International Journal of Reproductive BioMedicine
Volume:13 Issue: 2, Feb 2015

Polycystic ovary syndrome (PCOS) has been shown to cause a reduction in health-related quality of life (HRQOL). However، the relative degree of impairment in each domain differed among samples، and it was not clear which aspect of disease-specific HRQOL (modified polycystic ovary syndrome health-related quality of life questionnaire) was most negatively affected.

To systematically review the effects of PCOS on specific domains of HRQOL.

Literature search using search engine of database (PubMed، PsychInfo، CINAHL، CENTRAL، and Scopus) between 1998 to December 2013 yields 6 relevant publications. Pairs of raters used structural tools to analyze these articles، through critical appraisal and data extraction. The scores of each domain of polycystic ovarian syndrome questionnaire (PCOSQ) or modified version (MPCOSQ) of 1140 women with PCOS were used in meta-analysis.

The combine mean of emotional (4. 40; 95% CI 3. 77-5. 04)، infertility (4. 13; 95% CI 3. 81-4. 45) and weight (3. 88; 95% CI 2. 33-5. 42) dimensions were better، but menstruation (3. 84; 95% CI 3. 63-4. 04) and hirsutism (3. 81; 95% CI 3. 26-4. 35) domains were lower than the mean score of PCOSQ/MPCOSQ in related dimension.

The meta-analysis showed that the most affected domains in specific HRQOL were hirsutism and menstruation. Based on these findings، we recommend healthcare providers to be made aware that HRQOL impairment of PCOS is mainly caused by their hirsutism and menstruation، which requires appropriate management

The omega-3 (ω-3) fatty acid eicosapentaenoic acid (EPA) is currently used in the clinic as a nutritional supplement to improve infertility, particularly in women with polycystic ovarian syndrome (PCOS).

The present study was designed to investigate the effect of EPA on insulin-like growth factor 1 (IGF-1) and cyclooxygenase 2 (COX-2) gene expression in primary cultured granulosa cells from patients undergoing in vitro fertilization (IVF), and also to compare this effect with those in granulosa cells of PCOS patients.

In this experimental study, human granulosa cells were isolated from follicular fluid of normal and PCOS women undergoing IVF by hyaluronidase digestions, followed by Percoll gradient centrifugation. Cells were cultured in vitro, exposed to a range of concentrations of the EPA (25-100 μM) for 24 hr, and investigated with respect to COX-2 and IGF-1 gene expression by real time-PCR.

In both groups, all doses of the EPA significantly induced IGF-1 mRNAgene expression compared to the untreated control. High doses of EPA in thepresence of recombinant (r) FSH produced a stimulatory effect on IGF-1 and asuppressive effect (p=0.01) on the COX-2 gene expression, which were morepronounced in granulosa cells from PCOS patients.

EPA affect diversely the gene expression of IGF-1 and COX-2 in granulosa cells, which were more pronounced in PCOS compared to control. These findings represent the possible underlying molecular mechanisms for the positive impact of the ω-3 fatty acids on reproduction, especially in patients with PCOS.

Premature luteinization during in vitro fertilization was commonly happened before the introduction of GnRh analogues. High level of unwanted progesterone is associated with adverse pregnancy outcome and is thought to be induced by inappropriate LH elevation.

To evaluate the progesterone level on the day of Human Chorionic Gonadotropin (HCG) triggering in GnRh agonist and antagonist protocols, and its correlation with clinical pregnancy rate and miscarriage rate.

One hundred and seven women underwent intracytoplasmic sperm injection with long agonist protocol (n=46) or antagonist protocol (n=61). Blood sample was obtained from each patient for progesterone level measurement in HCG administration day, then patients were divided into two groups according to their serum progesterone levels on the HCG triggering day: progesterone level <1.2 ng/ml, and progesterone level ≥1.2 ng/ml. Clinical pregnancy and miscarriage rates were evaluated as main outcomes and biochemical pregnancy rate and implantation rate were considered as secondary outcomes.

The increased prevalence rate of premature progesterone (progesterone level ≥1.2 ng/ml) in total patients was 13.1% (14/107) and in long agonist protocol group and antagonist protocol group was 15.2% (7/46) and 11.5% (7/61) respectively. Premature progesterone rise had no significant correlation with clinical pregnancy rate in total patients (p=0.174), agonist protocol (p=0.545), and antagonist protocol (p=0.129). Also premature progesterone rise had no significant association with miscarriage rate in total patients (p=0.077), agonist protocol group (p=0.383) and antagonist protocol group (p=0.087).

A significant rise in progesterone levels at the time of HCG triggering doesn’t lead to decrease in pregnancy rate and implantation rate and increase in miscarriage rate.

Testicular torsion is a medical emergency that requires surgical intervention to reperfuse the affected testis. Ischemia reperfusion injury is usually associated with proinflammatory cytokine generation and apoptosis of germ cells in the testes.

In this study we investigate the effect of ghrelin on the proinflammatory cytokines levels and germ cell apoptosis in testicular ischemia reperfusion.

45 male rats were selected for the study and randomly divided into 3 groups, each containing 15 rats. Animals in the testicular torsion and ghrelin treated groups were subjected to unilateral 720 counterclockwise testicular torsion for 1 hr and then reperfusion was allowed after detorsion for 4 hr, 1 and 7 days. The ghrelin-treated group received intraperitoneal injection of ghrelin 15min before detorsion. The expression levels of bcl-2-associated X protein and proliferating cell nuclear antigen in testicular tissue in the different groups were detected by immunohistochemical assay and tissue cytokines interleukin-1β, tumor necroses factor-α and interleukin-6 were measured using enzyme-linked immunosorbent assay.

After being treated by ghrelin, the population of immunoreactive cells against BAX in the spermatocytes on day 7 after reperfusion significantly decreased when compared to tortion/ detortion-saline animals (p=0.024). In contrast, PCNA expression in the spermatocytes and spermatogonia were not significantly different between tortion/ detortion-ghrelin and tortion/ detortion-saline groups on both experimental days. Administration of ghrelin significantly attenuated the testicular tumor necroses factor-α and interleukin-6 levels compared with the untreated animals, but had no significant effect on the level of interleukin-1β.

Ghrelin offers remarkable anti-inflammatory and anti-apoptotic effects in testicular ischemia reperfusion injury.

30% of patients with polycystic ovary syndrome (PCOS) show mild, transient hyperprolactinemia. It is suggested that a reduction of the dopamine inhibitory effect might raise both prolactin and luteinizing hormone.

To investigate the adjuvant cabergoline therapy effects on menstrual irregularity and androgen system in PCOS women with hyperprolactinemia.

This randomized clinical trial was done on 110 polycysticovary syndrome women with increased serum prolactin concentration [1.5 fold morethan normal level (>37.5 ng/ml)]. Participants were divided into two groups: Casegroup (n=55) treated with metformin 1gr/day and cabergoline 0.5 mg/week for 4months and control group (n=55) treated with metformin 1g/day and placeboweekly. Testosterone, prolactin, and dehydroepiandrosterone sulfate level weremeasured before and four months after intervention in two groups. Also, situation ofmenstrual cycles asked and recorded before and after intervention.

We found decrease in the mean of dehydroepiandrosterone sulfate, weightand total testosterone level in the two groups after intervention but their changeswere not significant. Patients in case group showed a significant decrease in serumprolactin level before and after intervention (p<0.001), but no difference was foundin control group. All patients in both studied groups had irregular menstrual cycles,which regulate after intervention and the difference was significant (p=0.02).

The results showed that cabergoline can be used as a safe administration in PCOS patients with hyperprolactinemia to improve the menstrual cycles. Considering that the administration of cabergoline plus metformin may reduce the required duration and dose of metformin, patient acceptability of this approach is higher.

Measurement of serum β-hCG concentration commonly used to diagnose tubal ectopic pregnancy (EP) and follow up patients treated conservatively.

The aim of this study was to determine the predictive value of maternal serum β-hCG concentration in ruptured tubal ectopic pregnancy to help physicians identify those women who are at greatest risk.

This is a cross-sectional study conducted on all women with a diagnosis of tubal ectopic pregnancy who were treated in Alzahra Hospital, in Rasht, from March 2002 to February 2011. The data was collected for each woman from medical records and included age, parity, gravidia, gestational age, primary level of serum β-hCG, rupture status, past history of pelvic inflammation disease, EP, abortion, and intrauterine contraceptive device use. Women with tubal rupture were compared to those without rupture. Statistical analysis was conducted by SPSS 19 for Windows.

A total of 247 cases of tubal ectopic pregnancy were recorded during the study period. One hundred and ninety seven (79.8%) were cases with unruptured EP and 50 patients (20.2 %) were cases with ruptured EP. The mean level of β-hCG was significantly higher in patients with ruptured EP compared to patients with unruptured EP (p=0.03). Logistic regression analysis revealed that >1750 IU/ml of β-hCG levels (OR: 1.41; 95% CI: 1.18-1.68) was the significant risk factors for tubal rupture.

Higher β-hCG levels seem to be significant risk factors for rupture of a tubal EP.

There have been speculations about the effects of hormonal changes and socio-demographic factors on periodontal health during pregnancy.

According to the lack of sufficient epidemiologic information about the periodontal status of pregnant women in Yazd, this study was accomplished to determine the changes of Community Periodontal Index for Treatment Needs (CPITN) during pregnancy and evaluating the possible relationship between this index and demographic characteristics of the mothers.

This was a longitudinal descriptive study. The samplesincluded 115 pregnant women who were referred to health centers of Yazd, Iran.The mothers’ data were obtained from a questionnaire consisted of 3 parts: consentpaper, demographic data and CPITN records. Examination was performed withdental unit light, flat dental mirror and WHO’s scaled probe.

In the beginning of the study, 60.1% of checked sextants had healthy gingival status. 25.9% had code1 and 14% had code 2. Code 3 and 4 were not seen in any sextants. There was a significant relationship between lower CPITN and higher maternal education, occupation and more frequencies of tooth-brushing but there was not a relationship between CPITN and mother’s age and number of pregnancies. CPITN had a significant relationship with increasing of the gestational age.

There might be a relationship between increasing the month of pregnancy and more periodontal treatment needs. CPITN Increasing during pregnancy shows the importance of periodontal cares during this period.

Measurement of serum β-hCG concentration commonly used to diagnose tubal ectopic pregnancy (EP) and follow up patients treated conservatively.

The aim of this study was to determine the predictive value of maternal serum β-hCG concentration in ruptured tubal ectopic pregnancy to help physicians identify those women who are at greatest risk.

This is a cross-sectional study conducted on all women with a diagnosis of tubal ectopic pregnancy who were treated in Alzahra Hospital, in Rasht, from March 2002 to February 2011. The data was collected for each woman from medical records and included age, parity, gravidia, gestational age, primary level of serum β-hCG, rupture status, past history of pelvic inflammation disease, EP, abortion, and intrauterine contraceptive device use. Women with tubal rupture were compared to those without rupture. Statistical analysis was conducted by SPSS 19 for Windows.

A total of 247 cases of tubal ectopic pregnancy were recorded during the study period. One hundred and ninety seven (79.8%) were cases with unruptured EP and 50 patients (20.2 %) were cases with ruptured EP. The mean level of β-hCG was significantly higher in patients with ruptured EP compared to patients with unruptured EP (p=0.03). Logistic regression analysis revealed that >1750 IU/ml of β-hCG levels (OR: 1.41; 95% CI: 1.18-1.68) was the significant risk factors for tubal rupture.

Higher β-hCG levels seem to be significant risk factors for rupture of a tubal EP.