International Journal of Reproductive BioMedicine
Volume:10 Issue: 1, Jan 2012

Precocious puberty, as early physical development and low final height might lead to psychosocial problems. To evaluate etiology and clinical feature of precocious puberty in a cohort of Iranian children. In this case-series study, 44 girls and 8 boys with precocious puberty referred to Endocrine Reserch Centre (Firouzgar), Institute of Endocrinology and Metabolism (Hemmat Campus), were examined in a 10 years period of time. Mean age of girls and boys was 7.43±1.4 years and 5.8±2.1 years respectively. Most of the patients fell within the age category of 7-7.9 years old (40.9% for girls and 50% for boys). Patients, concerning etiology of precocious puberty were classified in three categories: 42.6% of patients had central precocious puberty (CPP), including idiopathic CPP (87.5%) and neurogenic CPP (12.5%). 23.3% of patients had peripheral precocious puberty (PPP), including congenital adrenal hyperplasia (CAH) (42.8%), ovarian cysts (28.4%), McCune-Albright syndrome (14.2%) and adrenal carcinoma (14.2%). 34.1% of girls and 25% of boys had normal variant puberty including premature thelarche (57%), premature adrenarche (38%) as well as premature menarche (4.7%l). The most common etiology of precocious puberty in girls was idiopathic central precocious puberty and premature thelarche, while in boys they were neurogenic central precocious puberty and CAH. Therefore precocious puberty in girls is usually benign. In boys, CNS anomalies should first be considered in the differential diagnosis of CPP. Therefore brain Magnetic Resonance Imaging (MRI) is mandatory in all cases.

Phthalate esters have been shown to cause reproductive toxicity in both developing and adult animals. This study was designed to assess long-term effects of maternal exposure to Di (2-ethylhexyl) Phthalate (DEHP) on reproductive ability of both neonatal and adult male offspring. 60 female rats randomly divided in four equal groups; vehicle control and three treatment groups that received 10, 100 and 500 mg/kg/day DEHP via gavage during gestation and lactation. At different ages after birth, the volumes of testes were measured by Cavellieri method, testes weights recorded and epididymal sperm samples were assessed for number and gross morphology of spermatozoa. Following tissue processing, seminiferous tubules diameter and germinal epithelium height evaluated with morphometric techniques. Mean testis weight decreased significantly (p<0.05) in 500 mg/kg/day dose group from 28 to 150 days after birth. Significant decreases were seen in total volumes of testis in 100 (p<0.05) and 500 (p<0.01) mg/kg/day doses groups until 150 days after birth. Seminiferous tubules diameter and germinal epithelium height decreased significantly in 100 (p<0.05) and 500 (p<0.01) mg/kg/day doses groups during postnatal development. Also, mean sperm density in 100 mg/kg/day (p<0.05) and 500 mg/kg/day (p<0.01) doses groups and percent of morphologically normal sperm in highest dose group (p<0.05) decreased significantly until 150 days after birth. Present study showed that maternal exposure to Di (2-ethylhexyl) Phthalate during gestation and lactation caused to permanent and dose-related reductions of sperm and testicular parameters in rats offspring.

Missed abortion (Silent miscarriage) is defined as intrauterine fetal death before twenty weeks gestation. One of the most common causes of early missed abortions (before 10 weeks gestation) is cytogenetic abnormalities. To asses if there is a correlation between chromosomal aberrations (especially in chromosome 7) and missed abortion among at least two generations. After exclusion of direct causes of missed abortion, this study included 60 women (the study group) who had first trimestric missed abortion and 30 healthy women who did not suffer from any diseases during their pregnancy and had apparently normal outcome (the control group). All cases were diagnosed; the blood and tissue samples were collected from the mothers and abortuses from the Department of Obstetrics and Gynecology, Maternity Hospital, Ain Shams University. Cytogenetic analyses were performed by using conventional technique and G/T banding techniques and Fluorescence In Situ Hybridization (FISH) analysis with a whole chromosome 7 painting probe (WCP7) and a 7q subterminal probe (7q36, qter), prepared by chromosome micro dissection technique was used for confirming the specific chromosomal abnormality. Chromosomal analysis by G-banding technique was carried out in all families through three generations including the abortuses. We found highly statistical significant difference between maternal and abortal abnormal karyotype (p?0.005), where abnormal maternal karyotype was detected in 20% cases, 8.33% of them had insertional translocation between chromosomes 1 and 7 (46, XX, ins. (1; 7) (p32; q32.35). This insertion has appeared in two families and among two generations, and in one family among three generations. Chromosome 7 insertional translocation is a possible autosomal dominant inherited trait and may cause missed abortion.

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.

Clomiphene citrate (CC) an agonist and antagonist of estrogen, is the first line treatment in ovarian stimulation. Anti-estrogenic effect of CC in endometrial thickness and cervical mucus has negative effect on pregnancy rate. Letrozole is an Aromatase Inhibitor has been seen that has acceptable pregnancy rate compared to CC. The aim of this study was to compare the efficacy of letrozole and clomiphene citrate (CC) with gonadotropins for ovarian stimulation in women candidate for intrauterine insemination (IUI). One hundred sixty patients eligible to IUI therapy enrolled in this study. Patients randomized to two groups: group A (received letrozole-gonadotropin) and group B (received CC-gonadotropin). In group A (n=80) letrozole was given on days 3-7 of the menstrual cycles. In group B clomiphen citrate was given like letrozole combined with human menopausal gonadotropin (hMG) administered every day starting on day 8. Ovulation was triggered with urinary HCG when the leading follicle (s) reached 18 mm in diameter. A single IUI was performed 36-40 hours later. The ovarian stimulation response (E2 levels and number of follicles, clinical pregnancy and endometrial thickness) was primary outcome. Both groups were similar in demographic characteristics. There was a significantly lower peak serum E2 level in the letrozole group compared with CC. (236±86 Vs. 283±106 pg/mL, respectively; p<0.002). The number of mature (>18 mm) preovulatory follicles was significantly higher in CC group than letrozole group (2.2±.68 Vs. 2.02±0.63 respectively; p=0.025). Endometrial thickness measured at the time of hCG administration was significantly higher in letrozole group. (9.08±1.2 mm Vs. 8.1±1.9 mm; p=0.0001). The clinical pregnancy rate was comparable between two groups. Letrozole is a good and cost-effective alternative to CC in IUI cycles.

Clomiphen citrate (CC) is the first line therapy for women with infertility and poly cystic ovary syndrome(PCOS). However, 20-25% of women are resistant to CC and do not ovulate. The objective of this study was to evaluate the efficacy of sequential treatment of metformin and incremental doses of letrozole in induction of ovulation in cases of CC-resistant PCOS patients. In this prospective before-after study, we enrolled 106 anovulatory PCOS women who failed to ovulate with CC alone from Amir-Almomenin University Hospital in Semnan, Iran. After an initial 6-8 weeks of metformin treatment, they received 2.5 mg letrozole daily on days 3-7 after menes. If they did not ovulate with 2.5 mg letrozole, the doses were increased to 5 to 7.5 mg daily in subsequent cycles. The main outcomes were ovulatory rate, pregnancy rate and cumulative pregnancy rate. 13.33% of patients conceived with metformin alone. Ovulation occurred in 83 out of remaining 91 patients (91.2%). 78.02% of patients responded to lower doses of letrozole. Cumulative pregnancy rate was 60/ 105 (57.14%). We suggest that treatment in CC-resistant PCOS patients should begin at first with lower doses of letrozole and could increase to the higher dose depending on the patient response before considering more aggressive therapeutic alternatives such as gonadotropins.

The levonorgestrel-releasing IUD can help the treatment of dysmenorrhea by reducing the synthesis of endometrial prostaglandins as a conventional treatment. This study was performed to assess the frequency of dysmenorrhea, satisfaction and quality of life in women using Mirena IUDs as compared to those using copper IUDs. This double-blind randomized clinical trial was performed between 2006 and 2007 on 160 women aged between 20 to 35 years who attended Shahid Ayat Health Center of Tehran, and they were clients using IUDs for contraception. 80 individuals in group A received Mirena IUD and 80 individuals in group B received copper (380-A) IUD. Demographic data, assessment of dysmenorrhea, and follow-up 1, 3 and 6 months after IUD replacement were recorded in questionnaires designed for this purpose. To assess the quality of life, SF36 questionnaire was answered by the attending groups, and to assess satisfaction, a test with 3 questions was answered by clients. Dysmenorrhea significantly was decreased in both groups six months after IUD insertion as compared to the first month (p<0.001). However, statistically, Mirena reduced dysmenorrhea faster and earlier compared to cupper IUD (p<0.003). There isn’t any significant difference between these two groups in satisfaction and quality of life outcomes. There is no difference between these two groups in terms of the satisfaction and quality of life, therefor the usage of Mirena IUD is not a preferred contraception method.

The physiological changes in thyroid gland during pregnancy have been suggested as one of the pathophysiologic causes of preeclampsia. The aim of this study was comparison of serum levels of Tri?iodothyronine (T3), Thyroxine (T4), and Thyroid?Stimulating Hormone (TSH) in preeclampsia and normal pregnancy. In this case?control study, 40 normal pregnant women and 40 cases of preeclampsia in third trimester of pregnancy were evaluated. They were compared for serum levels of Free T3 (FT3), Free T4 (FT4) and TSH. The data was analyzed by SPSS software with the use of t?student, Chi?square, Independent sample T-test and Bivariate correlation test. p?0.05 was considered statistically significant. The mean age was not statistically different between two groups (p=0.297). No significant difference was observed in terms of parity between two groups (p=0.206). Normal pregnant women were not significantly different from preeclampsia cases in the view of FT3 level (1.38 pg/ml vs. 1.41 pg/ml, p=0.803), FT4 level (0.95 pg/ml vs. 0.96 pg/ml, p=0.834) and TSH level (3.51? IU/ml vs. 3.10? IU/ml, p=0.386). The findings of the present study do not support the hypothesis that changes in FT3, FT4 and TSH levels could be possible etiology of preeclampsia.

Estradiol (E2) is required for follicular development and play an important role in embryo implantation. The aim of this study was to assess the impact of serum E2 levels on the day of hCG administration in IVF-ICSI patients who are performed controlled ovarian hyperstimulation (COH). A total of 203 women who were undergone one time IVF cyclus were evaluated in this cross sectional study. All the patients were treated either with long protocol or with microdose flare protocol. The patients were categorized into five groups according to the serum E2 levels on the day of hCG administration. The mean number of the retrieved oocytes was (NRO) 10.6±6.7, mean fertilization rate was 55.7±24.8, and implantation rate was 9.0±19.2. Of 203 patients, 43 (21%) patients were pregnant. When the overall results are examined, the number of the retrieved oocytes and the number of transferred embryos were better in patients with serum E2 levels >4000 pg/ml and these values were statistically significant. There were no statistical difference in patients 37 years or older. In women? 36 years old, the IVF-ICSI outcomes were better in patients with serum E2 levels >4000 pg/ml. In spite of the lack of high quality evidence to support a positive association between serum E2 levels and IVF-ICSI outcomes, this study shows that high E2 levels during COH might be associated with an increased potential of pregnancy depending on better ovarian response. When the overall results are examined, the best scores were in patients with serum E2 levels >4000 pg/ml.

Role of genetic factors in etiology of preeclampsia is not confirmed yet. Gene defect frequency varies in different geographic areas as well as ethnic groups. In this study, the role of factor V Leiden mutation in the pathogenesis of preeclampsia syndrome among the pregnant population of northern shore of Persian Gulf in Iran, were considered. Between Jan. 2008 and Dec. 2009, in a nested case control study, pregnant women with preeclampsia (N=198) as cases and healthy (N=201) as controls were enrolled in the study. DNA were extracted from 10 CC peripheral blood and analyzed for presence of factor V Leiden mutation in these subjects. The maternal and neonatal outcomes of pregnancy according to the distribution of factor V Leiden were also compared among cases. In total, 17(8.6%) of cases and 2(1%) of controls showed the factor V Leiden mutation. The incidence of factor V Leiden was typically higher in preeclamptic women than control group (OR: 9.34 %95 CI: 2.12-41.01). There was no difference in incidence rate of preterm delivery< 37 weeks (OR: 1.23 %95 CI: 0.38-4.02), very early preterm delivery<32 weeks (OR: 1.00 %95 CI: 0.12-8.46), intra uterine fetal growth restriction (IUGR) (OR: 1.32 %95 CI: 0.15-11.30),and the rate of cesarean section (OR: 0.88 %95 CI: 0.29-2.62) among cases based on the prevalence of factor V Leiden mutation. The pregnant women with factor V Leiden mutation are prone for preeclampsia syndrome during pregnancy, but this risk factor was not correlated to pregnancy complications in the studied women.