Journal of Reproduction & Infertility
Volume:15 Issue: 4, Oct-Dec 2014

In recent years, there has been increasing number of studies about young people’s sexual behavior and its correlates in Iran (1-5). These findings will hopefully sensitize health policy makers to sexual risks (HIV, STIs, pregnancy, and abortion) among young people in general population and inform appropriate programs and interventions to protect young people from associated risks. However, some of these studies have important limitations that make the interpretation and generalization of the finding difficult, particularly at national level and will provide some biased results on this highly sensitive topic. Some of these methodological limitations are as follows: Some studies have assessed sexual behaviors of a specific sample of college students in a particular city, while explicitly or implicitly generalize the findings to Iranian youth. For instance, in the title and the main text, they tend to use Iranian youth instead of focusing on the study population which are college students in the particular city (3). College students in metropolitan cities tend to be more vanguard to new ideas and are more likely to be liberal in sexual attitudes and behaviors. Generally, unless we have a national representative sample, the rates cannot be generalized to the general population of young people. Moreover, the investigators need to acknowledge the heterogeneity between cities in the country in interpretation of the finding. Another issue is special features related to researches of sensitive subjects such as sexual behavior. Some studies which fail to get official consent from the institutions (schools or universities), they tend to interview students who are volunteers and volunteers tend to be more sexually curious and likely to be more interested to know about the topic or even might be more sexually experienced. They might see their participation as an opportunity to receive some information from the questionnaire or the interviewer (1), hence, researchers need to make sure that students who reject to participate are not different from volunteers. Similarly, the investigators need to make sure that respondents with missing data on sensitive questions are not different with those who responded. Obtaining a non-representative sample is another important limitation. If applying random sampling is not possible, using proportional probability to size (PPS) can be helpful. Because the sample comprises of different subgroups, for instance, students of government and private universities, or men and women, the proportion of these subgroups within the sample might be different with the proportion in the study population. Hence, if researchers failed to use PPS based on important subgroups; need to give appropriate weight to different subcategories at the analysis stage. This becomes more important when sexual behaviors of these subcategories are different and lack of weighting lead to biased results. For instance, studies showed that students in government universities are significantly more conservative in sexual attitudes and behaviors compared to students from private universities (1, 6). Hence, if a representative sample of students (both private and government) universities is considered, the same proportion of each type of university need to be selected in the sample as their proportion in the population, if these proportions are different, weighting is needed. There is little evidence of weighted sample in many of published papers (3, 4). Hence, samples which over-represent private students, will over estimate the sexuality of college students.

The success rate of reproductive treatment methods depends on many different factors. The most important and discussed ones in the literature are maternal age, the causes of infertility, the ovarian response to stimulation, the influence of the male factor and sperm quality, embryo quality and the various uterine pathologies. Some couples fail repeatedly after transferring good quality embryos without any obvious reason and this becomes a major continuing problem after IVF/ICSI procedures. It can be speculated that in these couples, insufficiency of the endometrium might be a possible reason for implantation failure. This review article summarized current literature describing the consecutive endomertial procedures involved in successful embryo implantation. It is believed that efforts to align criteria for definition of recurrent implantation failure (RIF) and attempts to classify different RIF types would develop guidelines for treatment procedures which would result in an increase in patients’ opportunities to conceive.

The study meant to define the prognostic factors that help in prescribing intrauterine insemination (IUI) for infertility treatment which remains an area of continuous improvements. The diagnostic indications of a cohort of IUI-treated patients and their corresponding pregnancy rates (PRs) were randomly and prospectively studied among Saudi cohort of 303 patients for a period of 20 months. The indications of IUI cases were statistically analyzed for those eligible patients over a period of twenty months (January 2010 till August 2011), and the PR that corresponded to each group was investigated as well. P-value less than 0.05 was considered significant. The highest PR, 18.87%, of the polycystic ovarian syndrome (PCOS)-only diagnosed patients, was significantly higher than the average PR of all other indications combined, 7.22%, (p=0.011, compared to all other groups combined). The second highest PR, 14.0%, of the tubal factor (TF)-only indication, was double the PR average of all other indications combined, though it did not reach significance. However, PCOS and TF accompanied by other indications caused the PR to drop to 5.88% and 5.56 %, respectively. However, a group of some hormonal-imbalance based indications had the least PR (0.0% to 2.70%). Those indications were elevated serum FSH, hyperprolactinemia, hypogonadotrophy, hypothyroidism and endometriosis. The rest of the indications had an average PR (8.33% to 11.11%). There is a reasonable chance of conception after IUI treatment for female factor infertility except in cases with sever hormonal imbalance. The PCOS cases having the best success chances.

Orgasmic disorder can create a feeling of deprivation and failure and provide mental problems, incompatibility and marital discord. This study aimed to compare the effects of Elaeagnus angustifolia flower extract and sildenafil citrate on female orgasmic disorder in women in 2013. In this randomized clinical trial, 125 women between 18-40 years old who suffered from orgasmic disorder were divided into three E. angustifolia, sildenafil citrate and control groups. The data were gathered using Female Sexual Function Index and through measurement of TSH and prolactin. The first intervention group had to consume 4.5 gr E. angustifolia extract in two divided doses for 35 days and the second one had to use 50 mg sildenafil citrate tablets for 4 weeks one hour before their sexual relationship. However, the control group had to consume the placebo. The data were analyzed using paired t-test, one-way ANOVA, and Bonferroni post-hoc test and p<0.05 was considered significant. The frequency of orgasmic disorder before the intervention was 41.5%, 40.5%, and 57.1% in E. angustifolia, sildenafil citrate, and control groups, respectively (p=0.23). However, these measures were respectively 29.3%, 16.7%, and 50% after the intervention (p=0.004). A significant difference between the two groups regarding sexual satisfaction after the intervention (p=0.003) compared to the beginning of the study (p=0.356). Besides, the highest reduction of changes after the intervention (58.82%) was observed in the sildenafil citrate group. Both E. angustifolia extract and sildenafil citrate were effective in reduction of the frequency of orgasmic disorder in women.

The purpose of this study was to assess the vasopressin effect on operation time and the need for electrocauterization frequency and ovarian reserve during laparoscopic stripping of ovarian endometriomas. This was a randomized prospective clinical trial, in which twenty patients between 18-35 years with unilateral endometriomas were randomly divided in two groups of cases and controls. Laparoscopic cystectomy was performed by hydrodissection and stripping method in both groups with diluted vasopressin injected in cases, in comparison to only saline injection in controls. Ovarian hemostasis was achieved by bipolar electrocoagulation. The operation time and frequency of electrocoagulation were compared between two groups. The ovarian reserve was determined by ultrasound examination and laboratory assessment one month before and two months after surgery in two groups. Non parametric data was analyzed by Mann-Whitney test. The p-value less than 0.05 was considered statistically significant. The operation time was less in cases than control group, but the difference was not statistically significant (p=0.065). The frequency of electrocoagulation for hemostasis was less in cases than controls but this difference was not statistically significant (p=0.132). The antral follicle count decreased in both groups two months later, while no significant difference was found between two groups. This study shows that diluted vasopressin decreases operation time and electrocauterization frequency during laparoscopic stripping of ovarian endometriomas; however, the difference between case and control group is not statistically significant.

This study was designed to investigate the effect of metformin and flutamide alone or in combination with anthropometric indices and laboratory tests of obese/overweight PCOS women under hypocaloric diet. This single blind clinical trial was performed on 120 PCOS women. At the beginning, hypocaloric diet was recommended for the patients. After one month while they were on the diet, the patients were randomly divided in 4 groups; metformin (500 mg, 3/day), flutamide (250 mg, 2/day), combined, metformin (500 mg, 3/day) with flutamide (250 mg, 2/day) and finally placebo group. The patients were treated for 6 months. Anthropometric indices and laboratory tests (fasting and glucose-stimulated insulin levels, lipid profile and androgens) were measured. A one-way ANOVA (Post Hoc) and paired t-test were performed to analyze data. A p≤0.05 was considered statistically significant. After treatment, reduction in weight, BMI, hip circumference was significantly greater in the metformin group in comparison to other groups (p<0.05). In addition, the fasting insulin was significantly greater in metformin group and flutamide group in comparison to metformin flutamide and placebo groups after treatment (p<0.05). Within groups, insulin level showed significant changes (before and after treatment) in metformin flutamide group and LDL reduction was significant in flutamide group before and after treatment. Post hoc tukey and two-tailed with p≤0.05 were used to define statistical significance. Using combination of metformin and flutamide improves anthropometric indices and laboratory tests in obese/overweight PCOS women under hypocaloric diet.

High dietary fat consumption may alter oocyte development and embryonic development. This prospective study was conducted to determine the relation between dietary fat consumption level، its food sources and the assisted reproduction parameters. A prospective study was conducted on 240 infertile women. In assisted reproduction treatment cycle، fat consumption and major food sources over the previous three months were identified. The number of retrieved oocytes، metaphase ΙΙ stage oocytes numbers، fertilization rate، embryo quality and clinical pregnancy rate were also determined. The data were analyzed using multiple regression، binary logistic regression، chi-square and t-test. The p-value of less than 0. 05 was considered significant. Total fat intake adjusted for age، body mass index، physical activity and etiology of infertility was positively associated with the number of retrieved oocytes and inversely associated with the high embryo quality rate. An inverse association was observed between sausage and turkey ham intake and the number of retrieved oocytes. Also، oil intake level had an inverse association with good cleavage rate. The results revealed that higher levels of fat consumption tend to increase the number of retrieved oocytes and were adversely related to embryonic development. Among food sources of fat، vegetable oil، sausage and turkey ham intake may adversely affect assisted reproduction parameters.

The main goal was to evaluate the attitudes and knowledge of Zoroastrians living in Iran towards oocyte donation (OD) and embryo donation (ED) program. This cross sectional study consisted of 318 Zoroastrians (n=175 for OD and n=143 for ED) of both sexes. The questionnaire form comprised two parts of general demographic characteristics of the participants and twenty multiple-choice questions about attitude and knowledge of participants towards OD and ED. For statistical analysis, the chi-square test was applied for comparison of data generated from ED and OD groups. Majority of the participants supported OD (69.7%) and ED (71.3%) for infertile patients. In addition, 40% and 42% preferred donation program (OD and ED, respectively), compared to adoption. About 60% of the respondents believed that the donors have no right to find the child and claim it as their own. In addition, more than half of the respondents thought that the recipients of oocyte/embryo should never know the name and address of the donors. More than half of the participants did not know whether their religion accepts donation program or not. Approximately, 80% of respondents supported psychological counseling for both donors and recipients. Moreover, about 56% of the participants necessitated the advertisement on OD/ED program in the mass media. Our preliminary data showed that Zoroastrians supported both OD and ED program equally for infertile couples.

The Demons-Meigs syndrome should usually be evoked in case of presence of a typical triad: abdominopelvic mass, ascites and hydrothorax. Its diagnosis appears crucial to prevent the realization of unnecessary surgical procedures. A 32-year-old woman presented in April 2012 to the emergency department of our maternity unit (General Hospital, Thiers, France) with an abdominal distension mimicking the symptoms of a pregnancy at term. Physical examination revealed a voluminous painful abdominopelvic mass, extended from the pelvis to the upper abdomen with a large right pleural effusion. Ultrasound and computed tomography showed it was a tumor measuring more than 300 mm in diameter with a right hydrothorax. Serum CA-125 level was 289 U/ml. Cytologic analysis of the pleural effusion didn’t show any malignant cells. In this study, Demons-Meigs syndrome was recognized. A laparoscopico-laparotomic management permitted an aspiration of 23 liters of a brownish liquid and an unilateral adnexectomy after pleural paracentesis was performed. Frozen section demonstrated benign mucinous cystadenoma. The final histologic findings objectified intracystic intestinal type ovarian mucinous borderline tumor. After multidisciplinary consultation, the patient was re-operated one month later. The exploration didn’t reveal any suspected lesions and appendectomy and omentectomy were performed. The postoperative course was uneventful. Serum CA-125 level was normal at the time of the reoperation and 24 months after the initial surgery. The preoperative recognition of a Demons-Meigs syndrome or a Demons’ pseudosyndrome is essential to avoid useless surgical procedures.

Giant uterine fibroid is a rare tumor of the uterus, usually symptomatic requiring surgical intervention. Uterine fibroid is generally common among black women. In this study, a case of 31 year old nullipara was reported who presented to the Gynaecology unit of Enugu State University Teaching Hospital (ESUTH), Nigeria with a history of progressive abdominal swelling of 8 years duration, six years duration of infertility and weight loss and dyspnoea on exertion. Physical examination and transabdominal ultrasound revealed a huge abdominopelvic mass. She had myomectomy. She had a histologically confirmed giant uterine fibroid that weighed 16.8 kg. She subsequently achieved a live birth. Giant uterine fibroids are relatively rare. It poses great challenges in its management. The surgical option of management should consider the fertility preservation and aspiration of couples especially in developing countries.