فهرست مطالب nezhat mousavifar

High incidence of infertility in our society (24.9%) is considered as a main problem. Intrauterine insemination (IUI) due to its low cost and non-invasiveness is selected as a first-line treatment for infertility treatment in assisted reproductive technique. This study was performed with aim to evaluate the frequency of pregnancy and its predicting factors in IUI cycles.
This cross-sectional study was performed on 308 infertile couples who had referred to Milad infertility center during 2011-2013. A total of 370 IUI cycles were performed for infertile women. Infertile women underwent Letrozole regimen along with recombinant FSH, and after monitoring by transvaginal ultrasound, when observing at least one mature follicle with size over 16 mm, HCG (5000 IU intramuscularly) was injected. 36 hours later, IUI was performed. IUI success and pregnancy rate were confirmed by pregnancy test and transvaginal ultrasound. Data was analyzed by SPSS software (version 16). P
The overall pregnancy rate was 23.8% in this study. The factors such as less IUI cycles (P=0.035), existence of just one known infertility factor (P=0.01), at least two mature follicles (P=0.001), endometrial thickness of at least 10mm (P=0.003), no use of tenaculum (P=0.01), ratio of progressive motile sperm more than 50% (P=0.015) and Total Motile Functional Sperm more than 5 million (P=0.015) significantly affect pregnancy rate. The woman's age (P =0.08), duration of infertility (P =0.94), type and etiology of infertility (P =0.083) and sperm concentration (P=0.269) and sperm morphology (P=0.67) did not significantly affect the pregnancy rate.
Less IUI cycles, existence of just one known infertility factor, at least two mature follicles, endometrial thickness of at least 10mm, no use of tenaculum, ratio of progressive motile sperm more than 50%, and TMFS more than 5 million are significantly effective on pregnancy rate in IUI cycles.

There are still many questions about the ideal protocol for letrozole (LTZ) as the commonest aromatase inhibitor (AI) used in ovulation induction. The aim of this study is to compare the ultrasonographic and hormonal characteristics of two different initiation times of LTZ in clomiphene citrate (CC) failure patients and to study androgen dynamics during the cycle. This randomized clinical trial was done from March to November 2010 at the Mashhad IVF Center, a university based IVF center. Seventy infertile polycystic ovarian syndrome (PCOS) patients who were refractory to at least 3 CC treatment cycles were randomly divided into two groups. Group A (n=35) receiving 5 mg LTZ on cycle days 3-7 (CD3), and group B (n=35) receiving the same amount on cycle days 5-9 (CD5). Hormonal profile and ultrasonographic scanning were done on cycle day 3 and three days after completion of LTZ treatment (cycle day 10 or 12). Afterward, 5,000-10,000 IU human chorionic gonadotropin (hCG) was injected if at least one follicle ≥18 mm was seen in ultrasonographic scanning. Intrauterine insemination (IUI) has been done 36-40 hours later. The cycle characteristics, the ovulation and pregnancy rate were compared between two groups. The statistical analysis was done using Fisher’s exact test, t test, logistic regression, and Mann-Whitney U test. There were no significant differences between two groups considering patient characteristics. The ovulation rate (48.6 vs. 32.4% in group A and B, respectively), the endometrial thickness, the number of mature follicles, and length of follicular phase were not significantly different between the two groups. LTZ is an effective treatment in CC failure PCOS patients. There are no significant differences regarding ovulation and pregnancy rates between two different protocols of LTZ starting on days 3 and 5 of menstrual cycle (Registration Number: IRCT201307096467N3).

The effects of exposure to electromagnetic fields (EMF) on reproduction systems have been widely debated. In this study, we aimed to investigate whether low frequency EMF could ameliorate the in vitro fertilization success rate in Naval medical research institute (NMRI) Mice. In this randomized comparative animal study, ten NMRI mice were randomly divided into 2 equal groups (control and experimental). 10 IU of human chorionic gonadotropin (hCG) was injected intraperitoneally to both groups in order to stimulate ovulating, and ovums were then aspirated and kept in KSOM (modified version of sequential simplex optimization medium with a higher K+ concentration) culture medium. Metaphase II ovums were separated, and sperms obtained by «swim out» method were added to metaphase II ovums in the culture medium. The experimental group was exposed to 1. 3 millitesla pulsed electromagnetic field at 4 kilohertz frequency for 5 hours. To assess the efficacy, we considered the identification of two-pronuclear zygote (2PN) under microscope as fertilizing criterion. Total number of collected ovums in the control and experimental groups was 191 and 173, respectively, from which 58 (30. 05%) and 52 (30. 36%) ovums were collected from metaphase II, respectively. In vitro fertilization (IVF) success rate was 77% in extremely low frequency- pulsed electromagnetic field (ELF-PEMF) for exposed group (experimental), whereas the rate was 68% for control group. Despite increased percentile of IVF success rate in exposed group, there was no statistically significant difference between 2 groups, but this hypothesis has still been stated as a question. Further studies with larger sample sizes and different EMF designs are suggested.

Ovarian hyper stimulation syndrome (OHSS) occurs mainly after excessive stimulation of the ovaries by exogenous gonadotropin administered in the context of ovulation induction and in vitro fertilization procedures (iatrogenic OHSS). Spontaneous OHSS is a rare event. Such cases would explain other etiologies except ovulation induction. In this case report, we have presented two cases of OHSS in spontaneously conceived pregnancies.

In this case report, we are going to present two cases of OHSS occurring in spontaneously conceived pregnancies. One of the patients mentioned the history of this syndrome in her sister, and the other one confronted with this syndrome in her second pregnancy. Both of them referred to the hospital with typical symptoms and signs of OHSS. They did not have Polycystic Ovary Syndrome (PCOS) and any other problem in pregnancy. Thrombophilia workup, Tumor markers, renin-aldosterone and thyroid function tests were normal.

The presence of OHSS in spontaneous pregnancy especially in familial pattern may lead us to evaluate some endogenous pathogenic factors.

PCOS (Polycystic Ovarian Syndrome) is associated with insulin resistance, obesity and disorders of lipid metabolism as well as infertility. Fenugreek seeds extract is successfully used in lowering blood glucose. Metformin has also the same effect but in a different way. The aim of this study was the assessment of fenugreek effects on insulin resistance in women with PCOS.This was a prospective randomized, double-blind, placebo-controlled trial. The study was conducted at the Montaserieh Hospital in Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi Province, Iran. The patient population included 58 oligo-anovulatory PCOS women with typical ovaries. Women were randomly allocated to receive hydroalcoholic extract of fenugreek seeds in capsules with metformin (n = 30) or placebo capsules with metformin (n = 28) and were assessed before and every 4 weeks within a treatment period of 8 weeks.Menstrual disturbance and metabolic parameters (markers of insulin resistance and hormonal parameters) were measured. Insulin resistance based on HOMA-IR (homeostasis model assessment for insulin resistance) model was not significantly different between two groups. Ultrasound scans were performed before and at the end of 8 weeks treatment with significant decrease in PAO (polycystic appearing ovaries) in group 1 (p = 0/01).Adjuvant therapy to the fenugreek seeds extract (with metformin) in PCOS women improved the sonographic results and menstrual cyclicity.

Infertility is a major public health problem with physical, psychological and social dimensions. The prevalence of psychological problems has been estimated to be high in infertile women. The purpose of this study was to examine the effectiveness of well-being therapy on stress and psychological well-being in infertile women who were referred to Montasariya infertility center in Mashhad. The current study was a quasi-experimental design with pre-test post-test in two experimental and control groups. Research population was the infertile women who were referred to Montasariya infertility center during summer of 1390. 22 infertile women were selected to participate in this study which randomly assigned in tow experimental (11 persons) and control groups (11 persons). The experimental group received 8 weekly sessions of well-being therapy. The data was gathered by using stress scale of DASS-21 (p<0/001) and psychological well-being scale (p<0/001). There were significant differences between two groups in stress and psychological well-being after the final session of intervention. So according to the results the psychological well-being was increased in experimental group (p<0/05), while consequently the stress was significantly reduced (p<0/05). Well-being therapy affect on decreasing stress and increasing psychological well-being in infertile women.

Body image is one of the most important issues in women's mental health and due to its relationship with physical, cognitive and emotional aspects of women’s life; it can predict their healthy or unhealthy behaviors. According to some research reports, women’s negative or positive body image can affect their marital relationships. Considering the impact of infertility on both body image and marital adjustment and the lack of evidence regarding the relationship of these two variables in infertility, this study aimed to investigate the relationship of body image with marital adjustment in infertile women in 2010 in Mashhad.

This correlational study was carried out on 130 infertile women referred to Montaserie Infertility Research Center in Mashhad who were selected through convenient sampling. Research tools were consisted of valid and reliable demographic questionnaire including personal and infertility-related information, modified Younesi Body Image Questionnaire and Spanier marital adjustment scale (DAS) which were completed by subjects. Data analysis was carried out by SPSS software (version 15/5) using t-tests, one way ANOVA, and Spearman and Pearson correlation test.

93/1% of women reported positive body image and 76/9% had high marital adjustment. There was a direct correlation between the overall score of body image with marital adjustment (P<0/001). There was also a direct correlation between the scores of body image subscales including body in loneliness (P= 0/001), real body (P=0/014), public image of body (P=0/016), spouse image of body (P<0/001) and spouse family image of body (P<0/001) with marital adjustment. However, this relationship was not observed between the subscale of ideal body and marital adjustment.

The presence of a direct correlation between body image and marital adjustment could guide developing educational or counseling programs particularly for infertile women who suffer from marital disputes.

Infertility is considered as a crisis in life and can cause severe stress for infertile couples. A variety of approaches has been suggested to manage this kind of stress in couples. This study addressed the effect of collaborative counseling on perceived infertility-related stress in infertile women undergoing IVF in Mashhad.

In this clinical trial, 60 women with primary infertility were selected from Montaserieh Infertility Research Center by convenient sampling and were randomly divided into intervention (29 cases) and control (31 people) groups. Women in intervention group received counseling in five meetings with collaboration of midwife, gynecologist and clinical psychologist. Control group were counseled routinely. Perceived infertility-related stress was measured at the beginning and embryo transfer day using Newton Fertility Problem Inventory that has five subscales. Mann-Whitney test and independent t-test were used for data analysis by SPSS software version 14.

A significant difference was found between two groups in terms of total perceived infertility-related stress score (p<0.048). The amount of stress reduction in intervention group was nearly 3.6 times more than the control group. There was also a significant difference between two groups regarding two the subscales of Fertility Problem Inventory including social concerns (p<0.031) and need for parenthood (p<0.002).

Collaborative counseling can decrease the infertile women's perceived infertility-related stress. Thus, it could be suggested as one of the stress management strategies in infertile women undergoing IVF.

Unintended pregnancy leads to unpleasant physical and psychological outcomes in both infant and mother. Unfortunately, many of these pregnancies are seen in women who use reliable contraceptive methods such as oral contraceptive pills. The aim of current study was to investigate the prevalence of oral contraceptive pills (OCP) in unintended pregnancies and the factors associated with its failure.

This descriptive-analytical study was conducted on 1000 pregnant women who referred to the obstetrics ward of Imam Reza hospital in Mashhad for labor from 2007 to 2008. A questionnaire was used for obtaining the demographics and type of contraception. Then mothers who had used oral contraceptive pills were asked for their applied methods. Data were analyzed by SPSS 11.5 software.

34.5% of studied women had unintended pregnancy that 3.91% had used contraceptive methods. The main method used in unintended pregnancies was OCP (40.3%). In OCP consumers, just 19.7% used OCP correctly. Fear of complications was the most prevalent cause of wrong use (42.2%). Other factors associated with OCP failure were age, education level and economic state which had significant relationship with failure (p<0.05).

Since OCP use is the most common contraception method and fear of complications is the most important cause of failure, training the correct method of OCP use and informing consumers about complications should be emphasized.

Supporting the luteal phase in patients undergoing Induction of ovulation together with intra uterine insemination (IUI) is routinely performed in some centers in Iran. This study was performed with the aim of comparing the effect of intra muscular progesterone injection and suppository progesterone for luteal phase support in these patients. This random prospective clinical trial was performed on 225 patients referred to Montaserieh infertility center affiliated to Mashhad university of medical sciences in year 2007. Patients undergoing induction of ovulation and IUI were randomly divided into two groups of treatment with 50 mg muscular progesterone injection (114 patients) and 400 mg vaginal suppository progesterone (111 patients) for luteal phase support. In patients whose serum βhCG was positive, their treatment course continued up to 12 weeks of gestation. Pregnancy rate, abortion and continuing of pregnancy were evaluated after 20th week of gestation. Data was analyzed using student t-test, exact Fisher, Mann-Whitney ad Chi square tests by SPSS 11.5 software. Pregnancy outcome were better in suppository progesterone treatment group (p=0.0008). In addition, low drug complications and abortions were reported in this group (p=0.000). Patient satisfaction was significantly higher in suppository progesterone treatment group (p=0.0000). The effect of suppository progesterone treatment was better in supporting luteal phase in patients with induction of ovulation and IUI, and it can be used due to lower complications and more patient satisfaction rate.