فهرست مطالب مریم افتخار

Recurrent miscarriage, as the occurrence of two or more of pregnancy loss before the 20th wk, can occur for multiple causes. One of the causes of miscarriage may be a defect in the process of angiogenesis because the delivery of nutrients to the fetus is decreased and it may lead to miscarriage. Also, micro ribonucleic acids play an important role in the development of diseases. The microRNAs 16 and 21 are the most well-known angiogenesis-related miRNAs, which their gene targets are vascular endothelial growth factor-A and phosphatase and tensin homolog, respectively.

To evaluate the changes in expression of microRNAs 16 and 21 and their association with the gene targets in women with unexplained RM.

In this case-control study, blood samples were taken from 25 women with unexplained RM and 25 controls. After extraction of RNA, the relative expression of microRNAs and their gene targets was measured using real-time quantitative reverse transcription-PCR method.

Our findings showed that miR-21 expression was significantly decreased in both plasma and peripheral mononuclear cells (p=0.04 and p=0.02, respectively) and could be associated with the PTEN expression (p=0.03), however, there is no significant correlation between miR-16 and VEGF-A.

One of the most remarkable results of this study is that miR-21 showed significant changes in both plasma and peripheral mononuclear cells, which can be related to the etiology and progression of RM.

Gonadotropin-releasing hormone agonists (GnRH-a) was increasingly used for triggering oocyte maturationfor the prevention of ovarian hyperstimulation syndrome. Studies suggest that GnRH-a might be used as a better trigger agent since it causes both Luteinizing hormone and follicle stimulating hormone release from a physiologic natural cycle.

The aim of this study was to evaluate the effect of dual-triggering in assisted reproductive technology outcomes.

192 normal responder women aged ≤42 years and 18

The mean of retrieved oocytes and obtained embryos were statistically higher in the dual-trigger group (group I), but the implantation and pregnancy rates were similar in two groups.

The results of our study did not confirm the favorable effect of dual-triggered oocyte maturation with a GnRH-a and a standard dosage of hCG as an effective strategy to optimize pregnancy outcome for normal responders in GnRH-antagonist cycles. We think that this new concept requires more studies before becoming a universal controlled ovarian hyperstimulation protocol in in vitro fertilization practice.

Chlamydia trachomatis and Neisseria gonorrhoeae are the most prevalent bacterial sexually transmitted diseases in women.

The purpose of this study was to investigate the prevalence of gonorrheal and chlamydial infections and determination of related risk factors in married women with vaginal discharge attending gynecological outpatient department (OPD) in Zanjan in 2013-2014.

In this cross sectional study, 100 married women aged 18-49 years with vaginal discharge were evaluated for signs and symptoms of gonococcal and chlamydial infections. Then cervical discharge samples and blood samples were collected from each subject for the detection of Nisseria gonorrhea and Chlamydia trachomatis by bacterial culture and serological tests, respectively.

The overall prevalence of Chlamydia trachomatis and Nisseria gonorrhoeae were 16% and 4%, respectively. There was no significant relationship between the contraception methods, previous history of vaginal infections, previous history of urinary tract infections, number of coitus per week and self-reported symptoms (itching, burning, abdominal pain) with prevalence of Nisseria gonorrhoeae and Chlamydia trachomatis.

According to our results, the prevalence of gonococci infection in Zanjan was remarkable and relatively was higher than other parts of Iran, therefore it is necessary to put emphasis on education and further preventive and therapeutic programs.

Although pregnancy rate in in vitro fertilization-embryo transfer (IVF-ET) cycles has been increased over the preceding years, but the majority of IVF-ET cycles still fail. Granulocyte colony stimulating factor (GCSF) is a glycoprotein that stimulates cytokine growth factor and induces immune system which may improve pregnancy rate in women with history of implantation failure.

The aim of this study was to evaluate GCSF ability to improve pregnancy rate in women with history of implantation failure

0.5 ml (300 μg/ml) GCSF was infused intrauterine in intervention group. Pregnancy outcomes were assessed based on clinical pregnancy.

The mean age of participants was 31.95±4.71 years old. There were no significant differences between demographic characteristics in two groups (p>0.05). The pregnancy outcome in GCSF group was improved significantly (p=0.043).

GCSF can improve pregnancy outcome in patients with history of implantation failure.

Gonadotropin-releasing hormone (GnRH) plays essential roles in embryo implantation, invasion of trophoblastic tissue, and steroid synthesis in the placenta.

The aim of this study was to evaluate the effect of GnRH antagonist administration on pregnancy outcomes in early implantation period.

In this retrospective study, 94 infertile women undergoing GnRH antagonist protocol who were at risk of ovarian hyperstimulation syndrome (OHSS) were included. Sixty-seven patients (group I) received Cetrorelix 0.25 mg/daily in the luteal phase for 3 days while in 27 participants (group II), it was not administered. Pregnancy outcomes were assessed based on chemical and clinical pregnancy rates.

The pregnancy outcomes were not significantly different between two groups (p=0.224).

The present study proposed that luteal phase GnRH antagonist administration does not influence the chance of successful pregnancy outcomes.

Despite major advances in assisted reproductive techniques, the implantation rates remain relatively low. Some studies have demonstrated that intrauterine infusion of granulocyte colony stimulating factor (G-CSF) improves implantation in infertile women.

To assess the G-CSF effects on IVF outcomes in women with normal endometrial thickness.

In this randomized controlled clinical trial, 100 infertile women with normal endometrial thickness who were candidate for IVF were evaluated in two groups. Exclusion criteria were positive history of repeated implantation failure (RIF), endocrine disorders, severe endometriosis, congenital or acquired uterine anomaly and contraindication for G-CSF (renal disease, sickle cell disease, or malignancy). In G-CSF group (n=50), 300 µg trans cervical intrauterine of G-CSF was administered at the oocyte retrieval day. Controls (n=50) were treated with standard protocol. Chemical, clinical and ongoing pregnancy rates, implantation rate, and miscarriage rate were compared between groups.

Number of total and mature oocytes (MII), two pronuclei (2PN), total embryos, transferred embryos, quality of transferred embryos, and fertilization rate did not differ significantly between two groups. So there were no significant differences between groups in chemical, clinical and ongoing pregnancy rate, implantation rate, and miscarriage rate

our result showed in normal IVF patients with normal endometrial thickness, the intrauterine infusion of G-CSF did not improve pregnancy outcomes.

Genital tuberculosis (GTB) is an important cause of female infertility, especially in developing countries. The positive results of polymerase chain reaction (PCR) in endometrial GTB in the absence of tubal damage raise the possibility of the detection of sub-clinical or latent disease, with doubtful benefits of treatment.

To evaluate the mycobacterium tuberculosis infection in endometrial biopsy samples collected from unexplained infertile women attending Yazd Research and Clinical Center for Infertility by using PCR techniques.

In this cross sectional study, 144 infertile women with unexplained infertility aged 20-35 years old and normal Histro-saplango graphy findings were enrolled. Endometrial biopsy samples from each participant were tested for mycobacterium tuberculosis detecting by PCR. In 93 patients, peritoneal fluid was also taken for culture and PCR.

The PCR results of endometrial specimens were negative in all cases, demonstrating that there was no GTB infection among our patients.

Our results showed that GTB could not be considered as a major problem in women with unexplained infertility. Although, studies have indicated that PCR is a useful method in diagnosing early GTB disease in infertile women with no demonstrable evidence of tubal or endometrial involvement.

Poor ovarian response to controlled ovarian stimulation is one of the most important interest points in assisted reproduction. Mild ovarian stimulation seems to be preferable to high dose of FSH regimens in women with a history of poor ovarian response in previous protocol. Clomiphene citrate and letrozole alone or in combination with FSH have been used in mild ovarian stimulation protocol.

To compare the efficacy of letrozole and clomiphene citrate for mild ovarian stimulation on assisted reproductive technology outcomes in poor responders.

In a randomized control study, 184 women aged between 20 and 45 years with the history of poor response to ovarian stimulation who were candidate for ART were randomly subdivided into two groups: group I (n= 80), women who underwent the clomiphene/gonadotropin/antagonist protocol; and group II (n= 87), patients who underwent the letrozole/gonadotropin/antagonist protocol. Groups were compared regarding implantation, chemical and clinical pregnancy rates.

There was a significant difference in the mean endometrial thickness between two groups (9.16±1.2 mm vs. 8.3±0.3 mm). The implantation rate was significantly higher in letrozole group compare to clomiphene group (7.2 vs. 6.6%, p=0.024 respectively). No significant differences were found in chemical and clinical pregnancy rate between two groups.

In mild ovarian stimulation protocol, letrozole and clomiphene have similar value for the poor responder. The optimal treatment strategy for these patients remains debated.

We often see patients with a thin endometrium in ART cycles, in spite of standard and adjuvant treatments. Improving endometrial growth in patients with a thin endometrium is very difficult. Without adequate endometrial thickness these patients, likely, would not have reached embryo transfer.

We planned this study to investigate the efficacy of intrauterine granulocyte colony-stimulating factor (G-CSF) perfusion in improving endometrium, and possibly pregnancy rates in frozen-thawed embryo transfer cycles.

This is a non-randomized intervention clinical trial. Among 68 infertile patients with thin endometrium (-7 mm) at the 12th-13th cycle day, 34 patients received G-CSF. G-CSF (300 microgram/1mL) to improve endometrial thickness was direct administered by slow intrauterine infusion using IUI catheter. If the endometrium had not reached at least a 7-mm within 48-72 h, a second infusion was given. Endometrial thickness was assessed by serial vaginal ultrasound at the most expanded area of the endometrial stripe.

The cycle was cancelled in the patients with thin endometrium (endometrial thickness below 7mm) until 19th cycle day ultimately The cycle cancelation rate owing to thin endometrium was similar in G-CSF group (15.20%), followed by (15.20%) in the control group (p=1.00). The endometrial growth was not different within 2 groups, an improvement was shown between controlled and G-CSF cotreated groups, with chemical (39.30% vs. 14.30%) and clinical pregnancy rates (32.10% vs. 12.00%) although were not significant.

Our study fails to demonstrate that G-CSF has the potential to improve endometrial thickness but has the potential to improve chemical and clinical pregnancy rate of the infertile women with thin endometrium in frozen-thawed embryo transfer cycle.

Frozen- thawed embryo transfer is an essential part of ART treatment and outcomes of this procedure are associated with several clinical factors. Several studies have showed an increase level of IVF outcomes in women with sufficient vitamin D.

whether treatment of vitamin D insufficiency can improve pregnancy rates in frozen-thawed embryo transfer cycles.

This is an interventional, randomized clinical trial. Serum 25-(OH) vitamin D level of 128 women who had undergone IVF/ICSI with cryopreservation of embryos was checked. One hundred fourteen infertile women with insufficient serum vitamin D (less than 30 ng/ml) were included in the study. Fifty seven women were treated with supplementary vitamin D, 50000 IU weekly, for 6-8 weeks and fifty seven women were received no supplementation. One hundred six women completed frozen thawed embryo transfer cycles and included in the final analysis. Primary and secondary outcomes were chemical and clinical pregnancy respectively.

Our study did not show any significant difference between vitamin D insufficient and treated women in term of chemical (29.40% vs. 29.10% respectively, p=1.00) or clinical (25.50% vs. 21.80% respectively, p=0.81) pregnancy rates.

Vitamin D insufficiency treatment is not associated with higher pregnancy rate in frozen-thawed embryo transfer cycles.

Frozen embryo transfer (FET) is one of the most important supplementary procedures in the treatment of infertile couples. While general information concerning the outcome of fresh embryo transfer has been documented, paucity of investigations has addressed the clinical factors influenced on pregnancy rates in FET.

In this study, we performed a retrospective analysis of clinical factors that potentially influence the outcome of FET.

We reviewed the data from 372 women who were subjected to FET registered from April 2009-2011 at the Research and clinical center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Baseline data and pregnancy rate were collected. The data were analyzed statistically using the Kolmogorov-Smirnov, and Mann-Whitney tests.

The clinical pregnancy rate was 57.7 and 29.2% in women <35 years old, and women >35 years old, respectively (p<0.0001). Clinical pregnancy rates in women with FSH <10 IU/ml, and FSH >10 IU/ml were 56.3% and 17.5 %, respectively (p<0.0001). Whereas the other clinical parameters consist of reason of fetus freezing, primary IVF protocol, IVF procedure, endometrial thickness, treatment duration to fetal transfer found to be unrelated to FET outcomes (p>0.05).

Female age and basal FSH level are the most important factors influencing the clinical pregnancy rate following FET.

Primary and secondary infertility are the most common presenting symptom in patients with pelvic tuberculosis (PT). Endometriosis is commonly associated with an increased risk of infertility.

Case: 

Here، we report a rare case of coexisting PT and endometriosis in a 30-year- old woman، and the effects of controlled ovarian stimulation on reactivation of pathogen.

Coexisting endometriosis and tuberculosis of fallopian tube and ovary، as in present case، may alter clinical and radiological features، leading to difficulty in diagnosis. Early diagnosis with surgical exploration and adequate treatment can improve the chances of conception and also minimize morbidity.

Malignancies are not rare in girl and women during their reproductive years. Over the past three decades, the survival rate for cancer has been improving due to progress in cancer diagnosis and treatment. These patients frequently experience a variety of treatment, and disease-related side effects that diminish their quality of life during and after treatment; among these are loss of fertility and sexual dysfunction. There have been recent advances in the field of fertility preservation, which can allow many of these genital cancer survivors to have children in the future. This topic review discusses available options and specific strategies for fertility preservation in adolescent and young women with malignancies who wish to preserve their ability to become pregnant in the future.

Gonadotrophin-releasing hormone (GnRH) agonist is used for controlling ovarian stimulation in assisted reproductive technology (ART) cycles which has some benefits.

To compare the efficacy of two different formulations of GnRH agonist: short-acting and long-acting, for ART protocols.

In a prospective randomized study, one hundred women who underwent ART cycles were randomly divided into two groups. In group I, the patients received one single injection of 1.87 mg Triptorelin in previous mid-luteal phase. In group II, Decapeptyl 0.1 mg per day started from previous mid-luteal phase. Pregnancy outcome in in vitro fertilization (IVF) cycle was compared between two groups.

There were no statistically significant differences in the number of retrieved oocyte (p=0.545), fertilization (p=0.876), implantation (p=0.716) and pregnancy rate (p=0.727) between the two groups.

There were not any advantages in IVF outcome between half-dose long-acting and short-acting GnRH agonist groups in ART cycle.

Repeated implantation failure (RIF) is defined as pregnancy failure after two to six times with at least ten high grade embryo transfer to uterus. A variety of causes have been anticipated for RIF, including anatomical, autoimmune, genetics, endocrine and thrombotic anomalies. Factors responsible for RIF have important implication regarding treatment however in many couples a perfect cause cannot be found.

Cases:

 In these case series, we reported nine couples with RIF that after investigation no definitive etiology was found for RIF and empirical therapy by heparin, aspirin and or immunotherapy was not effective. In these cases we recommended transfer of embryos to surrogate uterus. Nine patients were studied and six of them developed a normal pregnancy (pregnancy rate=66.66%).

This study showed that surrogacy is a good option for treatment of RIF.