فهرست مطالب مهبد ابراهیمی

Regarding to the prevalence of polycystic ovarian syndrome and its complication in women at reproductive age, this study was performed with aim to evaluate the relationship between total testosterone and sonographic findings in two groups of married hirsute women with normal and oligomenohrric mensturation in order to find it as a predictor and diagnostic factor to replace with current methods.

This case control study was performed on 93 hirsute patients in two groups of normal and oligomennohric menstruation in 2017-2018. Ferriman-Gallwey checklist was completed after clinical examination by gynecologist and then the patients were evaluated by vaginal ultrasonography and serum testosterone test. Data were analyzed by SPSS software (version 22) and t-test, Chi-square, Correlation, and regression tests. P<0.05 was considered statistically significant.

The level of total was 0.02- 2.8 nmol/lit, the mean of testosterone in regular menstruation group was 0.85 and in irregular menstruation group was 1.52. In regular menstrual hirsute group, there was significant relationship between hirsutism score in lower abdominal and thigh, and in irregular menstruation group, in lower abdominal and thigh and arm (p<0.05). In oligomennohric group, direct linear significant relationship was found between Gallwey score and sonographic findings (p<0.05). In addition, every quantified sonographic markers were checked with age, finally reverse linear relationship was found between mean number of follicles< 6 mm and age which indicates that the number of follicles< 6 mm will decrease with increasing age (p=0.01)

In both groups, the relationship between total testosterone and lower abdominal, thigh and arm hair growth is clear that can be as a predictor factor for total testosterone level. However the sonographic findings are as predictor factor in irregular mensturation patients group.

Gonadotropin-releasing hormone (GnRH) antagonist protocol has been proposed as a potentially proper option for the patients with limited ovarian reserve. Nevertheless, there is no significant difference in terms of clinical pregnancy between the GnRH antagonist and agonist cycles. The use of aromatase inhibitors such as letrozole was suggested by some studies.

The object of this study was to evaluate the efficacy of letrozole co-treatment with GnRH-antagonist protocol in ovarian stimulation of poor responder patients undergoing intracytoplasmic sperm injection.

A double-blinded randomized control trial was conducted on 70 infertile women with poor ovarian response based on Bologna criteria in two groups: letrozoleᩴantagonist (LA) group and placeboᩴantagonist (PA) group (n=35/each). The LA group involved at letrozole 2.5 mg daily over 5 days and recombinant human follicle stimulating hormone 225 IU/daily. The PA group received placebo over 5 days and recombinant human follicle stimulating hormone at the same starting day and dose, similar to LA group. GnRH-antagonist was introduced once one or more follicle reached ≥14 mm. The main outcome measures were the number of oocytes retrieved, fertilization rate, implantation rate, cycle cancellation rate, and clinical pregnancy rate.

There were no significant differences in demographic characteristics between groups. There were no significant differences between groups regarding the number of oocytes retrieved (p=0.81), number of embryos transferred (p=0.82), fertilization rate (p=0.225), implantation rate (p=0.72), total cycle cancelation rate (p=0.08), and clinical pregnancy rate (p=0.12).

The use of letrozole in GnRH-antagonist cycles does not improve clinical outcomes in poor responder patients undergoing intracytoplasmic sperm injection.

Receptivity of endometrium has a critical role in the establishment of pregnancy after embryo transfer in the treatment process of infertile couples. As the glycoprotein CA-125 is a product of human endometrium and is measurable in the peripheral circulation, it is investigated whether it might serve as an indicator of endometrial receptivity and predictor of pregnancy following Intracytoplasmic sperm injection (ICSI). In an observational diagnostic study, over a twelve-month period (from August 2013 to July 2014), all couples with male-factor infertility who attended to infertility clinic of Moheb Yas Hospital, Tehran and were candidate of performing ICSI, were invited to participate in the study. Based on the inclusion criteria of study, 64 women were eligible to take part in the study. They were assessed for serum CA-125 levels on the day of human chorionic gonadotropin (HCG) administration and also on the day of oocyte retrieval. After ICSI, the possibility of pregnancy was assessed by measuring serum concentration of &beta-HCG on 14 days after embryo transfer and also by visualizing the gestational sac by trans-vaginal ultrasound examination on four to five weeks after transfer. The pregnancy rate was compared between those with normal and high CA-125 levels. Among the subjects, 15 patients (23.4%) had high CA-125 levels, and totally 19 patients (29.7%) experienced pregnancy. Among those with normal and high CA-125 levels, 16 patients (32.7%) and 3 subjects (20%) experienced pregnancy, respectively, that showed no statistically significant difference according to Chi-square test (P=0.348). Also, according to the Fisher’s exact test, there was no correlation between CA-125 levels and the rate of pregnancy on the basis of body mass index (BMI). Totally, according to the obtained results in current study, it may be concluded that serum CA-125 levels has no prognostic value in prediction of the outcomes of ICSI among infertile couples with male-factor infertility.

Infertility is defined as failure to achieve pregnancy after one year of unprotected sexual intercourse. Infertility can be related to male or female factors. Varicocele is the most common cause of infertility in men that is correctable with surgery. The purpose of this study was to determine the effects of recombinant follicle-stimulating hormone (rFSH) on semen parameters in infertile men. This randomized clinical trial was done on 96 infertile men admitted to the Women's General Hospital Mohebe-Yas from September 2014 to September 2015. Inclusion criteria were to include varicocelectomy for unilateral idiopathic varicoceles and consent to participate in the study. Allergy to the drug combination and patient dissatisfaction were exclusion criteria. Patients participating in the study were divided into two groups randomly, one group received recombinant FSH three times a week and the other group received a placebo (normal saline) in the same way. After three months, the improvement of semen parameters, including motility, morphology and sperm count as well as the complications were determined in both groups. The data were analyzed with statistical software SPSS version 13 (Chicago, IL, USA). A total of 96 patients were enrolled in two groups of 48 men and women; both groups were matched in terms of underlying factors. The rate of improvement in the morphology and motility of sperm in the treated group was significantly more than the placebo group (P= 0.0001); but the changes in sperm count were not significantly different between the groups (P= 0.495). In summary, based on the results obtained in this study, it can be concluded that recombinant FSH is effective on improving semen parameters in infertile men after varicocelectomy compared with a placebo group and its major impact is on the morphology and motility of sperm.

Premature ovarian failure (POF) is a heterogeneous syndrome with several causative factors. Autoimmune mechanisms are involved in pathogenesis of 4-30 % of POF cases. The present review focuses on the role of autoimmunity in the pathophysiology of POF. The evidences for an autoimmune etiology are: demonstration of ovarian autoantibodies, the presence of lymphocytic oophoritis, and association with other autoimmune disorders. Several ovarian antigenic targets have been identified in POF patients. The oocyte seems to be the most often targeted cell. Lymphocytic oophoritis is widely present in POF associated adrenal insufficiency. Addisonۥs disease is one of the most common autoimmune disorders associated with POF. Early detection of this potentially life threatening disease was recommended in several studies. The gold standard for detecting autoimmune POF is ovarian biopsy. This procedure is not recommended due to unknown clinical value, expense, and risks. Several immunoassays have been proposed as substitute diagnostic tools. Nevertheless, there is no clinically proven sensitive and specific serum test to confirm the diagnosis of autoimmune POF or to anticipate the patient’s chance of developing POF or associated diseases. Some authors suggested the possible effects of immuno-modulating therapy on the resumption of ovarian function and fertility in a selected group of autoimmune POF patients. However, in most instances, this treatment fails to reverse the course of the disease. Numerous studies illustrated that standard treatment outcome for infertility is less effective in the presence of ovarian autoimmunity. The antibody-induced damage could be a pathogenic factor. Nevertheless, the precise cause remains obscure.

The presense of women in workplace is an unavoiding issue in modern world. The women work in different media. Occupational activities are suspected of having an adverse impact on outcomes of pregnancy. Premature delivery is a catastrophic event in course of pregnancy. The aim of the study was to define the incidence of premature delivery in occupationally involved pregnant women. A total of 287 primigravida women in an urban society with singleton pregnancies at 22 to 24 weeks gestation were enrolled in a prospective study. They worked in industrial manufactures. The patients reported the number of hours worked per week and answered specific questions designed to determine the following 5 sources of occupational fatigue including: 1- posture، 2- work with industrial machines 3- physical exertion 4-mental stress and 5- environmental stress. The risk of preterm delivery increased with standing more than 3 hours during activities in work place (p. value=0/019). There was not a statistically significant relationship between premature delivery and other sources of occupational fatigue. There was not a statically significant relationship between premature rupture of fetal membranes and the sources of occupational fatigue. There was not a statistically significant relationship between premature delivery and increasing number of hours worked per week. The relationship between premature delivery and occupational fatigue may provide guidelines according to pregnant women and their employers can be advised.

Sonohysterography refers to a procedure in which fluid is instilled into uterine cavity transcervically during trans-vaginal ultrasound examination to visualize uterine cavity and tubal patency. This procedure is unknown for the most researchers and physicians in our country. We collected the valid articles about sonohysterography in literatures in the last decade (2000-2012). We searched in Google scholar، Pub med، OVID، MEDLINE، EMBAS، Cochrane Labrary، SID، Iran medex، Mag Iran، and Med Lab. The accuracy of sonohysterography in evaluation of uterine cavity is the same as hysteroscopy. This procedure has ability to visualize uterine cavity and to differentiate between septate and bicornuate uterus. In comparison with hysterosalpingography، this procedure gives more information about uterine cavity. Sonohysterography has high sensitivity and specificity in the evaluation of tubal patency. It serves as valuable first line screening test in abnormal uterine bleeding and congenital uterine anomalies. Sonohysterography is a useful، cost-effective، simple and safe screening method with high quality and low potential for side effects for the evaluation of uterine cavity and tubal patency in infertile women and the patients with abnormal uterine bleeding. Patients tolerate this procedure well. This procedure can be used as a screening test for patients who need invasive procedures.

Controlled ovarian hyperstimulation and intrauterine insemination (IUI) cycle is an ideal protocol for some subfertile patients. So, we decided to try this therapeutic protocol for the patients with unilateral tubal blockage diagnosed by hysterosalpingography (HSG).

To evaluate the effect of unilateral tubal blockage diagnosed by HSG on cumulative pregnancy rate (CPR) of the stimulated IUI cycles.

A cross-sectional analysis was performed between October 2006 and October 2009 in an academic reproductive endocrinology and infertility center. Two groups of patients undergoing stimulated IUI cycles were compared. Sixty-four infertile couples with unilateral tubal blockage diagnosed by HSG as the sole cause of infertility in the group (?), and two hundred couples with unexplained infertility in the group (II). The patients underwent 3 consecutive ovarian hyperstimulation (Clomiphen citrate and human menopausal gonadotropin) and IUI cycles. The main outcome measurements were the CPRs per patients for 3 consecutive stimulated IUI cycles.

Cycle characteristics were found to be homogenous between the both groups. CPRs were similar in group? (26.6%) and group II (28%) (p=0.87; OR=1.075; 95% CI: 0.57 -2.28).

Unilateral tubal blockage (diagnosed on HSG) has no effect on success rate of stimulated IUI cycles, so COH and IUI could be recommended as the initial therapeutic protocol in these patients.

Premature ovarian failure (POF) is a common condition; its incidence is estimated to be as great as 1 in 100 by the age of 40 years. Physiologic replacement of ovarian steroid hormones seems rational until the age of normal menopause. Temporary return of ovarian function and pregnancy may occur rarely in women with POF. We report a case of POF who conceived during hormone replacement therapy.

Case:

 A 30 years-old woman with confirmed POF after pelvic surgery and sever emotional stress conceived spontaneously.

Return of ovarian function and achievement of pregnancy is possible in women with POF.