International Journal of Reproductive BioMedicine
Volume:17 Issue: 1, Jan 2019

The etiological nature of preeclampsia is heterogeneous. The use of biomarkers indices in early pregnancy helps to have appropriate stratification of pregnancies into high- and low risk for the purpose of choosing timely interventions. The aim of this systematic review was to determine the pathogenic role of soluble soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) inthe prediction of preeclampsia in women. We performed a systematic search of the international databases including PubMed, Scopus, and Web of Science until August 2017. The quality of included studies was assessed using the Newcastle-Ottawa Scale. The primary outcome in this review was preeclampsia. The statistical heterogeneity was assessed using the X2 test and quantified by I2. Pooled effects size was obtained by random effects model. Subgroup  analyses were also carried out. Totally, 284 records were identified in the initial search and 15 records were finally included in the meta-analysis. The pooled odds ratios (ORs) for the association between the high level of sFlt-1 and low level of PlGF and subsequent development of preeclampsia among women were 5.20 (95% CI: 1.24–9.16) and 2.53 (95% CI: 1.33–3.75), respectively. The mean difference for sFlt-1 and PlGF in women with preeclampsia compared to controls was 1.15 (95% CI: 0.43–1.86) and –0.94 (95% CI: –1.37–0.52),respectively. According to the results from this meta-analysis, increased levels of sFlt-1 and reduced levels of PlGF predict the subsequent development of preeclampsia.

Oxidative stress is the most frequent cause of female infertility disorders including polycystic ovary syndrome (PCOS). Genistein as a major component of soybean isoflavone scavenges free radicals by antioxidant activities. The present study examines the antioxidant effects of genistein on ovarian tissue following experimental PCOS in rats. Twenty female Wistar rat were randomly divided into the following groups (n=5 each group): (I) control group (no treatment); (II) induced PCOS (injection of estradiol valerate); (III) genistein-treated non-PCOS (received genistein); and (IV) genistein-treated PCOS groups. The weight of rats were measured and the blood samples collected and centrifuged. The oxidant and antioxidant activity of plasma and ovaries were measured. All rats were sacrificed under anesthesia, and ovaries were collected and weighted. Histological examination and follicular quality were assessed by staining. In histological observation, the induced PCOS rats displayed more number of atretic follicles and the follicular quality in genistein-treated rats was similar to the control groups. The plasma and ovaries malondialdehyde levels significantly increased in PCOS rats (p < 0.001), while the total antioxidant capacity levels, glutathione peroxidase, and superoxide dismutase activities significantly decreased (p < 0.001). The plasma and ovary  malondialdehyde levels significantly decreased in PCOS rats that were treated with genistein (p < 0.001) and the total antioxidant capacity (p < 0.05), glutathione peroxidase, and superoxide dismutase activities significantly increased (p < 0.001). Treatment with genistein preserved follicular quality by increasing antioxidant activities and scavenging oxidant levels in PCOS rats.

The current treatment regimen for ovarian stimulation in Intracytoplasmic sperm injection (ICSI) patients is daily injections of Gonadotropins. Recombinant DNA technologies have produced a new recombinant molecule that is a long-acting Follicle Stimulating Hormone (FSH), named corifollitropin alfa. A single injection of long-acting FSH can replace seven daily FSH injections during the first week of controlled ovarian stimulation (COS) and can make assisted reproduction more patients-friendly. There is limited data with different results in this area. To compare the effectiveness of long-acting FSH vs. daily r-FSH in terms of  pregnancy and safety outcomes in women undergoing ICSI cycles. In this clinical trial study, 109 women who were the candidates  for ICSI at azzahra hospital were divided in two groups. The first group received 150 units of daily Gonal-f from second or third day of menstruation. The second group received a 150IU corifollitropin alfa on the second or third day of mensuration, and the treatment continued from day eighth of stimulation with Gonal-f based on the ultrasound finding. Both the groups received GnRH antagonist from fifth day of stimulation. Two groups were compared in terms of number of dominantfollicles, number of oocytes, stimulation duration, total number of embryos, number of transferred embryos, and success rate of pregnancy. No significant difference was found between the two groups in terms of stimulation duration, number of follicles, number of oocytes, total number of embryos, and number of transferred embryos. Moreover, pregnancy outcomes including chemical pregnancy rate (positive pregnancy test), clinical pregnancy rate (detection of fetal heart), the rate of ovarian hyper-stimulation syndrome, multiple-pregnancy, ectopic pregnancy, and miscarriage didn’t have a significant difference between the two groups. As corifollitropin alfa was as effective as r-FSH, it could be used as an alternative to ovulation stimulation method in patients undergoing ICSI.

Vitamin D deficiency is a common nutritional concern and leads to several problems among some population groups. The aim of the current study was to evaluate the relationship between maternal vitamin D status and gestational weight gain, maternal biochemical parameters, mode of delivery, and infants’ growth indices at birth. A longitudinal study between March and June 2017 was carried on 82 mothers in Ahvaz. Blood samples of each mother were obtained at the mean of the third trimester to assay lipid indices (total cholesterol, triglycerides, lowdensity lipoprotein, and high-density lipoprotein cholesterol), fasting blood sugar, and 25-hydroxy vitamin D. Anthropometric assessment of newborns was recorded from neonatal health card at birth. Mean maternal 25-hydroxy vitamin D level was 22.52 nmol/L; 7.33% of mothers had vitamin D deficiency, 76.6% had vitamin D insufficiency, and 15.9% were normal. The mean neonate birth weight, length, and head circumference of mothers who were  on the third tercile of 25-hydroxy vitamin D serum level was significantly higher than  those in the first tercile (p < 0.001, p = 0.004 and p < 0.001, respectively). Maternal vitamin D serum level had an adverse relationship with fasting blood sugar. Low levels of serum vitamin D may cause adverse pregnancy outcomes and delivery of infants with insufficient growth at birth.

Many couples experience decreasing sexual satisfaction in postpartum period. Various sexual health counseling approaches have been designed for postpartum women to address their common sexual concerns and problems. This study aimed to investigate the effectiveness of Women’s Postpartum Sexual Health Program (WPSHP) on women’s sexual satisfaction in postpartum period. The study was a single blind randomized clinical trial on 75 postpartum women aged 18–35 yr with low sexual satisfaction who attended urban health-care centres in Mashhad, Iran in 2016. Data were collected using a demographic questionnaire, the Depression Anxiety Stress Scales-21, and the Larson Sexual Satisfaction Questionnaire. The intervention group received counselling based on the WPSHP, a four-session, group- and couples-based program. The control group  just received postpartum routine care. Both the intervention and control groups were homogeneous for demographic variables. According to the Mann-Whitney test, sexual satisfaction score in the  intervention group was significantly higher than the control group 8 weeks after the intervention (p < 0.001). According to the Wilcoxon test, there was a significant difference in the mean score of sexual satisfaction before and after intervention in the intervention group (p < 0.001). WPSHP caused higher levels of sexual satisfaction. It is therefore recommended to use this program in women during the postpartum period to promote their sexual satisfaction.

In some patients with a family history of the gender-linked disease, determination of the fetal gender in the first trimester of pregnancy is of importance. In X-linked recessive inherited diseases, only the male embryos are involved, while in some conditions, such as congenital adrenal hyperplasia, female embryos are affected; hence early determination of fetal gender is important. The aim of the current study was to predict the gender of the fetus based on the accurate measurement of the fetal anogenital distance (AGD) by ultrasound in the first trimester. To determine the AGD and crown-rump length in this cross-sectional study, 316 women with singleton pregnancies were exposed to ultrasonography. The results were then compared with definitive gender of the embryos after birth. The best cut-off for 11 wk to 11 wk, 6 days of pregnancy was 4.5 mm, for 12 wk to 12 wk, 6 days was 4.9 mm, and for 13 wk to 13 wk, 6 days was 4.8 mm. AGD is helpful as an ultrasonographic marker that can determine fetal gender in the first trimester, especially after 12 wks.

One of the stressful and critical experiences that threat the individual, family, marital, and social stability is infertility. To identify the effects of midwifery-led counselling programs on the perceived stress of the women undergoing assisted reproductive  treatment. In this randomized clinical trial, 50 infertile women who underwent in vitro fertilization treatment for the first time were enrolled in two groups. The intervention group received six sessions of group counselling by M.Sc. midwifery of counseling student and the control group received only the routine care. All participants filled Newton’s standard questionnaire before and at the time of puncture, embryo transfer and the pregnancy test. The mean ± SD scores for the perceived infertility stress before the intervention in the control and the intervention groups were 167.92 ± 12.14 and 166.75 ± 13.27, respectively. The mean of perceived stress after intervention at the time of oocyte puncture in the control and case group were 177.12 ± 19.37 and 115.75 ± 13.88, at the time of embryo transfer were 179.40 ± 18.34 and 118.08 ± 15.37, and at the time of pregnancy test was 183.76 ± 14.97 and 120.50 ± 16.24, respectively. The perceived stress of infertility after intervention were statistically significant in the two group (p ≤ 0.001). Group counselling is one of the effective methods for reducing the perceived stress in the women undergoing assisted reproductive treatment.

A unicornuate uterus is present in 0.1% of the general population. This müllerian anomaly carries significant obstetrical risk including abortion, preterm delivery, and rudimentary horn ruptures. The patient is a 24-yr-old primigravida with 12-wk gestational age and a twin pregnancy in the unicornuate uterus and non-communicating rudimentary horn. One fetus in the unicornuate uterus and other in the rudimentary horn that was ruptured. In urgent laparotomy rudimentary horn and fallopian tube excised. Pregnancy in theunicornuate uterus was continued and at 38-wk gestational age, cesarean section due to premature rupture of the membrane was performed and then normal fetus was delivered. Twin pregnancy in a unicornuate uterus and rudimentary horn is a rare condition that carries a considerable risk to the mother. There is a need for increased awareness of this rare condition to prevent maternal morbidity and mortality.