فردوس محرابیان

Assisted reproductive techniques have increased the chances of pregnancy for couples looking for a way to treat their infertility. To increase the effectiveness of these methods, studies are needed to identify the determinants of a successful pregnancy with these techniques.

The present study is a cross-sectional retrospective study that was performed on 253 couples who were referred for infertility treatment to the infertility clinic of Shahid Beheshti Hospital in Isfahan from April 2019 to March 2020 to evaluate the results of pregnancy in vitro fertilization. Demographic, clinical, and laboratory data from patient records were collected and entered into checklists.

Out of 253 couples, eighty-five (33.6%) became pregnant by IVF. The mean age of women with successful pregnancies was 33.96±5.2 years and in the unsuccessful pregnancies was 35.84±5.07 years. The results of this study showed that women who had a successful pregnancy after IVF were significantly younger than women who did not have a successful pregnancy (P=0.006). In the classification of patients into two groups of positive and negative pregnancies, younger age, adequate vitamin D levels, and higher sperm motility were the determinants of pregnancy in the first period of fertilization (Fresh protocol). Also, the existence of a failed history of infertility treatment in couples has been introduced as a negative factor for IVF fertility. 13(15.9%) abortions occurred and 11(12.9%) infants who were born with this method needed intensive care.

Lower age at the time of fertilization, higher vitamin D levels, and more active sperms were found to have important and prognostic roles in the success of pregnancy by in vitro fertilization technique.The results of the present study showed that, Increased unsuccessful treatment has been associated with the history of failed treatment. Therefore, to respond to the relationship between previous infertility treatments and success in subsequent pregnancies in the IVF process, It is recommended to conduct studies with larger sample size and at a higher time efficiency.

Restless legs syndrome (RLS) is a sensory-motor disorder in which, a person experiences leg
discomfort, and tries to improve it by leg motion. Pregnancy is among the factors that primarily causes or
secondarily exacerbates restless legs syndrome. In this study, we assessed the incidence of this syndrome among
pregnant women, and its association with preterm delivery.
This was a cross-sectional study on 172 pregnant women with preeclampsia in 2015-2018 selected
based on a census method. Restless legs syndrome diagnostic questionnaire and its severity based on
International Restless Leg Syndrome Study Group rating scale (IRLS) were evaluated and compared in patients.
Moreover, demographic information including age, smoking, body mass index (BMI), number of gravities,
number of abortions, age of pregnancy, type of delivery, neonate's weight at the time of delivery, and neonates'
gender were recorded and compared.
Findings: There was no association between restless legs syndrome and mother's age, body mass index,
smoking, number of gravities, number of abortions, and time of delivery (P > 0.050 for all). Duration of
pregnancy was 33.43 ± 3.87 and 32.22 ± 4.26 weeks in patients with and without restless legs syndrome,
respectively. 85.7% of patients with restless legs syndrome had preterm delivery. Severity of restless legs
syndrome was 17.47 ± 6.11 and 12.5 ± 3.98 in patients with preterm and term labor, respectively, but no
significant association (P = 0.063).
Based on findings of the current study, although restless legs syndrome among the women with
preeclampsia was accompanied with preterm labor, and also was more severe among them, no statisticalassociation was found in these regards. Further studies are recommended.

Monocytes are a key component of the immune system, which play an important role in inflammatory and innate immune responses. So the isolation of these cells is important in immunology researches and accordingly many methods have been developed for the monocyte isolation. One of the least expensive and simple separation methods is using the ability of these cells to adhere to solid surfaces that were examined in this study.
In this way, after the isolation of peripheral blood mononuclear cells (PBMCs), monocytes were isolated from cell suspension by using the adhesion ability of these cells to the plastic surface.Isolated monocytes were stained by using specific antibodies labeled with fluorescent dyes (PE, FITC) binding to specific markers on the surface of monocytes CD11b and CD14 and the purity of cells were characterized by flow cytometry.
Flow cytometry results after separation of monocytes shown that 90.2% of cells were expressed two markers CD11b and CD14.
Although there are several monocyte isolation methods, each of them have advantages and disadvantages. One of the least expensive and Simple method of isolation is using adhesion ability of these cells that provides possibility of monocyte isolation with high purity.

This study aimed to evaluate the diagnostic value of anti-Mullerian hormone (AMH) marker in predicting response to treatment of infertility in patients with polycystic ovary syndrome (PCOS).
This study was conducted on 80 patients with PCOS who were candidates for infertility treatment. In all patients, the serum levels of AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone and estradiol were measured in the 3rd day of menstrual cycle; then were treated using clomiphene. For the patient who responded to clomiphene, human menopausal gonadotropin (HMG) was added. Then, in the patient with follicle of size of 17 mm, human corionic gonadotropin (HCG) was administered followed by intercourse after 36 hours. After 14 days from HCG injection, βhCG was measured. In patients with positive βhCG, transvaginal sonography was done after 2 weeks. The relationship between serum level of AMH and pregnancy rate were assessed. P value of more than 0.05 was concedered as significant.
Findings: Cut-of-point for AMH level according to presence or absence of pregnancy was 4.85 ng/ml and it was not statistically significant (P = 0.079).
This study shows that the serum level of AMH is not an appropriate predictor of responsing to treatment with clomiphene gonadotropin in weman with PCOS.

As for increasing the rate of cesarean section, its cost and limited resources in our country, this study was done aimed on assessing demographic factors and background variables as predictors of cesarean section. This cross sectional study was conducted on 2124 term pregnant women referred to Isfahan hospitals in May 2009. Sampling method was census. Data were collected and analyzed using SPSS software version 15 and logistic regression model. P value less than 0.05 was considered statistically significant. Women who had one or two children compared to nulliparous, age equal or higher than 20-35 compared to age less than 20, having education and job, admitted in private hospital and women who covered by various insurances had more elective cesarean section. The odds ratios in all of them were significant (p<0.05). Women with high eco-social level and also having insurance in pregnancy period can consider as predictive factors for elective cesarean section.

Adhesion is a common complication of gynecology surgery so different barrier agents and solutions have been used during these operations to separate and protect tissues from adhesion after surgery. Adept is one of these solutions that have been postulated to reduce the chance of adhesion following gynecolgy surgery. To evaluate the effect of 4% icodextrin in reducing adhesion formation in comparing with sterile water and human amniotic fluid in rabbits. In this prospective experimental study 30 white Newzealand female rabbits were selected and randomized in to three treatment groups. The rabbits were anesthetized and an abdominal incison was made, uterine horns were abrated with gauze until bleeding occurred. Before closing the abdomen, the traumatized area was irrigated either by 30cc of sterile water, 30cc of 4% Adept or 30cc of human amniotic fluid. The solutions were labeled only as solutions A (steriel water), B (icodextrin), or C (human amniotic fluid). On the seventh day after surgery, second laparotomy was performed to determine and compare adhesion formation in rabbits. There was significant difference between mean score of adhesions in 4% icodextrin group (2.1±0.70) in comparison to sterile water group (10.4±0.60) and amniotic fluid group (8.7±0.84). But the difference between mean score of adhesions in amniotic fluid group in comparison to sterile water group was not significant (8.7±0.84) versus (10.4±0.60). The use of 4% icodextrin solution was more effective than human amniotic fluid and sterile water in reducing adhesion formation in a gynecological surgery model in rabbits

It has been shown that contraceptive pills, which are commonly used orally, have some side effects, such as vomiting, nausea, high blood pressure. Vaginally usage of the contraceptive pills reduces these side effects. This study aimed to evaluate and compare the effect of orally and vaginally usage of low dose contraceptive pills on bleeding pattern in dysfunctional uterine bleeding. In this clinical trial study, 100 women who had been referred to the Shahid-Beheshti and Al-Zahra hospitals of Isfahan as having dysfunctional uterine bleeding were divided into two equal groups. Groups 1 were given contraceptive pills orally and group 2 vaginally. Using pictorial bleeding assessment, the amount and duration of uterine bleeding were measured at the beginning and end of the study. In addition, the side effects of the pills were evaluated at the end of the study from both groups. Data were analyzed using Chi- square test. Low dose contraceptive pill in vaginal route decreased bleeding amount and duration of bleeding more effectively than oral rout (P<0.05). The side effects of contraceptives, such as nausea and vomiting was significantly higher in orally-used group compared to the vaginally-used group (P<0.05), but vulvo-vaginitis was significantly higher in vaginally-used group (P<0.05). Using the contraceptive pill by vaginal rout is a safe method with few side effects compared with the oral rout.

Asymptomatic bacteriuria (ABU) is one of the most common problems during pregnancy. In our public health system, screening of ABU by urinalysis (UA) is free for all pregnant women but urine culture (UC) is more sensitive and specific than UA. Determination of condition to screening asymptomatic bacteriuria with urine culture was the main field of the study. 200 pregnant women in two groups were screened by Dipstick UA and UC. Costs (6) were calculated per groups, and prevented symptomatic bacteriuria was considered as effectiveness (E). Proportion of C/E was estimated. Sensitivity analysis was performed over wide ranges of prevalence of asymptomatic bacteriuria (ASB). Prevalence of bacteriuria was 4 percent. Direct costs in leukocyte esterase- nitrite dipstick group were 723600 Rials and in leukocyte esterase- nitrite dipstick + urine culture group were 1788800 Rials. The incremental costs in first group were 70200 Rials and cost savings in second group were 46800 Rials. The prevention ratio in first group was 55 percent, and in urinalysis +urine culture was 100 percent. The cost- effectiveness ratio in first group was 1. 3 and in second group was 1. 7. In sensitivity analysis, if prevalence of ASB was 13 percent، -effectiveness of these strategies were equal and if prevalence was 14 percent and higher, the cost- effectiveness with leukocyte esterase- nitrite dipstick+ urine culture was lower than leukocyte esterase- nitrite dipstick group. According to our findings, prevalence of ABU was low, screening of ABU by UA in public system is cost/effective at the present situation, but epidemiologic trend study is necessary to make decision about screening tools.