فهرست مطالب atossa mahdavi

The aim of the present study was to evaluate the effect of the intrauterine administration of platelet-rich plasma (PRP) before embryo transfer (ET) on pregnancy outcomes in women with repeated implantation failure (RIF).

This randomized controlled trial included 120 RIF women who were candidates for frozen-thawed ET. In the PRP group (n=60), the intrauterine infusion of 0.5 mL PRP was performed 48 hours before ET, and the control group (n=60) underwent ET without intrauterine administration.

The implantation rate (28% vs. 11.9%, P<0.001), clinical pregnancy (51.6% vs. 26.6%, P=0.005), and live birth rate (58.3% vs. 28.3%, P=0.001) in PRP group were significantly higher compared to the control group. Based on the results, there was no significant difference with regard to miscarriage (12.5% vs. 12.9%, P=0.97) and multiple pregnancy rate (0.133% vs. 0.05%, P=0.11) between the two groups. Finally, preterm delivery was significantly higher in the PRP group (P<0.001).

According to this study, the result revealed that PRP is effective in the improvement of pregnancy outcomes in RIF patients. Further studies are needed to identify the group of patients who would benefit from this intervention.

Intrauterine retention of fetal bone fragments is a rare condition that could happen after abortion (especially illegal abortion). It can cause secondary infertility as bone fragments can work as an intrauterine contraceptive device.

A 25-year-old Iranian woman was referred to Shariati Hospital due to infertility. During infertility work up to normal semen analysis, adequate ovarian reserve with regular ovulatory cycles was documented. An ultrasound scan revealed focal echogenic shadowing lesions inside the uterine cavity. Hysteroscopy was conducted and many intrauterine bone fragments were revealed. Six months after hysteroscopic removal of fetal bones, the patient became pregnant and delivered a healthy and term baby.

Intrauterine fetal bone retention is a scarce event that happens after pregnancy termination due to the incomplete evacuation of fetal tissues. It can cause dysfunctional uterine bleeding, menorrhagia, dysmenorrhea, pelvic pain, abnormal vaginal discharge, and secondary infertility. The detection of the problem and the removal of the remained bones by hysteroscopy have made possible to treat the patient safely and restore normal uterine function and female fertility.

Cervical ectopic pregnancy (CEP) is a rare and dangerous form of ectopic pregnancy in which the blastocyst is installed within the endo-cervical canal. CEP diagnosis requires special awareness to evaluate patient precisely. Individualizing controversial medical and surgical management strategies is of importance in medical practice.

A 35-year-old nulliparous woman on her 9th week of pregnancy was referred to our hospital with vaginal bleeding preliminary misdiagnosed as aborting intrauterine pregnancy. Transvaginal ultrasound revealed an empty uterus and a viable triplet pregnancy just below the level of internal os. Cervical curettage after cerclage suture placement procedure removed conception tissues completely. Consequently, in the next few hours vaginal bleeding decreased to minimal amount and vital signs remained within normal limits and there was no hematocrit change. On follow-up day 32, serum B-HCG became negative.

CEP diagnosis requires special attention and awareness to evaluate patient precisely along with skillful assessment of possible risk factors. Lifesaving treatment beside fertility preservation was successful with pre-curettage cerclage.

Trigeminal neuralgia (TN) is the most common neuralgia in the head and neck region and a common cause of orofacial pain. It is routinely treated with carbamazepine. Laser, acupuncture and radiofrequency are among other treatment modalities for this condition. This study sought to assess the efficacy of laser therapy in conjunction with carbamazepine for treatment of TN.
A total of 30 patients who met the inclusion criteria were divided into 2 groups of cases and controls (n = 15) by double blind randomized controlled clinical trial. All patients received 100 mg carbamazepine at baseline and another 100 mg after 2 days for pain control. In the case group, low level laser therapy (LLLT) was also performed in addition to pharmaceutical therapy. Sham laser was used in the control group instead of LLLT. Treatment was continued for 9 sessions (3 days a week). The intensity of pain was measured and compared in the 2 groups using visual analog scale (VAS) in 3 period. The qualitative variables among the groups were compared using the repeated measures analysis of variance (ANOVA).
The severity of pain was lower at the end of treatment in the case compared to the control group so this difference was statistically significant (P = 0.003). The severity of pain decreased in both groups over time. Significant difference was noted in this regard between the 2 groups either (P = 0.003). At the end of treatment pain intensity dropped in the intervention group from 6/8 to 1/2 and control group from 6/6 to 2/7.
Laser therapy did add to the value of pharmaceutical therapy for treatment of TN. Both groups experienced significant improvement over time. So it is better to used laser complementary therapy to reduce side effects and the medicine dosage.

The most prevalent endocrine disease with unknown etiology among women in their fertility period is Polycystic Ovarian Syndrome (PCOS). The disease causes some changes in oxidative stress system, which in turn, is associated with such diseases as metabolic syndrome, diabetes, cardiovascular diseases, and periodontitis. The present study investigated periodontal status and total antioxidant status in serum of women with PCOS.
In this cross-sectional, analytic study eighty women, 40 with PCOS as cases and 40 infertile women without PCOS participated. Interview, oral examination and radiographs, and laboratory tests served as data collection tools. Body Mass Index (BMI), Community Periodontal Index (CPI), Periodontal Disease Index (PDI), bone loss, and total anti-oxidant status (TAS) in serum of the participants were measured. Chi-squre test, Mann-Whithney test, and linear regression served for statistical analysis.
While in case group 21 patients had bone loss, in control group bone loss was found in 11 pateints (P=0.022). The distribution of maximum CPI score among cases was significantly different from that among controls in that more frequent higher scores existed among cases (P=0.016). The mean PDI in case and control group was 6.23±3.3 and 4.48±2.6, respectively (P=0.015). In general linear model the level of serum TAS was significantly associated with CPI (P=0.039) and BMI (P=0.019).
Women with PCOS seem to be more susceptible to periodontal disease compared to other women. This calls for comprehensive periodontal care and regular dental visits for patient
with PCOS.

The effect of elevated progesterone level on human chorionic gonadotropin (HCG) day in in vitro fertilization cycles is controversial. Some suppose that rise in progesterone level seems to have a negative impact on implantation and pregnancy by desynchronizing the endometrium, while others disagree.
To evaluate the superiority of the frozen cycle over fresh cycle on live birth in patients with elevated progesterone level on HCG day.
In this double-blind, randomized clinical trial, 72 women undergoing assisted reproductive technology with elevated progesterone level (≥1.8 ng/dl) on HCG day were included. The participants were grouped by fresh versus frozen embryo transfer, randomly. Finally, the clinical pregnancy and live birth rate were compared.
The implantation rate was 21.51%. The clinical pregnancy rate was 47.22% in fresh embryo transfer group (17/36) and 41.66% in frozen group (15/36) (p=0. 40). The live birth rate was not significantly difference between two groups (p=0.56).
None of the fresh and frozen cycles are superior to the other and we recommend individualizing the decision for each patient. The frozen cycle may impose more emotional stress on patients .

This study investigated efficacy and side effects of Morphine suppository for pain management after the first elective caesarean delivery in comparison to Diclofenac suppository. One hundred women aged 18-40 with term pregnancies undergoing elective caesarean section for the first time participated in this prospective project. Exclusion criteria included drug sensitivity, fetal malformations or defects, and complications during the cesarean operation. After same spinal anesthesia and same surgical techniques and in the recovery room patients consecutively received 100 mg diclofenac suppository or 10 mg morphine suppository. The pain severity was rated by “Numerical Rating Scale.” There was not the difference between two groups in terms of basal information. Pain score was significantly different between two groups in the first 12 hours (5.66 ±1.36 in morphine group and 3.63±0.96 in diclofenac group) but not in the second 12 hour period. Considering pain scores every two hours in first 12 hours and every 4 hours in second 12 hours, morphine group had higher scores in comparison to diclofenac group. Also, the morphine group required pethidine injection sooner than the other group. The time giving first pethidine injection was 3.28±2.16 hours after operation in morphine group and 5.24±4.07 hours after operation (P

Improvement of assisted reproductive technique (ART) results in higher pregnancy rates from positive Beta HCG to take home baby statistics. Despite developments in culture media allowing blastocyst stage transfer, some centers apply second, third and sometimes fourth day post injection for embryo transfer. This study aimed to compare their reproductive outcomes. This prospective cohort study conducted on 218 infertile couples with at least 4 oocytes retrieved and 2 good quality embryos. They were divided consecutively into 2nd (ET2) or 3rd (ET3) day embryo transfer. Some patients experienced 4rd (ET4) day embryo transfer due to weekend reasons, so we included them in our comparison as well. There were 98, 97 and 23 patients in the aforementioned groups, respectively. Reproductive and pregnancy outcomes were evaluated by Chi square and t-test with the significance level set at α=0.05. Totally, 73 patients (33%) had positive beta HCG and 39.7 percent of them (n=29) experienced pregnancy loss. Positive Beta HCG was detected in 31(31.6%) of ET2 patients, 38 (39.2%) of ET3 patients and 4 (17.4%) of ET4 group. Abortion or pregnancy loss was reported in 9(29%) of ET2 patients, 18 (47.4%) of ET3 patients and 2 (50%) of ET4 group. Our study demonstrated that there may be a higher pregnancy as well as higher abortion in day 3 embryo transfer.

Sexually transmitted infections (STIs) are among the most common causes of illness in the world and have far-reaching health, economic and social consequences for many countries. Failure to diagnose and treat STIs at an early stage may result in serious complications and sequels.

This study aimed to determine the prevalence of Chlamydia trachomatis infection in patients who remain symptomatic after completion of their first episode of treatment for STI.

We conducted a cross-sectional study on 49 patients suffering from symptoms or signs of sexually transmitted infections despite their first complete anti STI treatment. Conducting physical exam and smear preparation from vaginal discharge, diagnosis was confirmed by Polymerase chain reaction (PCR) method on every patient’s first-voided urine sample.

Among the etiologic factors investigated in this study, Chlamydia was reported in 17 patients. Trichomoniasis, Candidiasis, Gonorrhea and nonspecific germs were next organisms with 11, 9, 6 and 6 patients, respectively. Sixteen specimens were PCR positive (32.65%), while 33 patients had negative PCR results (67.34%) for Chlamydia trachomatis.

Gonorrheal infection was the most prevalent infection in patients with completed treatment (6/10), which must be remembered in patients follow ups, because this prevalence warrants empirical therapy for Gonorrheain similar clinical conditions. Chlamydia trachomatis was the responsible organism in approximately a quarter of patients (17/75) who despite their full compliance on anti-Chlamydial treatment still suffered from signs and symptoms of STI. This rate also recommends empirical therapy for Chlamydia trachomatis in the similar clinical signs and symptoms.

Budd-Chiari syndrome (BCS) refers to thrombosis of hepatic veins as well as intrahepatic or suprahepatic inferior vena cava. We present for the first time a case of possible occurrence of Budd-Chiari syndrome with the history of depot medroxy progesterone acetate (DMPA) injections in a 33-year-old Iranian woman. An underlying disorder can be identified in most of patients with BCS. Many of these disorders are characterized by a hypercoagulable state, but it may occur due to other unknown pathophysiologic factors. Also, medical evaluation was performed for inflammatory, immunologic, and thrombotic disorders as well as hepatic imaging. Considering different case reports like this study may help to decrease the percentage of idiopathic cases.

Detection of best predictor of ovarian reserve in patients with temporarily or consistently elevated early follicular phase serum levels of FSH is one of the most important goals in assisted reproductive technique (ART). To evaluate whether high level of anti-mullerian hormone level is related to success of ART in patients with temporarily or consistently elevated early follicular phase serum levels of FSH. Sixty three women underwent intracytoplasmic sperm injection (ICSI) with GnRH-agonist long protocol or intrauterine insemination (IUI) in a prospective cohort study. FSH, inhibin B and anti-Mullerian hormone (AMH) levels were measured in these women whom were divided to three groups (persistently elevated FSH, variably elevated FSH and, normal FSH level). Basal characteristics, stimulation parameters, and pregnancy occurrence were evaluated. AMH was significantly higher in women with persistently elevated early follicular phase FSH achieving pregnancy. Women with normal FSH did not have significant difference in AMH level between conceived and non conceived cycles. Women with only one elevated early follicular phase FSH achieving pregnancy did not have significant difference in AMH level with non pregnant women. Response to gonadotropin stimulation, recommendation to oocyte donation significantly differed between the groups. This study has demonstrated that relatively young women with persistently or intermittently elevated day 3 FSH levels have diminished ovarian reserve and lower ART success. However, in women whose FSH levels were constantly elevated, AMH (not inhibin B) concentrations were significantly higher in ART cycles resulting in pregnancy. Therefore, AMH level is a good predictor of ART outcome in patients with elevated early follicular phase serum levels of FSH.

Isolated fallopian tube torsion is rare and often difficult to diagnose. Definitive diagnosis is always made at laparoscopic or via laparotomy exploration performed for suspected ovarian torsion. Early diagnosis and conservative laparoscopic treatment especially in a reproductive age woman is warranted as a means of preserving fallopian tube integrity and maintaining fertility. Here, we describe a case with isolated right fallopian torsion being managed by conservative laparoscopic surgery.

Endometriosis is an estrogen dependent disease. Levels of Cancer antigen-125 are significantly higher in women with moderate to severe endometriosis. However, patients with unruptured endometriosis rarely have serum CA-125 levels more than 1000 U/mL. This case report presents a diffuse, unruptured ovarian endometrioma in a 29- year-old woman, leading to an extraordinary high serum CA-125 and CA19-9 levels; usually typical of advanced ovarian carcinoma. Our experience emphasizes on benign gynecologic conditions such as endometrioma, which should be taken into account as a possible differential diagnosis in women with exaggerated elevation of the serum CA-125 level.

Reviewing the literature, reveals that pentoxifylline (PTX) plus tocopherol (vitamin E) are used mainly to promote sperm quality. However trials focusing on the effects of these drugs in female partner are limited. Combination of pentoxifylline and vitamin E appeared to improve the pregnancy rate in patients with a thin endometrium by increasing the endometrial thickness and improving ovarian function.

To determine whether combined PTX and tocopherol treatment can improve clinical pregnancy rate.

One hundred twelve infertile women undergoing standardized controlled ovarian hyperstimulation for ICSI- ZIFT entered this randomized clinical trial. Patients were randomized to equal groups of combined PTX and tocopherol therapy or none (not receiving PTX and tocopherol). These drugs were administered to the intervention group for two cycles before starting ICSI-ZIFT cycle. Main outcome measure was clinical pregnancy rate. SPSS.11 software (SPSS Inc. Chicago IL.) was used for data collection and analysis.

The clinical pregnancy was higher in the intervention (combined PTX and tocopherol) group in comparison to the other group (57.14% vs 39.29%, p=0.01). However, there was no difference in the mean endometrial thickness, number of retrieved oocytes, the number of metaphase II oocytes and grade of them in both groups.

This study showed that PTX plus tocopherol could improve the ZIFT outcome in infertile couples. Local effects and anti oxidative characteristics of these drugs may be the cause of better results.

Sexually transmitted infections (STIs) remain a public health problem of major significance in most parts of the world. This study aimed to detect the most prevalent pathogens in patients with signs and symptoms of STI referring to a group of university clinics in Tehran. In this cross-sectional study using randomized cluster sampling, 507 consecutive male and female patients presenting with signs and symptoms of STI referring to selected health care centers of Shahid Beheshti University were evaluated between May 2005 and May 2007. Diagnosis was made according to WHO criteria for signs and symptoms of STI in addition to microscopic study of genital discharges. The most prevalent STI pathogens were Candida, Trichomona, Neisseria gonorrhoeae and Chlamydia with respective frequencies of 53.96%, 18.87%, 4.91% and 22.26% in women and 47.10%, 8.67%, 9.50% and 34.71% in men. Candida was detected in majority of cases. Chlamydia was the most prevalent STI in both sexes. Simple preventive care has crucial role in decreasing the frequency of STIs in society.

Zinc deficiency is an important health problem in developing countries. The aim of this study was diagnosis of zinc deficiency among young female students of Tehran University of Medical Sciences. This cross sectional study evaluated 420 medical and paramedical students of Tehran University in 2005. All of them were female and in the first year of their education. Serum concentrations of zinc were measured by enzymatic method students in whom had sufficient criteria to enroll in the study. Zinc concentration more than 85 µ/dl was considered as normal value. Concentration less than 50 µ/dl was defined as severe zinc deficiency. Mild and moderate deficiencies were described as zinc levels between 50 to 85 µ/dl. Analysis was performed by t-test, chi-square and ANOVA using SPSS software. Zinc deficiency was found in 7.1% of the participants. In women with body weights between 50.1-60 kg, zinc deficiency was less than patients with body weight of ≤ 50 Kg (p=0.04). In zinc deficient group acne was observed more frequently (p=0.01). Also anemic participants (Hb<12) had lower zinc level than non anemic women (Hb≥12) (p=0.001). This study found severe and mild to moderate zinc deficiency in 1.4% and 5.7% of female students, respectively. Zinc deficiency is common in anemic students. Zinc supplementation is recommended in anemic patients and in cases of confirmed zinc deficiency.

Volvulus of the small bowel, although being rare, carries a high risk of strangulation and ischemic necrosis. Preoperative diagnosis is difficult and may be complicated by pregnancy, labor and the post-cesarean-section state. Delay in diagnosis and surgical intervention increases morbidity and mortality rates.We present a 20- year- old primigravida woman (GA=10 weeks) with massive intestinal necrosis. Her initial symptoms were abdominal pain and nausea. Her complaints were attributed to pregnancy and she came with acute surgical abdomen. Emergent laparotomy was performed. Gangrenous, distended loops of small intestine passed through a defect in the mesentery were resected. Primary end to end anastomosis of jejunum and ileum was done and the defect causing volvulus was repaired. It is concluded that surgical acute abdomen must be considered in differential diagnosis of abdominal discomfort in pregnancy. In the case of small bowel volvulus early surgery is mandatory to reduce the risk of gangrene, which is known as doubling the mortality rate.