فهرست مطالب عالیه قاسم زاده

Interventional studies about platelet rich plasma efficacy in the patients with Repeated Implantation Failure (RIF) are not sufficient, while RIF is one of the major limiting factors in treating infertile patients. Therefore, the current study was designed to evaluate whether autologous intrauterine platelet rich plasma (PRP) instillation improves endometrial thickness (ET) in RIF patients during in vitro fertilization-embryo transfer (IVF-ET).

In this interventional study, a total of 20 women were enrolled whose embryo transfer cycles were canceled due to lack of proper growth of the endometrium or repeated implantation failure. In the study subjects, PRP was administered intrauterinely, and ultrasound was performed again 72 hours after the injection and the thickness of the endometrium was checked with Doppler ultrasound. Data were analyzed using SPSS 18 software.

The mean ET was calculated 6.80 ± 1.46 mm on the 10th day of menstruation, but 72 hours after the first PRP infusion, the mean ET was 8.09 ± 2 mm. The mean differences of increasing ET was 1.28 ± 0.53 mm (P < 0.02). After 72 hour of infusion, endometrial vascularity was good in 9 patients (45%) and moderate in 11 patients (55%). Two weeks following IVF-ET, β-HCG test was positive in 9 patients (45%) and negative in 11 patients (55%).     

The use of autologous PRP significantly improved the ET and endometrial vascularity, and most importantly increased pregnancy rate and live birth rates in RIF patients.

Oral progesterone is recommended as an alternative to gonadotropin-releasing hormone (GnRH) agonists and antagonists to prevent luteinizing hormone (LH) surge in assisted reproductive technology (ART) cycles. However, there are little data regarding its use.

We aimed to compare the effect of oral Utrogestan and Cetrotide (a GnRH antagonist) on preventing LH surge in ART cycles.

In this randomized clinical trial, 100 infertile women undergoing ART who received recombinant follicle-stimulating hormone (FSH) at 150-225 IU/day were randomly assigned to receive either Utrogestan 100 mg twice a day (case group) or GnRH antagonist protocol (control group) from cycle day 3 until the trigger day. Triggering was performed with 10,000 IU hCG) when there were at least three mature follicles. Viable embryos were cryopreserved for transfer in the next cycle for both groups. The number of oocytes retrieved and transfered embryos were compared between groups.

The case group had significantly higher progesterone levels on triggering day, more follicles of >14 mm with higher maturity, and more oocytes retrieved with a higher rate of embryos transferred. A small increase in the pregnancy rate was observed in the case group, with no significant between-group differences. The most important result was the lack of premature LH surge in either group upon serum LH assessment on the triggering day.

Utrogestan is an alternative treatment that could reduce the LH surge rate and increase the ART outcomes including number of oocytes retrieved and transfered embryos compared with GnRH agonists and antagonists.

Despite advances in clinical and laboratory techniques, including stimulating ovulation and transferring embryo, success rate of pregnancy remains is about 30%. The aim of this study was to assess the effect of intra uterine G-CSF on implantation and clinical pregnancy rate in patients with implantation failure in IVF.
This study was a randomized clinical trial on patients undergoing in vitro fertilization within an age range of 45-18 years and a history of failure in implantation for two or more times. A total of 34 patients receiving G-CSF in the intervention group and 38 patients in the control group were enrolled.
Mean age of the participants was 34.1 years with a standard deviation of 6.4 years. The average number of years of fertility was 10 years with a standard deviation of 5.2 years. The average number of embryos implanted in the intervention group was 2.88 with a standard deviation of 0.33. The figures for the control group were 2.97 and 0.37, respectively. The two groups did not differ significantly. With respect to the potential clinical and laboratory fertility outcomes, including existing gestational sac with observed heart rate and positive serum βHCG, no statistically significant difference was observed between the two groups.
It seems that the effect of G-CSF on improving fertility outcomes in patients with implantation failure does not exist and more related studies are recommended in this regard.

Infertility is one of the major issues in society and its incidence is estimated to be almost 10-15%.. Chlamydia is an important cause of sexually transmitted diseases leading to infertility.

This study was designed to determine the frequency of anti-Chlamydia trachomatis (anti-C. trachomatis) antibodies in infertile women at Alzahra hospital, Tabriz, Iran.

In this cross-sectional study, the blood samples were collected randomly from 184 infertile women (case group) and 100 pregnant women (control group).the frequency of specific IgG and IgM anti-Chlamydia trachomatis antibodies were evaluated using ELISA.

The frequency of anti-C. trachomatis IgG in pregnant and infertile women was 18% and 35.88%, respectively. The frequency of anti- C. trachomatis IgM in pregnant and infertile women was 2% and 5.44%.Our results showed the significant high rate of anti-Chlamydia trachomatis IgG (p=0.035), IgM (p=0.004) (p0.05).

According to the high frequency of antibody anti-C. trachomatis among infertile women in competition to the control group, evaluation and treatment of Chlamydia infections is necessary in these patients.

The multiple-choice questions (MCQs) are the most commonly used type of test items in medical education examinations. This method could be reliable tool for guarantee of education quality if develop carefully and according to standard test preparation criteria. This study aimed to compare some quality indicators of multiple-choice questions of pediatric, general surgery, internal medicine and genecology and obstetrics residency in pediatric residency promotion examinations (2010 and 2011) held at the Tabriz university medical science (TUMS), with board certification questions in these disciplines during the above years, and special consideration for improved quality management and monitoring of university internal examinations. Methods and Materials: In this cross-sectional study, we evaluated 2400 MCQs format of preboard examination of (TUMS) and national board examination in these disciplines. Individual MCQs evaluated for taxonomy levels (Bloom levels I, II and III) and following structural principles (based on Millman check list). Data analyzed by SPSS (version 18) software. Quality of MCQs in preboard examination of (TUMS) and national board examination in these disciplines was different and this difference was significance in some discipline. We find more perfect quality in national board MCQs examinations in general surgery and in preboard examination of (TUMS) in internal medicine. Pediatric and general surgery residency preboard MCQs examinations of (TUMS) were significantly low level of learning in comparing to national board MCQs examinations,and had more structural problems. To prevent descending quality of national and internal university examinations, management and monitoring of these exams is recommended.

More than half of all infertility cases are contributed by males. One of the important causes of infertility is free radicals in seminal fluid which causes sperm DNA oxidation and alteration in organic bases in DNA structure that finally leads to sperm destruction and reduction of its movement and fertility ability Therefore, in addition to semen analysis, sperm function tests are recommended. One of these performance tests is the evaluation of sperm double-stranded DNA. So the effect of vitamins E, C, omega-3W supplementation)) and zinc (Zn) as a treatment of anti-oxidative stress on the level of DNA fragmentation of sperm as well as the outcome of pregnancy in IUI candidates couples will be examined. The aim of this study was the evaluation of effects of ant oxidative treatment on sperm DNA fragmentation and IUI pregnancy tests. In a randomized clinical trial study, 150 infertile IUI candidates who met our inclusion criteria were enrolled in the study. A simple non-probability sampling was performed and 150 infertile couples (aged 25-40 years) attending were classified into five groups of 30 as follows: control group, the group receiving vitamin C, the group receiving vitamin E, the group receiving omega- 3, and the group receiving zinc (Zn); all groups were treated for 2 months. Statistical analysis was performed by SPSS, and DNA fragmentation index results were compared between the groups. The mean DFI in group receiving Zn before and after the treatment was 33.6±2.14 and 21±2.9 respectively. The mean DFI in group receiving Vitamin C before and after the treatment was 38±5.36 and 26.9±5.4 respectively, and in the control group it was 34.7±3.66 in the first sampling and 35.3±5.4 in the second sampling. In the group receiving omega 3, it decreased from 37.2±4.72 before treatment to 22.6±3.5 after the treatment. In the group receiving vitamin E, it was 37.1±3.54 before the treatment that decreased to 21±3.09 after the treatment. The comparison of the changes in 5 groups shows that vit. E was effective in reducing the fragmentation rate significantly (P<0.001). The pregnancy rate was not significantly different in study groups based on the chi-square analysis. Accordingly, this study and better response to treatment in groups receiving antioxidants comparing to the control group, we can conclude that the antioxidant therapy can decrease the sperm DNA fragmentation. The difference between the control and case groups was significant; the most considerable decrease in defragmentation was in group receiving vit. E. There were no cases of pregnancy in groups receiving the antioxidants and no cases of pregnancy were seen.

More than 40% of infertilities are due to endometriosis. Ultrustructural and histochemical study of endometrium will help to clarify the etiology of endometriosis.

The aim of the present study was to investigate the ultrastructure and occurrence of apoptosis in endometrial cells of women with or without endometriosis.

In the present case-control study، endometrial specimens from 12 women without endometriosis (as control) and 12 women with endometriosis (as case) were examined. Specimens for control group were obtained from the patients that were referred to gynecology hospital for hysterectomy due to various reasons. In case group the endometriosis was diagnosed according to laparoscopy and endometrial samples were taken using pippel biopsy. The specimens from both case and control groups were processed for Transmission Electron Microscopy (TEM)، TUNEL reaction technique and morphometric studies.

The results show that endometrial epithelium lost its continuity in women with endometriosis and endometrial cells have euchromatic nucleus in comparison to those from non-endometriosis. There were several apoptotic cells in the luminal and glandular endometrial epithelium and stroma from endometrium of control group. However، apoptotic cells were rarely seen in the endometrium from women with endometriosis. The difference in number of apoptotic cells between two groups statically was significant (p<0. 001).

Regarding the ultrastructural characteristics of endometrial epithelial cells and comparison of apoptotic occurrence in control and case groups it is concluded that endometrial cells in endometriosis group have higher potential to survive and possibly implant.

Backgrounds and Recently، the activity of paraoxonase-3 enzyme has been reported in follicular fluid، where the concentration of this enzyme in follicular fluid is three times higher than serum. However، the rule of this enzyme in the ovarian function is yet unknown. In the present study، the activity of this enzyme and the ratio of antioxidant/peroxidation activity within the follicular fluid of infertile and fertile who underwent reproductive cycles stimulatory will be evaluated and compared and their variation are correspond with to the oocyte number. The follicular fluid obtained from 50 infertile couples who underwent assisted reproductive techniques، follicular fluid paraoxonase-3 enzyme activity was determined by High Performance Liquid Chromatography، high-density lipoprotein was measured by sedimentary، total antioxidant capacity was by ELISA method and levels of malondialdehyde by tiobarbituric acid assay. From 50 women that present in this study، 20 women were infertile and 30 subjects were fertile. The paraoxnase-3 activity rate in follicular fluid of infertile women were significantly lower in compared with fertile women (p<0. 05). The average ratio of paraoxonase-3/ malondialdehyde in follicular fluid of infertile women were obtained lower than fertiles. Malondialdehyde concentration in follicular fluid of infertile women were significantly high (p<0. 05). The level of high-density lipoprotein and total antioxidant capacity in follicular fluid were not significantly. The result of present study showed that paraoxonase-3 activity and paraoxonase-3/ malondialdehyde rato in follicular fluid of infertile women are lower and while malondialdehyde levels conversly was higher.

Backgrounds and In assisted reproductive technology it is necessary to use and measure hormones for induction and maintaining the pregnancy. Oxytocin that is secreted by hyophysis has a great role in biology of reproduction. This study was conducted to measure the relation between follicular oxytocin and reproduction outcome. In this cross sectional study، in 110 women، candidates of assisted reproduction the follicular fluid oxytocin was measured. All recruties were selected randomly from Alzahra hospital infertility center of Tabriz university of medical sciences and in all of them HCG was used for induction of ovulation. The average age of Women was 28. 28 years. 84. 5 percent of their infertility was a primary type. The most common causes of infertility were male factors followed by anovulation for each women averagely 13. 47 oocyte were obtained and average of follicular fluid oxytocin was 230. 7 mIu/ml. 19. 1 percent of women became pregnant. Follicular oxytocin amount was different in various phases of follicle development and there wasn’t relation between follicular oxytocin and chance of pregnancy outcome.

Endometriosis is a common chronic inflammation which leads to infertility and chronic pelvic pain in affected women. Secretory phospholipase A2 type IIa (sPLA2IIa) is an acute phase reactant that is markedly increased in inflammatory disorders. To assess the effects of? -3 and? -6 polyunsaturated fatty acids (PUFAs) administration in endometrial cells culture on sPLA2IIa level and cell survival comparing homolog ectopic versus eutopic endometrial cells from endometriosis patients. In this experimental study, ectopic and eutopic endometrial tissue samples obtained from 15 endometriosis patients were immediately frozen. After thawing and tissue digestion, mixed stromal and endometrial gland cells were cultured for 8 days in three different culture media; balanced? -3/?-6, high? -3 and high? -6 PUFAs ratio. Cell survival was measured using 2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-(phenylamino) carbonyl-2H- tetrazolium hydroxide (XTT) method and sPLA2IIa level assessed with ELISA technique. The sPLA2IIa level was significantly higher in the ectopic endometrial cell culture compared to the eutopic group for each of the three matched treatments (balanced, high? -3 and high? -6). Also the sPLA2IIa level in the ectopic endometrial cell group was remarkably increased by each of the three PUFAs treatments compared to control condition (p<0.05, p<0.01, p<0.05 respectively). Cell survival in the eutopic group was significantly decreased by high? -6 culturing compared to control medium (p<0.05). The increase in sPLA2IIa level in ectopic endometrial cells by fatty acid treatments (especially high? -3), strengthens the hypothesis that PUFAs stimulate secretion of cytokines leading to increased sPLA2IIa level.

Endometriosis is a common chronic inflammation causing major problems including infertility. The role of omega-3 and omega-6 fatty acids as their potential anti-inflammatory effects in endometriosis needs to be further explored. The objective of this study was to compare serum phospholipid fatty acid profile in endometriosis patients with controls, and to explore the correlation of this profile with the severity of the disease. Sixty-four endometriosis patients and 74 control women, in reproductive age, participated in this study. Among the endometriosis patients, 19 cases were in stage I, 27 cases in stage II, 8 cases in stage III, and 10 cases in stage IV. Each patient underwent laparoscopy. Before surgery, 5 ml of blood was obtained. After extraction of the total lipids, serum total phospholipid fraction was isolated by thin layer chromatography. Fatty acid composition of the phospholipid fraction was determined by gas chromatography and the resulted profile was compared in endometriosis patients and controls. The profile was also compared in the endometriosis group based on the severity of disease. Stearic acid was significantly lower in the endometriosis group as compared to controls (P= 0.030). No other fatty acid compositions were significantly different between patients and controls. Serum ratio of eicosapentaenoic acid (EPA) to arachidonic acid (AA) was in reasonable correlation with the severity of endometriosis (r = 0.34, P = 0.006). According to these findings, levels of fatty acids in serum total phospholipids seem not to be a marker for endometriosis, but the EPA to AA ratio was a relevant factor indicating severity of illness.

Infertility involves pregnancy failure without using preventive measures for a year post intercourse. Transvaginal color Doppler ultrasonography (TCDU) is a method used for infertility diagnosis. Unexplained infertility diagnosed when all standard evaluations of infertility become normal. The uterine arteries hemodynamic indexes (UAHI) as a useful mean for pregnancy evaluation will be changed pre and post gestation. The aim of the present study was to determine UAHI changes in unexplained infertility via TCDU.

This prospective cohort study was done 50 women with unexplained infertility in Al Zahra hospital, Tabriz in September of 2005. The transvaginal color Doppler ultrasonography performed on patients in the 2nd day of menstruation and post intrauterine insemination. Human chorionic gonadotrophin (HCG) (5000-10000 IU) was intramuscularly injected post dominant follicle observation (17-18 mm diameter). Intra uterine insemination was then performed 24-48 h later. Then, hemodynamic indexes including uterine arteries, endometrial thickness and echogenicity were measured by sonography and compared in pregnant and non pregnant groups.

No significant difference found between mean right and left uterine arteries hemodynamic indexes on 2nd day of menstruation and HCG injection day in non-pregnant and pregnant groups. Mean pulsatility index was raised with the increase of endometrial thickness in non-pregnant and decreased with the increase of endometrial thickness in pregnant women.

The present study showed that uterine arteries hemodynamic index changes may not be a reliable method to evaluate pregnancy in women with unexplained infertility.