The effect of weight loss program on serum anti-Müllerian hormone level in obese and overweight infertile women with polycystic ovary syndrome.

We evaluated the predictive value of serum anti-Müllerian hormone (AMH) levels for improved menstrual cycles in response to dietary management in women with polycystic ovary syndrome (PCOS). In addition, we assessed the effect of a restricted calorie diet for 12 weeks on serum AMH levels. This intervention study was carried out at Rohan Institute, Tehran, Iran from 2013 to 2015. A total of 105 overweight and obese women with PCOS and reproductive impairment participated in a 12-week weight loss program (WLP). The serum AMH levels, weight, and menstrual cyclicity were assessed at baseline and post-intervention for all of the participants. A total of 90 patients completed the 12-week WLP. Of the 90 patients, 65 (72.2%) responded to the intervention with improvements in menstrual cyclicity. There were no significant differences in terms of age, baseline AMH levels, and other hormone profiles between responders and nonresponders. Responders had a significantly lower baseline body mass index (BMI) and waist circumference compared with nonresponders. These factors were the clinical predictors for a menstrual response after the intervention. The AMH levels did not significantly change after 12-week WLP despite the overall reduced weight; however, women who responded with improved reproductive function had a greater reduction in AMH levels.

Barriers of Palliative Care in Neonatal Intensive Care Units.

OBJECTIVE: Neonatal nurses face numerous barriers in providing end-of-life (EOL) care for neonates and their families. Addressing neonatal nurses' attitudes could provide insight into barriers that impede neonatal palliative care (NPC). This study thus conducted to examine neonatal nurses' attitude toward barriers in providing NPC in Southeast Iran. METHOD: In this cross-sectional study, a translated modified version of Neonatal Palliative Care Attitude Scale was used to examine attitudes of 70 nurses toward barriers of palliative care in 3 neonatal intensive care units in Southeast Iran. RESULTS: Findings indicated that overall 42.63% of nurses were strongly agreed or agreed with the proposed barriers in NPC. Among all categories, the highest and the lowest scores belonged to the categories of "insufficient resources" (3.42 ± 0.65) and "inappropriate personal and social attitudes" (2.33 ± 0.48), respectively. Neonatal nurses who had less education and study regarding NPC reported the presence of more barriers to NPC in the categories of "inappropriate organizational culture" and/or "inadequate nursing proficiency." Also, younger nurses had more positive attitudes toward the category of inappropriate organizational culture as being a barrier to provision of NPC (4.62). CONCLUSION: The findings suggest that developing a context-based instrument is required to represent the barrier more precisely. Neonatal palliative care can be improved by establishing a special environment to focus on infants' EOL care. This establishment requires standard palliative care guidelines and adequate NPC-trained nurses.

Metabolic syndrome in infertile women with polycystic ovarian syndrome

ABSTRACT Objective The aim of the present study was to determine the prevalence of metabolic syndrome (MS) in infertile Iranian women with polycystic ovary syndrome (PCOS) using the ATPIII criteria. Subjects and methods In this cross-sectional study, 624 women with PCOS were enrolled at a tertiary referral center in Tehran, Iran, between April, 2012 and March, 2013. Diagnosis of MS was according to ATPIII criteria. Also, we divided PCOS patients into following two main groups: (i) with MS (n = 123) and (ii) without MS (n = 501), and then compared variables between two groups. Results The mean age, body mass index (BMI) and waist circumference were 28.6 ± 4.3 years, 26.7 ± 3.7 kg/m2 and 85.2 ± 8.7 cm, respectively. The prevalence of MS was 19.7%. Our findings showed that age, BMI, waist circumference and all metabolic parameters were higher in PCOS women with MS than related values in those without MS. The most and least prevalent forms of MS were low level of high density lipoprotein-cholesterol (HDL-C) and hypertension, respectively. Conclusion It seems the prevalence of metabolic syndrome in our country isn’t as high as western countries. The prevalence rate of MS increased with age and BMI. One of the major cardiovascular risk factors, low level of HDL-C, is the most prevalent metabolic abnormality in our participants.

Metabolic syndrome in infertile women with polycystic ovarian syndrome.

OBJECTIVE: The aim of the present study was to determine the prevalence of metabolic syndrome (MS) in infertile Iranian women with polycystic ovary syndrome (PCOS) using the ATPIII criteria. SUBJECTS AND METHODS: In this cross-sectional study, 624 women with PCOS were enrolled at a tertiary referral center in Tehran, Iran, between April, 2012 and March, 2013. Diagnosis of MS was according to ATPIII criteria. Also, we divided PCOS patients into following two main groups: (i) with MS (n = 123) and (ii) without MS (n = 501), and then compared variables between two groups. RESULTS: The mean age, body mass index (BMI) and waist circumference were 28.6 ± 4.3 years, 26.7 ± 3.7 kg/m2 and 85.2 ± 8.7 cm, respectively. The prevalence of MS was 19.7%. Our findings showed that age, BMI, waist circumference and all metabolic parameters were higher in PCOS women with MS than related values in those without MS. The most and least prevalent forms of MS were low level of high density lipoprotein-cholesterol (HDL-C) and hypertension, respectively. CONCLUSION: It seems the prevalence of metabolic syndrome in our country isn't as high as western countries. The prevalence rate of MS increased with age and BMI. One of the major cardiovascular risk factors, low level of HDL-C, is the most prevalent metabolic abnormality in our participants.

A randomized controlled trial evaluating the effect of ethinyl estradiol during clomiphene citrate cycles among women with polycystic ovary syndrome.

OBJECTIVE: To investigate the effects of low-dose ethinyl estradiol (EE) on the clinical pregnancy rate among women with polycystic ovary syndrome (PCOS) undergoing ovulation induction with clomiphene citrate (CC). METHODS: Between March 12, 2011, and February 10, 2013, a randomized, double-blind, placebo-controlled trial was conducted at the Royan Institute Research Center, Tehran, Iran, among women with PCOS who were aged 25-30 years, were undergoing their first intrauterine insemination cycle, and had a history (≥2 years) of infertility, oligomenorrhea, or amenorrhea. Participants were randomly allocated to receive EE (0.05 mg daily for 5 days) or placebo, co-administered with CC cycles (100 mg daily for 5 days). The primary outcome was clinical pregnancy rate. Analyses were per protocol: patients who discontinued the intervention were excluded. RESULTS: Analyses included 45 women who received CC and EE, and 50 women who received CC and placebo. The number of women who achieved a clinical pregnancy was higher among participants who received CC and EE (13 [29%]) than among those in the control group (5 [10%]; P =0 .02). No adverse effects of EE were reported. CONCLUSION: The combination of CC and EE seems to increase the clinical pregnancy rate among women with PCOS undergoing intrauterine insemination. ClinicalTrials.gov:NCT01219101.

Effect of low-dose aspirin therapy on implantation rate in women undergoing in-vitro fertilization cycles.

OBJECTIVE: To determine the effect of low-dose aspirin on ovarian response, implantation and pregnancy rates in patients undergoing in-vitro fertilization (IVF) cycles. METHODS: We performed a randomized analysis of 145 infertile women with a mean+/-SD age of 29.6 +/- 4.47 years who underwent cycles of IVF. Patients received 100 mg of aspirin (n=72) or placebo (n=73) daily. This study was conducted in Royan Institute, Tehran, Iran from April 2002 to January 2004. Aspirin was started on the 21st of their preceding menstrual cycle and it was continued until menstruation or a negative pregnancy test. Pregnant women received the medication until 12 weeks of pregnancy. The main outcome measures were number of follicles >or=15 mm, number of oocytes retrieved, serum E2 levels, cancellation rate, Ovarian Hyperstimulation Syndrome (OHSS) occurrence, number of embryos transferred, and implantation and pregnancy rates. RESULTS: There were statistically significant differences between the treatment group and the control group in the number of follicles (7.4 +/- 4.1 versus 9.0 +/- 4.8) and OHSS occurrence (5.6% versus 23.3%) but not in the other measures. CONCLUSION: The addition of aspirin low dose (100 mg/daily) to the standard long protocol for oocyte retrieval did not improve implantation and pregnancy rates in unselected patients undergoing IVF cycles.

The role of ketoconazole in the prevention of ovarian hyperstimulation syndrome in patients with polycystic ovary syndrome during assisted reproductive technology cycles.

OBJECTIVE: To assess the clinical efficacy of ketoconazole (KCZ) as an inhibitory enzyme on ovarian steroidogenesis, in prevention of ovarian hyper- stimulation syndrome (OHSS) during assisted reproductive technology (ART) in patients with polycystic ovarian syndrome (PCOS). METHODS: We included 58 PCOS patients, enrolled for in-vitro fertilization or intracytoplasmic sperm injection in a randomized clinical trial between November 2000 and October 2001 in the Royan Institute, Tehran, Iran. Twenty-eight patients received KCZ during the stimulation phase and 30 patients were controls. We compared serum E2 levels, number of lead follicles, number of retrieved oocytes, fertilization rate, occurrence of OHSS and cancellation rate using student's t-test, Chi-square and Fisher exact test. RESULTS: We found no significant differences between the 2 groups in the peak serum estradiol level, the number of lead follicles, oocytes, and fertilization rate. One patient in the control group had clinical symptoms of severe ovarian hyperstimulation, and none from the treated group. CONCLUSION: This study reveals no significant effect of KCZ on the incidence of OHSS during ART cycles; however, also no significant negative effects of KCZ on the number and maturity of oocytes or on fertilization rate.