Association of meteorological factors and seasonality with preeclampsia: a 5-year study in northeast of Iran.

BACKGROUND: Preeclampsia is one of the common causes of maternal and fetal mortality, and an important problem of pregnancy. This disorder can cause intracranial hemorrhage, intravascular coagulation, pulmonary edema, liver and renal failures and placental abruption. OBJECTIVE: To evaluate the effects of seasonal and monthly changes of weather, humidity and temperature on the incidence rate of preeclampsia according to the conception and delivery times. MATERIALS AND METHODS: Retrospective analysis of hospital records of 20,520 consecutive singleton live birth pregnancies of 20-42 weeks of gestation during 2002-2008 was performed. After including preeclamptic cases, on the basis of American College of obstetricians and gynecologists (ACOG) criteria, gestational age and time of conception was estimated and the mean relative temperature and humidity of each month was derived from monthly climatological data collection of IRAN METEOROLOGICAL ORGANIZATION (IRIMO) between 22 June 2002 and 19 March 2008 (68 months). Statistics of each month's births were registered separately. RESULTS: Mean maternal age of 262 qualified singleton pregnant women with preeclampsia out of 20,520 deliveries were 26.48 years old and 85.9% of deliveries were done by cesarean section method. Based on time of conception, the highest prevalence was detected in summer, especially in September (11.06875%) and August (10.3053%) and the lowest prevalence was found in winter and early spring, especially in January (5.7552%) and April (5.7252%). CONCLUSION: Seasonal (monthly) variations of the weather (humidity and temperature) have a significant impression on preeclampsia prevalence.

A randomized trial of ovulation induction with two different doses of Letrozole in women with PCOS.

OBJECTIVE: To compare the effects of either a 5 or 7.5 mg daily dose of Letrozole in PCOS women undergoing ovulation induction and timed intercourse. DESIGN: Prospective randomized trial. SETTING: Academic infertility care center. PATIENTS: Sixty-seven PCOS patients with infertility. INTERVENTIONS: Patients were randomly divided into two groups and treated with either 5 mg/day (30 patients, group 1) or 7.5 mg/day (37 patients, group 2) Letrozole for 5 days starting from day 3 of the menstrual cycle. When the leading follicle reached 18 mm in diameter, ovulation was triggered by an injection of HCG and timed intercourse was advised thereafter. MAIN OUTCOME MEASURES: The primary outcome measures were the number of follicles and days to reach mature follicle and the secondary endpoints were endometrial thickness, day 7 testosterone level, ovulation and pregnancy rates. RESULTS: The mean age, BMI, duration of infertility and basal hormone levels in both groups were similar. There was no significant difference in the endometrial thickness (7.87 ± 1.67 vs 7.16 ± 2.04), the number of intermediate (0.83 ± 0.75 vs 0.62 ± 0.76) and mature follicles (1.13 ± 1.11 vs 1.22 ± 1.03) on days 12-14 between group 1 and 2, respectively. The days to reach mature follicle were similar in both groups (12.8 ± 1.36 vs 12.6 ± 1.22). Also there was no significant difference in the day 7 testosterone level and day 21 progesterone level between the two. Ovulation occurred in 90 and 89.2% of patients in group 1 and 2, respectively without a statistically significant difference. The pregnancy rate per first ovulatory cycle was 25.8% in group 1 and 21.2% in group 2 without significant difference. No OHSS was observed in either group. CONCLUSION(S): The results of this study did not show any advantage to the use of 7.5 mg/day over 5 mg/day dose of Letrozole as the first line treatment for induction of ovulation in women with PCOS.

Comparison of GnRH antagonist with long GnRH agonist protocol after OCP pretreatment in PCOs patients.

PURPOSE: To evaluate the efficacy of GnRH antagonist in comparison with the GnRH agonist protocol in OCP pretreated polycystic ovary syndrome (PCOs) patients undergoing their first ART cycle. MATERIALS AND METHODS: Prospective randomized controlled trial. University-based tertiary fertility center. Ninety-five PCOs patients under 35 years of age, with primary infertility were randomized to an ovarian stimulation protocol consisting of either. GnRh antagonist (study group) or GnRH agonist (control group) after pretreatment with OCP. Coasting or GnRH agonist Trigger was used when estradiol level > or =3,000 pgr/ml in the control and study group, respectively. Both groups received 800 mg vaginal progesterone and 4 mg oral estradiol valerate for luteal phase support. RESULTS: There was no statistically significant difference in the age, body mass index, basal FSH, duration of infertility, the number of oocytes retrieved, the number of embryos transferred, Serum E2 levels on day of trigger, fertilization rate, chemical and clinical pregnancy rates between the two groups. None of the patients in the study group developed ovarian hyperstimulation syndrome (OHSS) compared with 22.2% of patients in the control group. Total duration of treatment and the number of HMG ampoules used were lower in the study group. CONCLUSION: Antagonist protocol and GnRH agonist trigger for ovulation whenever necessary has a similar cycle outcome to the GnRH-agonist protocol in OCP pretreated PCOs patients, with significantly reduced risk of OHSS.

Quality of Life and General Health in Pregnant Women Conceived with Assisted Reproductive Technology: A Case-Control Study.

BACKGROUND: Infertility affects different aspects of life including the quality of life (QOL) in infertile couples. Many infertile couples conceive via using assisted reproductive technology (ART). However, the effect of pregnancy and childbearing on QOL is not known in these couples. This study aimed to evaluate QOL and general health during pregnancy and after successful treatment of infertility, in women conceived with ART. MATERIALS AND METHODS: In this case-control study, QOL and general heath were evaluated in 40 women conceived with ART and 40 women who conceived spontaneously and served as the control group. WHO quality of life- BREF (WHOQOL-BREF) inventory was used to evaluate QOL and General Health Questionnaire-28 (GHQ-28) was applied to evaluate general health. These two questionnaires were completed in the first and second trimester of pregnancy and results were compared between the two groups. RESULTS: Mean age of women was 29.4 ± 4.4 and 29.6 ± 5 years in ART and control group, respectively. QOL in women conceived with ART was similar to QOL in the control group in the first and second trimester of pregnancy while general health score (distress level) in women conceived with ART was significantly higher than that of the control group in both trimesters. Although distress level decreased in the second trimester in ART group, but yet, it was higher than that recorded for the control group. CONCLUSION: After pregnancy, QOL in women conceived with ART is similar to women conceived spontaneously. However, these women experience higher distress level in the first and second trimester of pregnancy compared to women conceived spontaneously.

Seroprevalence, transmission, and associated factors of specific antibodies against cytomegalovirus among pregnant women and their infants in a regional study.

OBJECTIVE: To assess specific anti-cytomegalovirus (CMV) antibodies, clinical status, and demographic data in pregnant women and their infants in northeast Iran. METHODS: This cross-sectional study was conducted on 225 systematic randomly selected-pregnant women and their newborns attending public hospitals in Mashhad, Iran between December 2007 and January 2008. Two specialists performed clinical assessment and obtained the demographic data. The sera from mothers and the umbilical cord of infants were then collected at the time of delivery and anti-CMV antibodies, IgG, and IgM, were measured. RESULTS: Although, all mothers and their neonates were positive for anti-CMV IgG (100%), only 6 were positive for anti-CMV specific IgM (2.6%), and their infants were negative. However, in one infant the clinical features of CMV infection were observed by radiological evaluation (CT scan) (0.4%). There was no correlation between anti-CMV IgG in neonates and number of parity, history of abortion, mothers` and neonates` blood groups, gestational age, and economical status. However, the concentration of anti-CMV IgG in neonates with normal delivery was significantly lower than with cesarean delivery (p=0.03), and in girls compared with boys (p=0.04). CONCLUSION: Anti-CMV IgG transmission to neonates is associated with gender and type of delivery. Despite anti-CMV IgM showing active CMV infection in mothers, virus transmission to the fetus might not occur.

Luteal phase estradiol versus luteal phase GnRH antagonist administration: their effects on antral follicular size coordination and basal hormonal levels.

BACKGROUND: The differential efficacy between long GnRH agonist with antagonist can partly be due to the preexisting differences in the early antral follicles before ovarian stimulation. OBJECTIVE: To compare the effect of pretreatment by estradiol with GnRH antagonist on antral follicular size coordination and basal hormone levels in GNRH antagonist protocol. MATERIALS AND METHODS: On cycle day 3 (control/day 3), women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones then were randomized to receive oral estradiol 4mg/day (n=15) or 3mg cetrorelix acetate (n=15) in luteal phase before subsequent antagonist protocol. Participants were re-evaluated as on control/day 3. RESULTS: There was a significant reduction of mean follicular sizes in each group after medical intervention (7.63±2.11 Vs. 4.30±0.92 in group A and 8.73±1.96 Vs. 4.13±1.11 in group B) (p=0.0001). The magnitude of follicular size reduction was significantly higher in group B (-4.60±2.04 Vs. -3.33±2.28) (0.027). There was a non significant attenuation of follicular size discrepancies in two groups. FSH and inhibin B levels in the day 3 of the next cycle in both groups were significantly decreased but did not have significant difference between two groups. CONCLUSION: Both luteal E2 and premenstrual GnRH antagonist administration reduces the follicular sizes significantly and GnRH antagonist acts more potently than E2 in this way but attenuation of follicular size discrepancies in both treatment is not significant.