فهرست مطالب razieh dehghani-firouzabadi

 In vitro fertilization has advanced in many ways, and new techniques are challenging. Blastocyst transfer is an alternative method for embryo transfer (ET) to improve in vitro fertilization outcomes.

 The present study was performed to determine the effect of pregnancies resulting from ET in the blastocyst stage compared to the cleavage stage in frozen cycles to select a better method of assisted reproduction.

 This cross-sectional study was conducted on 194 women who referred to the Yazd Reproductive Sciences Institute, Yazd, Iran, between April 2019 and December 2020. They had a frozen ET as either cleavage or blastocyst (n = 97/each group). The study compared the pregnancy and fetal outcomes in the 2 groups of ET at the cleavage and blastocyst stages.

 The results showed that the blastocyst stage group had higher levels of anti-Mullerian hormone, ovule number, 2 pronuclear number, and embryo number than the cleavage stage group. The frequency of chemical pregnancies was 52.6% and 36.1% in blastocyst and cleavage group respectively (p = 0.02). Also, the frequency of clinical pregnancies was 41.2% and 22.7% in blastocyst and cleavage group respectively (p < 0.001). No statistically significant difference was observed between 2 groups in abortion, preterm delivery, multiple births, preterm premature rupture of membranes, gestational diabetes and preeclampsia, ectopic pregnancy, neonatal hospitalization in Neonatal Intensive Care Unit, and fetal abnormalities (p > 0.05).

 The results showed that transmission in the blastocyst stage compared to the cleavage stage is associated with an increase in chemical and clinical pregnancy, while other pregnancy outcomes are the same in both groups.

The authors have been informed of an error that occurred on page 657 in which the IRCT code has been entered incorrectly, which should be corrected as: "IRCT2012091310328N3". On behalf of the author, the publisher wishes to apologize for this error. The online version of article has been updated on 12 April 2021 and can be found at http://dx.doi.org/10.18502/ijrm.v17i12.5801

The social and cultural challenges facing surrogate mothers have been explored in several studies. However, few studies have discussed the motivations of surrogate mothers, their expressions and interpretations of their lived experiences, and their feelings of personal and spiritual satisfaction.

This study aims to present the positive experiences of surrogate mothers from a phenomenological perspective.

Using a phenomenological approach, this study was conducted from September 2020 to January 2021 in the city of Yazd, Iran. Participant observation and semi-structured interviews were used to collect the data among 12 participants with at least 1 experience of surrogate motherhood.

Our findings showed that, despite having had harsh physical and socio-cultural experiences such as fear of social labeling and stigma, participants felt a kind of inner satisfaction and a positive view of their actions. A core theme found in the study was mothers' satisfaction. The main categories included feminine self-sacrifice and positive rewards. Feminine self-sacrifice included 2 sub-categories: creating happiness and conveying motherly feelings, while positive rewards included good childbirth, family acceptance, and halal income.

This study showed that surrogate mothers experience conflicting feelings of inner satisfaction and social stigma during surrogacy. Some of those interviewed were willing to go through surrogacy again, but they feared social labeling and stigma, being misunderstood by others who are not fully informed about surrogacy, and being subjected to family and social disapproval.

The authors have been informed of some errors that occurred in the published paper. The errors are listed as:

A paragraph has been added to Materials and Methods section about blinding.
The statistical test which has been used in tables I, II has been changed from chi-square test to Fischer exact test.
The study results were re-analyzed, and some p-values were modified in tables.
The lasst paragraph of discussion section has been removed.


The authors wish to apologize for these errors. The online version of the article has been updated on August 29, 2021, and can be found at http://dx.doi.org/10.29252/ijrm. 15.4.231.

Endometriosis is a disease that affects women of reproductive age. This disease is characterized by the presence of endometrial-like tissues (endometrial or stromal glands) outside the uterus and shows significantly elevated prevalence in industrial regions. Additionally, an interaction between genetics and environmental factors is assumed for the disease. Enzymes belonging to the cytochrome P450 (CYP) family are participated in detoxification process of a wide range of environmental toxins and carcinogens. Thereby, they are good link for the interaction. CYP1A1 which belong to cytochrome P450 (CYPs) superfamily, is a very important gene for the metabolism of carcinogens.

The aim of this study was to analyze the frequency of the MspI polymorphism of CYP1A1 gene and its relation to endometriosis.

Genomic DNA was isolated from 93 endometriosis women and 139 healthy controls. Genotyping was performed using polymerase chain reaction followed by restriction fragment length polymorphism analysis.

Frequencies of the TT, TC, and CC genotype of CYP1A1 gene polymorphism in patients were 73.1%, 22.6%, and 4.3%, while frequencies in controls were 74.1%, 22.3%, and 3.6%, respectively. So there was no significant differences between the genotypes in two groups (p=0.961).

According to our study, MspI polymorphism of CYP1A1 gene appears to be not associated with the risk of endometriosis in the studied population. However, additional studies, especially with larger sample size are needed to validate these findings.

Gestational trophoblastic tumor (GTT) most commonly follows a molar pregnancy. In fact, it can occur following gestational events such as induced or spontaneous abortion, ectopic pregnancy, and term pregnancy. In this study, we present the case of a patient with ectopic pregnancy who was treated with a single dose of methotrexate (MTX). The maximum titer of beta subunit of human chorionic gonadotropin (BHCG) was 402. Work up of occult metastatic GTT was carried out following MTX therapy, due to elevated BHCG titer. In the positron emission tomography (PET) scan, a 17-mm lesion was detected in the right lung and treated via thoracotomy resection and adjuvant chemotherapy. Within an 18-month follow up, the patient did not reveal any symptoms and the BHCG titer level did not increase. Findings of this study revealed that after MTX therapy for ectopic pregnancy patients need to be followed up. Moreover, lack of BHCG titer decline, even in low tittering after treatment with MTX, can be related to GTT tumors or inadequate treatment for ectopic pregnancy.

Selection of the best embryo for transfer is very important in assisted reproductive technology (ART). Using morphological assessment for this selection demonstrated that the correlation between embryo morphology and implantation potential is relatively weak. On the other hand, aneuploidy is a key genetic factor that can influence human reproductive success in ART.

The aim of this lab trial study was to evaluate the incidence of aneuploidies in five chromosomes in the morphologically high-quality embryos from young patients undergoing ART for sex selection.

A total of 97 high quality embryos from 23 women at the age of 37or younger years that had previously undergone preimplantation genetic screening for sex selection were included in this study. After washing, the slides of blastomeres from embryos of patients were reanalyzed by fluorescence in-situ hybridization for chromosomes 13, 18 and 21.

There was a significant rate of aneuploidy determination in the embryos using preimplantation genetic screening for both sex and three evaluated autosomal chromosomes compared to preimplantation genetic screening for only sex chromosomes (62.9% vs. 24.7%, p=0.000). The most frequent detected chromosomal aneuploidy was trisomy or monosomy of chromosome 13.

There is considerable numbers of chromosomal abnormalities in embryos generated in vitro which cause in vitro fertilization failure and it seems that morphological characterization of embryos is not a suitable method for choosing the embryos without these abnormalities.

Ovarian hyperstimulation syndrome (OHSS) is one of the most important complications of assisted reproduction treatment. Many substances are involved in the regulation of the vascular permeability, which have been concerned to cause OHSS. Vascular endothelial growth factor (VEGF) has emerged as one of the main angiogenic factors, which could be responsible for increased vascular permeability.

In this study the association of vascular endothelial growth factor -460C/T and  G/C polymorphisms and susceptibility to ovarian hyperstimulation syndrome was evaluated.

In this cross sectional study, VEGF gene polymorphisms were amplified by Polymerase chain reaction- Restriction Fragment Length Polymorphism in 75 women with established OHSS (case group) and 85 normoresponder (control group) which received conventional ovarian stimulation regimen.

There was no significant difference in the frequency of -460 C/T polymorphism between cases and controls (p=0.85). The frequency of  G/C polymorphism was significantly higher in the OHSS women (p=0.03, OR=2.44; 95% CI=1.23-4.82).

In women who developed OHSS, VEGF gene polymorphism  could be effective. Two of the polymorphisms -460 C/T and  G/C were reported to be associated with increased VEGF basal promoter activity. However, only  G/C gene polymorphisms were more frequent in cases than controls.

The appropriate choice of a contraceptive method has been a major issue in reproductive health research. Cu T intrauterine device (Cu T IUD) has been introduced as one of the most effective contraceptive methods in the world, however, the relationship between prior use of Cu T IUD and secondary infertility has not been evaluated in Iran. To examine the association of Cu T-380A IUD and secondary infertility in Iran.
A retrospective cohort study was conducted from December 2010 to September 2011 in the Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. A total of 750 married women (15-49 years old) with at least one parity, whom were referred to four educational healthcare centers of Shahid Sadoughi University of Medical Sciences, were selected as participants. They were divided into two groups (case and control) based on previous history of using Cu T-380A IUD. Data were gathered using a standard reliable questionnaire along with a face-to-face interview and were analyzed with descriptive and analytical (χ²) tests.
Mean period of Cu T-380A IUD usage in the case group was 57.46 ± 47.74 months and mean time length from Cu T-380A IUD removal to pregnancy was 14.87 ± 5.18 months in this group. We observed no relationship between the use of Cu T-380A IUD and frequency of secondary infertility (3.5% in the case group versus 2.7% in the control group, P=0.52).
Given the relatively large sample size studied here, it is unlikely that Cu T-380A IUD results in secondary infertility and may be used by Iranian women as a safe contraceptive method.

Implantation is one of the essential steps for the success of assisted reproductive techniques (ART). Their success depends on three main factors: embryo quality, endometrial receptivity (ER), and synchrony between embryo and endometrium. There are various factors that regulate the complex process of implantation. In this regard, one may refer to human chorionic gonadotropin (hCG) as the most important factor.

This study aims to investigate the effect of intrauterine hCG injection before embryo transfer (ET) on pregnancy outcome in infertile couples.

A total of 159 patients undergone In vitro Fertilization/ Intracytoplasmic Sperm Injection (IVF/ICSI) with an antagonist protocol were evaluated. Patients were divided into three groups (n=53). Group 1 received 500 IU of hCG, group 2 received 1000 IU of hCG intrauterine injection before ET, and the control group underwent ET without hCG preceding intrauterine injection.

There was no significant difference among the groups. The implantation rates were 18.86%, 13.52%, and 14.37%, chemical pregnancy rates were 34%, 32.1%, and 35.3%, and clinical pregnancy rates were 34%, 32.1%, and 31.4% respectively.

The pregnancy outcome in IVF/ICSI /ET cycles cannot be improved through hCG intrauterine injections before ET.

Intrauterine insemination (IUI) is one of the therapeutic approaches for infertility. The objective of this study was to evaluate DNA integrity and apoptosis role in success of IUI in both mild male and female factor infertility. Patients were divided into two groups: M (mild male factor; n=29) and F (female factor; n=31) undergoing single IUI. Ejaculates were analyzed and chromatin quality was assessed using chromomycin A3 (CMA3) staining. In addition, spermatozoal apoptosis was recognized using TUNEL assay. Statistical analyses were done using t-test and Mann Whitney test for sperm apoptosis and sperm chromatin by SPSS. Data were expressed in mean ± SD for variables. P<0.05 was considered statistically significant. Sperm concentration and progressive motility were higher in F than M group. Sperm with normal morphology were statistically similar in M and F infertile patients (32.7±15.6% vs. 35.5±9.07%, p=0.39). Sperm chromatin immaturity was higher in patients with mild male infertility, when compared with the other group (p<0.01). Also, 32.0±5.6% and 30.8±6.1% of the spermatozoa showed signs of apoptosis in groups M and F, respectively (p=0.49). Very low (3.4%) clinical pregnancy rates were noticed in patients with mild male factor infertility Defect in sperm motility as well as high rates of DNA damage and apoptosis may be involved with very low rate of pregnancy outcomes in patients with mild male factor infertility. Therefore, it seems the application of IUI may have better outcomes in patients with female infertility compared to mild male factor infertility.

Based on classical two-cell, two-gonadotropin theory, in the follicle, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) put on their main effects on the granulosa and theca cells. LH is essential for androgens production. Androgens are used for estradiol production by granulosa cells. Profound suppression of LH concentrations in some normogonadotropic patients can cause several adverse effects. The main clinical purpose of this study was that normoresponder women treated with controlled ovarian super ovulation for IVF or ICSI may benefit from co-administration of rLH. 40 patients who were candidates for assisted reproductive technology (ART) were randomly selected. In all patients long luteal protocol was used for ovulation induction. Patients were randomly divided into two groups: Group 1 (n=20) with standard long protocol (GnRH agonist) and r-FSH alone, Group 2 (n=20) with standard long protocol (GnRH agonist) and r-FSH with r-LH. Results were statistically analyzed and compared in two groups. The number of retrieved oocytes, mature oocytes, cleaved embryos, transferred embryos, estradiol levels in Human chorionic gonadotropin (hCG) administration day, implantation rate and clinical pregnancy rate in group 2 were higher but not significantly different. Administration of rLH in late follicular phase had no beneficial effect on outcomes in young women with mean age of 31 years. Maybe a greater sample size should be used to see the effects more accurately; also it is possible that rLH will be useful in older patients.

Preterm labor (PTL) is one of the most important causes in neonatal mortality and morbidity. Late preterm labor (34-36w) includes 75% of such birth. Assisted reproductive technology (ART) pregnant women are at increased risk of PTL. The study has been undertaken to determine whether beginning and continuing 17-α hydroxy progesterone caproate can reduce risk of PTL or change neonatal mortality. In a double-blind clinical randomized control trial, 106 women were treated by ART technique for their infertility and in gestational age at 16 weeks entered in our study. In one group, 17-α hydroxy progesterone caproate (Femolife) was injected intramuscularly every week until 36 weeks of gestation and in another group; placebo was injected from 16 until 36 weeks of gestetion. Data collected from pregnancy outcomes, infancy, and subsidiary problems were statistically analyzed by a questionnaire. The risk of PTL in placebo group was 2.48 higher than control group that was not significant (Cl: 0.81-9.94). Femolife side effect in case group was gestational diabetes and local complication was not frequent. NICU admission was not significantly different between groups. Although it seems that 17-α hydroxy progesterone caproate does not cause significantly decrease in PTL in singleton ART gestations but any reduction of PTL in such high risk pregnancies may improve final gestational outcome. There is critical need for larger clinical trials to better understanding causes of PTL, specifically late preterm labor, to prevent mortality and morbidity in ART gestation

This study was conducted to determine the effect of omega-3 supplementation on sex hormone-binding protein (SHBG), testosterone, free androgen index (FAI) and menstrual status in women with PCOS. This double-blind randomized clinical trial was conducted on 78 overweight/obese women with PCOS. Participants were randomized to receive omega-3 (3gr/day) or placebo for 8 weeks. Data about weight, height and nutrient intake as well as blood samples were collected before and after intervention. Serum concentrations of testosterone (nmol/L) and SHBG (nmol/L) were measured. FAI was also calculated as the ratio of testosterone to SHBG. Seventy eight patients (age: 26.92±5.46 yrs, Body Mass Index: 31.69±4.84 Kg/m2) completed the study. There was no significant difference in mean age, weight, height, Body Mass Index and intake of energy, and macronutrients between 2 study groups before and after treatment. All the participants had irregular periods. After the trial the percentage of regular menstruation in the omega-3 group was more than the placebo group (47.2% vs. 22.9%, p=0.049). Furthermore, testosterone concentration was significantly lower in the omega-3 group compared with placebo, after supplementation (p=0.04). SHBG and FAI did not change in either group. Omega-3 supplementation could reduce serum concentrations of testosterone and regulate menstrual cycle without significant effect on SHBG and FAI. Future studies with longer period of supplementation are warranted. There is some evidence regarding the effect of poly unsaturated fatty acid intake on androgen levels and gonadal function in polycystic ovary syndrome (PCOS).

Sildenafil citrate may increase endometrial thickness and affect the outcome of frozen-thawed embryo transfer cycles.

The aim of this study was to estimate the effect of sildenafil citrate on ultrasonographic endometrial thickness and pattern and to investigate the estrogen level on the day of progesterone administration, the implantation rate and chemical pregnancy rate in frozen embryo transfer cycles.

This randomized controlled trial was conducted on 80 patients who had an antecedent of poor endometrial response and frozen embryos. 40 patients were given estradiol by a step up method with menstruation to prepare the endometrium, and the other 40 were given sildenafil citrate tablets (50 mg) daily in addition to the above treatment protocol from the first day of the cycle until the day progesterone was started. This was discontinued 48-72 hours prior to the embryo transfer.

The endometrial thickness was significantly higher in the sildenafil citrate group (p<0.0001), the triple line patterns of the endometrium were significantly higher in the sildenafil citrate group (p<0.0001), while the intermediate patterns of the endometrium were not significantly different in the two groups. The echogen patterns of the endometrium were significantly higher in control group (p<0.0001). Finally, implantation rate and the chemical pregnancy rates were higher in the sildenafil citrate group but not significantly.

As our study shows, the oral use of sildenafil citrate is a good way to improve the endometrial receptivity. We recommend the routine use of oral sildenafil citrate in patients with a previous failure of assisted reproduction technology cycles due to poor endometrial thickness.

One of the most important steps in success of assisted reproductive techniques is appropriate ovulation induction and effective ovarian follicles stimulation. The aim of this study was to investigate the comparison of low-dose hCG plus gonadotropin releasing hormone (GnRH) agonist on ovulation induction and with standard dose hCG alone in intrauterine insemination technique with antagonist protocol. This clinical trial was conducted on 100 infertile couples who referred to infertility research center in Shahid Sadoughi university of medical sciences، Yazd، 2010 - 2011. Infertile women aged 18 to 35 who were treated with antagonist protocol were divided randomly into two groups after development of at least 3 follicles beyond 18mm diameter. Low dose of hCG (2500 IU) plus GnRH agonist (0. 2mg Triptorelin، intra muscular) were given to one group (n=70) and the next group (n=70) received hCG alone (10،000 IU، intra muscular). After 34 to 36 hours of injection intrauterine insemination was done in both groups. Data were analyzed with SPSS software version 11. 5 and T student and Chi-square tests. P value less than 0. 05 was considered significant. The patients were not different in terms of endometrial thickness، estradiol levels on day of hCG injection and the number of used gonadotropin ampoules (p=0. 1). Higher incidence of ovarian hyperstimulation syndrome (OHSS) was seen in the only hCG group، but this difference was not statistically significant (p=0. 1). Chemical pregnancy was significantly higher in low dose of hCG plus GnRH agonist (p=0. 03). However، no differences were observed between two groups in terms of clinical pregnancy (p=0. 07). Using low dose hCG plus GnRH agonist can be considered as an appropriate and alternative method instead of standard methods of hCG in ovulation induction with antagonist protocols.

Determination of oocyte fertilization and embryo quality are one of the most important purposes in ART cycles. Follicular fluid provides an important microenvironment for development of oocytes and some biochemical characteristics of the follicular fluid, such as pregnancy-associated plasma protein-A (PAPP-A), may play an important role in prediction of success rate of ART. This study was performed to evaluate whether there was any difference in follicular fluid PAPP-A, fertilization, and embryo quality between GnRH agonist long protocol and flexible GnRH antagonist multiple-dose protocol in ART cycles. A total of 100 women who were candidates for ART were enrolled the study and were divided into two groups, GnRH agonist (GnRHa) long protocol (n=51) and flexible GnRH antagonist (GnRHant) multiple-dose protocol (n=49). Follicular fluid sample was obtained from a single mature follicle and follicular fluid PAPP-A level, fertilization and embryo quality of the same oocyte were evaluated in both groups. There was no significant difference in the mean levels of follicular fluid PAPP-A between the GnRHa protocol and GnRHant protocol (3.5±1.4 vs. 3.8±1.9, respectively). The mean levels of follicular fluid PAPP-A in fertilized oocyte and good quality embryo were comparable in GnRHa and GnRHant protocols. Our data indicated that no differences of follicular fluid PAPP-A levels were observed between cycles using GnRHa long protocol and those of using flexible GnRHant multiple-dose protocol.

GnRH agonist and antagonist were developed to control the premature release of LH surge. There is some difference between two protocols. We compared the outcome of frozen-thawed embryo transfer in infertile women who used GnRH agonist or antagonist protocol for previous COH cycle and evaluation of any adverse effect of GnRH antagonist on oocyte and embryo. The study group included all infertile women who referred to Yazd Research and Clinical Center for Infertility. Overall 20-35 years old women who were candidate for frozen-thawed embryo transfer with regard to inclusion and exclusion criteria were participated in the study. The patients based on previous control ovarian stimulation (COH) protocol divided in to two groups: GnRH agonist long protocol (n=165) and GnRH antagonist multiple dose protocol (n=165). Frozen-thawed embryos were transferred after endometrial preparation in both groups. Main outcome measures were: implantation, chemical and clinical pregnancy rate. The implantation and clinical pregnancy rate following cryopreserved embryo transfer in GnRH agonist group and antagonist group were 16.3% vs. 15.7% (p=0.806) and 38.1% (63/165) vs. 36.9% (61/165) (p=0.915) and chemical pregnancy rate was 44.8% (74/165) vs. 43.6% (72/165) (p=0.915) respectively. There was no statistically difference between two groups in terms of implantation and pregnancy rate. Although pregnancy rate in fresh embryo transfer in antagonist cycles was lower than agonist groups, Therefore decrease in these parameters might be due to detrimental effect of GnRH antagonist on the endometrium, not embryo or oocyte.

Endometriosis is one of the most common gynecologic disorders. It is a complex trait and both genetic and environmental factors have been implicated in its pathogenesis. There is growing evidence indicating that exposure to environmental contaminants is a risk factor for endometriosis. Glutathione-S-Transferase M1 (GSTM1) is one of the genes involved in detoxification of endogenous and exogenous compounds. Several studies have indicated an association between GSTM1 null mutation and endometriosis. In this study, the possible association between the GSTM1 gene null genotype and susceptibility to endometriosis in woman from central and southern Iran was investigated. One hundred and one unrelated premenopausal women with endometriosis and 142 unrelated healthy premenopausal women without endometriosis were enrolled in the study. Genomic DNA was extracted from Peripheral blood in all subjects. GSTM1 null genotyping was performed by polymerase chain reaction (PCR). There was no significant difference between frequencies of GSTM1 null genotype in case and control groups (50.5% Vs. 52.1%, p=0.804). Furthermore, this genotype was not associated with severity of endometriosis in our sample (p=0.77). further studies involving gene-environment and gene-gene interactions, particularly combination of GSTM1 and other GST gene family polymorphisms are needed.

Abnormal uterine bleeding is a common presentation of uterine abnormalities among premenopausal and postmenopausal women. To evaluate and compare the diagnostic accuracy of saline contrast sonohysterography and hysteroscopy for detecting the cause of abnormal uterine bleeding. A total of 65 women with abnormal uterine bleeding were enrolled in this study. A prior saline contrast sonohysetrography followed by a hysteroscopy was performed in all cases. Sensitivity, specificity, positive and negative predictive value and test accuracy were calculated. As the most common abnormality, SCSH showed hyperplasia in 19 patients while hysteroscopy diagnosed polyp in 15 cases. A sensitivity of 73.3%, 71.4% and 90.9% were reported for polyp, hyperplasia and submucous myoma respectively whereas the specificity was calculated 96% for polyps, 82.3% for hyperplasia and 90.7% for submucous myoma. Comparing with hysteroscopy, sonohysterography showed a high sensitivity and specificity for detecting submucous myoma but not for endometrial polyp and endometrial hyperplasia.