical Sciences. Animals were maintained in plastic cages with 12/12 h light/dark cycle at 21±2oC. All experimental animals were carried out in accordance with Ahvaz University Ethical Committee. Hydro-alcoholic extract of celery was prepared by maceration method. The rats were divided into four groups of 8 animals each: control, did not receive anything; vehicle, received propylene glycol; experimental groups, and received hydro-alcoholic extract of celery with doses of 100 and 200 (mg/kg) with solvent of propylene glycol by gavage once every 48 hours for twenty days. At the end of 20th day, rats were scarified under ketamine and xylazine anesthesia then the epididymis and testes were carefully separated. The epididymis was used for sperm count and testes were prepared for morphometric and histologic evaluation. Statistical significance of differences were assessed with one-way ANOVA by SPSS for windows (version 15) followed by LSD test. P 0.05). Evaluation of tissue sections showed that germinal epithelium in the control group was normal and tissue damage was not observed in epithelial tissue. However, in the vehicle group, epithelium was destroyed and arrangement of epithelial cells was disordered, and fluid aggregation is seen into the epithelial cell and also, reduction of epithelium thickness was observed. In the experimental group (100 mg/kg), there was arrangement in germinal epithelium cells but fluid aggregation was observed into the epithelial cells. A reduced epithelial thickness was seen only in some tubules. However, all these histological changes were less than the vehicle group. In the experimental group (200 mg/kg), tissue destruction was largely improved, and there was an arrangement of the epithelial cells, there was not fluid aggregation into the epithelium, and the thickness of the epithelium was returned almost too normal state. The results of the present study showed that hydro-alcoholic extract of celery improved the destructive effects of propylene glycol on the testes and sexual cells. These findings are similar to previous studied (7, 8). Previous studies have demonstrated that excessive alcohol consumption in men can cause a deficiency in testosterone production and testicular atrophy. Testicular atrophy results primarily from the loss of spermatogenic cells of the seminiferous tubules that this can be caused by oxidative stress generated by alcohol (9). Researches also indicated alcohol with involvement of phase system and activation of caspases induced apoptosis in testicular cells (10). Spermatogenesis and maturation of sexual cells depends on protection of cytotoxic and pathologic lesions that threatens these events. Free radicals due to a strong desire to get electrons induce damage to molecules such as fatty acid of biological membranes and its oxidation. Celery is a strong antioxidant due to flavonoids such as apiein and apigenin (5, 6). Antioxidant compounds are able to protect cell membranes against damage. Antioxidants directly or indirectly impact on hypothalamic-pituitary-testicular axis thus increase sperm count and fertility (5, 6). So celery can be considered as a medicinal herb for infertility. However, further clinical studies are recommended. The study in the form of a research plan was approved with no 91s8 of Research Deputy of Ahvaz Jundishapur University of Medical Sciences. Finally, we acknowledge deputy vice-chancellor for research affairs of AJUMS for financial support, and particularly Research Consultation Center (RCC) for technical support.

Recurrent IVF failure and hereditary thrombophilia.

Abstract: Background: Objective: Aim of this case-control study was to determine whether hereditary thrombophilia is more prevalent in women with recurrent IVF failures. Materials and Methods: Case group comprised 96 infertile women, with a history of recurrent IVF failure. Control group was comprised of 95 healthy women with proven fertility who had conceived spontaneously. All participants were assessed for the presence of inherited thrombophilias including: factor V Leiden, methilen tetrahydrofolate reductase (MTHFR) mutation, prothrombin mutation, homocystein level, protein S and C deficiency, antithrombin III (AT-III) deficiency and plasminogen activator inhibitor-1 (PAI-1) mutation. Presence of thrombophilia was compared between groups. Results: Having at least one thrombophilia known as a risk factor for recurrent IVF failure (95% CI=1.74-5.70, OR=3.15, p=0.00). Mutation of factor V Leiden (95% CI=1.26-10.27, OR=3.06, P=0.01) and homozygote form of MTHFR mutation (95% CI=1.55-97.86, OR=12.33, p=0.05) were also risk factors for recurrent IVF failure. However, we could not find significant difference in other inherited thrombophilia’s. Conclusion: Inherited thrombophilia is more prevalent in women with recurrent IVF failure compared with healthy women. Having at least one thrombophilia, mutation of factor V Leiden and homozygote form of MTHFR mutation were risk factors for recurrent IVF failur e. The largest percentage of failed invitro fertilization (IVF) cycles, are due to lack of implantation. As hereditary thrombophilia can cause in placentation failure, it may have a role in recurrent IVF failure.

Prevalence and clinical significance of antinuclear antibodies in Iranian women with unexplained recurrent miscarriage

Abstract: Background: Antinuclear antibodies (ANAs) in women with recurrent miscarriage have been reported. The presence of moderate to high titers of these antibodies represents an autoimmune condition that can endanger the health of the fetus in pregnant women. Objective: In this study, we evaluated the prevalence of ANAs in Iranian women with a history of two or more unexplained abortion. Materials and Methods: 560 women with unexplained recurrent miscarriage and 560 healthy controls accounted for this study over a period of 13 months. ANAs were detected by indirect immunofluorescence technique. Results: ANAs were detected in 74 of 560 (13.21%) patient with recurrent miscarriage, and in only 5 of 560 (0.9%) controls (p 1.640) were seen in about 46% and 16% of cases respectively. Finally evaluating of microscopic ANA patterns revealed that about half of positive cases had antibodies against DNA- histone complex, associated with systemic lupus erythematosus disease. Conclusion: Antinuclear antibodies are not uncommon in women with unexplained recurrent miscarriage, suggesting the possible role of an autoimmune disorder on abortion, at least in a subgroup of patients.

Molecullar and biochemical effect of alcohlic extract of Alpinia galanga on rat spermatogenesis process

Abstract: Background: Alpinia galanga (A. galanga) belongs to the Zingiberaceae family has anti-oxidant effects in animals and humans body and often is used as medicament or part of medicaments in Asian folk medicine for various applications. Objective: The objective of this study was to investigate the molecular and biochemical influence of alcoholic extract from the rhizomes of A. galangal on the spermatogenesis process in male rat. Materials and Methods: Forty five Wistar male rats were divided into three groups, control (n=15) and two tested groups (n=30). Alcoholic extract (5%) of plant was given by oral route at doses of 100 and 300 mg/day for 56 days and spermatogenesis parameters, hormone changes and expression level of the cAMP-responsive element modulator (CREM) gene were assessed. Results: Methanol extract of A. galanga increased serum testosterones level significantly in both treated groups in comparison with control group (p<0.05). Besides, the percentage of sperm viability and motility in both tested groups were significantly increased. Follicle stimulating hormone FSH hormone, morphology and weight were affected in both treated groups. With 300 mg/day an increase in sperm count was observed. Sperm motility was increased in two treated groups whereas testis weight was decreased in treated groups. Real time analysis of treated cells of testis showed increase level of mRNA related to CREM gene involved in spermatogenesis process after 56 days induction. Conclusion: It is concluded that application of ethanolic extract of A. galanga significantly increased sperm percentage, viability, motility and testosterone hormone. This suggested that this plant may be promising in enhancing sperm healthy parameters.

Laparoscopic ovarian electrocautery versus gonadotropin therapy in infertile women with clomiphene citrate-resistant polycystic ovary syndrome: A systematic review and meta-analysis

Abstract: Background: Some trials have compared laparoscopic ovarian drilling (LOD) with gonadotropins but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies. Objective: To evaluate the relative efficacy of LOD and gonadotropins for infertile women with clomiphene citrate- resistant poly cystic ovary syndrome (PCOS). Materials and Methods: A complete electronic literature search in databases including EMBASE, MEDLINE, Cochrane Library and Google scholar for some specific keywords was accomplished. We contained randomized clinical trials comparing outcomes between LOD, without medical ovulation induction, and gonadotropins. Results: Six trials, covering 499 women, reported on the primary outcome of pregnancy rate. There was no evidence of a difference in pregnancy rate when LOD compared with gonadotropins (OR: 0.534; 95% CI: 0.242-1.176, p=0.119, 6 trials, 499 women, I 2 =73.201%). There was evidence of significantly fewer live births following LOD compared with gonadotropin (OR: 0.446; 95% CI: 0.269-0.74, p=0.02, 3 trials, 318 women, I 2 =3.353%). The rate of multiple pregnancies was significantly lower in the LOD arm compared to the gonadotropins arm (OR: 0.127; 95% CI: 0.028-0.579, p=0.008, 3 trials, 307 women, I 2 =0%). Conclusion: Our result revealed that there was no evidence of a significant difference in rates of clinical pregnancy and miscarriage in women with clomiphene citrate-resistant PCOS undergoing LOD compared to the gonadotropin arm. The decrease in multiple pregnancies rate in women undergoing LOD makes this option attractive. The increase in live birth rate in the gonadotropin group may be because of the higher rate of multiple pregnancies in these women. However, more focus on the long-term effects of LOD on ovarian function is suggested.