Impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during the COVID-19 pandemic.

BACKGROUND: Infertility continued to be a major stressor among women with infertility during COVID-19pandemic. This study aimed to evaluate the impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during COVID-19 pandemic. METHOD: In this cross-sectional study, 386 women with infertility completed the questionnaires of PC-PTSD-5 and Fertility Problem Inventory (FPI) at an infertility center between 2020 and 2022. RESULTS: The mean of fertility problems was 145.20 (± 32.31). In terms of FPI subscales, the means were as follows: Sexual concern 21.80 (± 7.58), social concern 26.53 (± 8.94), relationship concern 26.02 (± 9.18), need for parenthood concern 40.88 (± 8.98), and rejection of childfree lifestyle 29.96 (± 7.69). The highest mean of FPI subscales was related to the need for parenthood concern in women with infertility. The strongest correlation was found between the subscales of sexual concern and social concern followed by sexual concern and relationship concern. The variables of PC-PTSD were a predictor of fertility problems (ß = 0.203, P < .0001). Additionally, the variables of PC-PTSDwere a predictor of sexual concern (ß = 0.248, P < .0001), social concern (ß = 0.237, P < .0001), relationship concern (ß = 0.143, P < .020), and need for parenthood concern (ß = 0.101, P < .010). After adjusting for demographic characteristics, there was a significant relationship between FPI with job (ß=-0.118, P < .031), education (ß=-0.130, P < .023), living place (ß = 0.115, P < .035), smoking (ß = 0.113, P < .036), relationship with husband (ß = 0.118, P < .027), and PC-PTSD symptom (ß = 0.158, P < .0001). In addition, the multivariate linear regression showed a significant association between sexual concern and education (ß=-0.152, P < .008), smoking (ß = 0.129, P < .018), PC-PTSD symptom (ß = 0.207, P < .0001); social concern and job (ß=-0.119, P < .033), PC-PTSD symptom (ß = 0.205, P < .0001); relationship concern and education (ß=-0.121, P < .033), living place (ß = 0.183, P < .001), relationship with husband (ß = 0.219, P < .0001); and rejection of childfree lifestyle and job (ß=-0.154, P < .007). CONCLUSION: Systematic PTSD screening during COVID-19 pandemic by healthcare providers can be uniquely used to identify, evaluate, and treat trauma-related health conditions in infertility settings, which can link women with infertility to mental health services. This can be novel and useful for future policymakers and practitioners in the infertility field.

Molecular mechanisms of microRNA-216a during tumor progression.

MicroRNAs (miRNAs) as the members of non-coding RNAs family are involved in post-transcriptional regulation by translational inhibiting or mRNA degradation. They have a critical role in regulation of cell proliferation and migration. MiRNAs aberrations have been reported in various cancers. Considering the importance of these factors in regulation of cellular processes and their high stability in body fluids, these factors can be suggested as suitable non-invasive markers for the cancer diagnosis. MiR-216a deregulation has been frequently reported in different cancers. Therefore, in the present review we discussed the molecular mechanisms of the miR-216a during tumor progression. It has been reported that miR-216a mainly functioned as a tumor suppressor through the regulation of signaling pathways and transcription factors. This review paves the way to suggest the miR-216a as a probable therapeutic and diagnostic target in cancer patients.

Psychiatric Symptoms in Women with High-risk Pregnancy in the Postpartum Period: A Case-control Study

Abstract Objective: Psychiatric symptoms are common mental issues in pregnancy and the postpartum period. There is limited information regarding the psychiatric symptoms of women with high-risk pregnancy in the postpartum period. This study aimed to compare the severity of psychiatric symptoms and psychological distress in women with high-risk and low-risk pregnancies in the postpartum period. Methods: This case-control study examined 250 women in the postpartum period in two groups with low-risk (n = 112) and high-risk (n = 138) pregnancies. Women completed the Brief Symptom Inventory-53 (BSI-53) and the Risk Postnatal Psychosocial Depression Risk Questionnaire (PPDRQ). Results: The mean severity of psychiatric symptoms in women with high-risk pregnancies was significantly higher than that in women with low-risk pregnancies (39.34 ± 17.51 vs. 30.26 ± 17.08). Additionally, the frequency of psychological distress in women with high-risk pregnancies was approximately twice higher than that in women with low-risk pregnancies (30.3% vs. 15.2%). Furthermore, the risk factors for depression in women with high-risk pregnancies were almost 1.5 times (59.8% vs. 39.8%) higher than the factors in women with low-risk pregnancies. The results of the logistic analysis indicated that high-risk pregnancies could be twice the odds ratio of developing postpartum psychological distress (ß = 2.14, 95% CI 1.4-6.3, p= 0.036). Conclusion: Psychiatric symptoms and the psychological distress index are higher in postpartum women with high-risk pregnancies than in postpartum women with low-risk pregnancies. The study suggests that obstetricians and pregnant women's health care providers should strongly consider screening of psychiatric symptoms in women with high-risk pregnancies both during pregnancy and after delivery as the women's routine care priorities.

MicroRNAs as the critical regulators of cell migration and invasion in thyroid cancer.

Thyroid cancer (TC) is one of the most frequent endocrine malignancies that is more common among females. Tumor recurrence is one of the most important clinical manifestations in differentiated TC which is associated with different factors including age, tumor size, and histological features. Various molecular processes such as genetic or epigenetic modifications and non-coding RNAs are also involved in TC progression and metastasis. The epithelial-to-mesenchymal transition (EMT) is an important biological process during tumor invasion and migration that affects the initiation and transformation of early-stage tumors into invasive malignancies. A combination of transcription factors, growth factors, signaling pathways, and epigenetic regulations affect the thyroid cell migration and EMT process. MicroRNAs (miRNAs) are important molecular factors involved in tumor metastasis by regulation of EMT-activating signaling pathways. Various miRNAs are involved in the signaling pathways associated with TC metastasis which can be used as diagnostic and therapeutic biomarkers. Since, the miRNAs are sensitive, specific, and non-invasive, they can be suggested as efficient and optimal biomarkers of tumor invasion and metastasis. In the present review, we have summarized all of the miRNAs which have been significantly involved in thyroid tumor cells migration and invasion. We also categorized all of the reported miRNAs based on their cellular processes to clarify the molecular role of miRNAs during thyroid tumor cell migration and invasion. This review paves the way of introducing a non-invasive diagnostic and prognostic panel of miRNAs in aggressive and metastatic TC patients.

Mental and personality disorders in infertile women with polycystic ovary: a case-control study.

BACKGROUND: Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility in women. OBJECTIVE: The current study investigated mental and personality disorders in infertile women with and without PCOS. METHODS: This case-control study evaluated 400 infertile women who referred to the Infertility Center in Babol city (North of Iran). Participants were categorized into the case group (201 PCOS) and the control group (199 without PCOS). All of the participants completed the Millon Clinical Multi-axial Inventory-III (MCMI-III). RESULTS: The mean scores for clinical personality patterns were significantly higher for six personality disorders (schizoid, avoidant, antisocial, depressive, sadistic, and negativistic) and for three classes of severe personality disorder patterns (schizotypal, borderline, and paranoid) in infertile women with PCOS than in women without PCOS. The mean scores for eight clinical disorders (somatoform, manic disorder, dysthymia, alcohol-dependence, drug-dependence, post-trauma stress disorder, major depression, and delusion disorder) were also higher in infertile women with PCOS than in women without PCOS. CONCLUSION: The scores of many mental and personality disorders are higher in infertile women with PCOS than in women without PCOS. Thus, clinicians should prioritize recognizing and treating psychological problems of infertile women with PCOS.

Differences between infertile women with and without PCOS in terms of anxiety, coping styles, personality traits, and social adjustment: a case-control study.

PURPOSE: The aim of the study was to identify differences in the level of anxiety, stress coping ways, personality traits, and social adjustments in infertile women with polycystic ovary syndrome (PCOS) compared to those without PCOS. METHODS: In a case-control study, 257 infertile of women were recruited at Fatemeh Azahra Infertility and Reproductive Health Research Center (Babol, Iran) from May 2016 to December 2017. A total of 135 women with PCOS and 122 women without PCOS completed the following questionnaires; State-Trait Anxiety Inventory (STAI), Ways of Coping Questionnaire (WCQ), NEO Five-Factor Inventory (NEO-FFI), and Bell's Adjustment Inventory. RESULTS: Infertile women with PCOS had a higher mean score of trait anxiety than those without PCOS (46.19 ± 5.29 vs 44.49 ± 5.13, P = 0.004), but no difference was observed for state anxiety. The two groups did not have any significant differences in the mean scores of social adjustment and ways of coping, except for social support and problem-focused coping which were higher in the PCOS group. The PCOS personality traits of PCOS infertile women were not different regarding neuroticism, extraversion, agreeableness, conscientiousness. The only exception was that infertile PCOS women had a significantly higher mean score of openness to experience than those without PCOS (P = 0.049). CONCLUSIONS: Clinicians could take advantage of the psychological differences of infertile women with PCOS and without PCOS for better management of PCOS in infertility settings; despite higher levels of anxiety they are more likely to cope with stress and are welcome to new experiences.

Factors associated with spontaneous abortion following intracytoplasmic sperm injection (ICSI).

OBJECTIVE: The aim of this study was to describe the miscarriage rates and the factors associated with cases of spontaneous abortion observed in women offered intracytoplasmic sperm injection (ICSI). METHODS: This cross-sectional study enrolled women who became pregnant with the aid of ICSI treated at the Babol Infertility Center (Iran) within a period of five years (2010-2015). Data were collected from patient charts and, in some cases, through phone calls. The study looked into the incidence of spontaneous abortion in women offered ICSI and the factors associated with miscarriage. The chi-square test, Fisher's exact test, and the t-test were used to analyze the data. RESULTS: From a total of 145 pregnant women, 120 were included in our study. The prevalence of miscarriage was 20%. Galactorrhea was significantly more present in patients who had miscarriages (25% vs. 9.37%, p=0.04). There was a marked difference in the duration of infertility of miscarriage and non-miscarriage patients offered ICSI (6.6±8.3 vs. 4.9±7.3 years, p=0.05). No association was found between maternal age, BMI, cause of infertility, hormonal pattern, type of infertility, history of surgery, polycystic ovary syndrome, number of oocytes, or day of retrieval with miscarriage.

Sexual function in women with polycystic ovary syndrome and their hormonal and clinical correlations.

Polycystic ovary syndrome (PCOS) appears to be related to sexual dysfunction, especially if associated with obvious clinical and hormonal signs of hyperandrogenism. The objective of this study was to determine the correlation of PCOS and its hormonal and clinical parameters with sexual function. This prospective, cross-sectional study conducted on 18-45-year-old PCOS women (according to the Rotterdam criteria), who were referred to the Reproductive Endocrinology Research Center, Iran, was invited to participate from January 2012 to December 2015. The Female Sexual Function Index (FSFI) was used to evaluate sexual function, and serum levels of total and free testosterone, androstenedione, and sex hormone-binding globulin (SHBG) were determined and employed to calculate free androgen index (FAI) values. Univariate and multiple logistic regression analyses were performed to examine the association between sexual dysfunction and independent variables. In all, 783 participated in the study and 492 women fully completed the Female Sexual Function Index (FSFI) questionnaire. Of these, 226 (45.75%) women met the criteria for sexual dysfunction. The mean age of women was 24.91 ± 4.90 years. No significant association between having a low score for any FSFI domain and having a low serum total or free testosterone or androstenedione and SHBG level was demonstrated. There was association between FAI > 4.5 and increased sexual function score but it is not significant. Logistic regression analysis showed that there were significant associations between sexual function score and the literacy, alopecia, and infertility. No evidence of associations between low scores for any of the sexual domains evaluated and low serum total and free testosterone levels, but the low literacy, alopecia, and infertility contributed to low sexual function in women with PCOS. The burden of PCOS and sexual dysfunction suggests the need for further attention to this patient population.

Marital Intimacy and Predictive Factors Among Infertile Women in Northern Iran.

INTRODUCTION: Infertility is a stressful state that may decrease attachment between spouses. Marital intimacy is a real need in infertile women. AIM: The aim of this study was to evaluate marital intimacy and predictive factors among infertile women in Northern Iran. MATERIALS AND METHODS: This cross-sectional study was conducted at Fatemeh Zahra Infertility and Reproductive Health Center of Babol Medical Sciences University in 2014. A total of 221 infertile women participated in this study. The instrument used in this research was Marital Intimacy Need Questionnaire (MINQ). Statistical analyses was performed using linear and logistic regression with p<0.05 indicating statistical significance. RESULTS: An 88.5% of infertile women had good marital intimacy. The mean and standard deviation of the marital intimacy was 349.11±49.26 and in marital intimacy domains including: emotional (42.28±7.23), psychological (41.84±7.59), intellectual (42.56±7.46), sexual (42.90±7.41), physical (43.59±6.96), spiritual (51.61±8.06), aesthetic (42.66±6.75), and social intimacy (42.59±6.89). The highest mean of marital intimacy domains is related to spirituality in infertile women. Physical and sexual domains had the high mean in infertile women. The lowest mean in marital intimacy domains was psychological intimacy. There was a significant correlation between the domains of marital intimacy. The strongest correlation was between the physical and sexual intimacy (r=0.85). There was a significant inverse association in marital intimacy with the age difference of spouses (p<0.01), and tobacco use (p<0.02). There was a statistically significant association in the marital intimacy with husband's occupation, and cause of infertility (p<0.02). CONCLUSION: Early screening and psychosocial intervention strategies suggest in the setting of female infertility to identify and prevent the predictive factors that may cause marital conflict.

Comparison of the serum iron, ferritin levels and total iron-binding capacity between pregnant women with and without gestational diabetes.

BACKGROUND: Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy. GDM causes substantial morbidity and mortality and long- term complications. GDM-related risk factors have not been completely identified yet. Some studies have found relationship between increased serum ferritin and impaired oral glucose tolerance test but the relationship between serum ferritin and risk of GDM has been controversial. The aim of the study was to determine serum iron and ferritin levels and total iron binding capacity (TIBC) in women with GDM and comparison with normal pregnant women. MATERIALS AND METHODS: This case-control study was performed among 200 pregnant women (case = 100, control = 100) who were referred to Yahya-Nejad Hospital in the second trimester in Babol from 2008 to 2009. GDM was diagnosed by impaired OGTT based on Carpenter and Coustan criteria. The 2 groups were matched in age, gestational age and parity. RESULTS: High serum ferritin level increased the risk of gestational diabetes to 2.4-fold [OR = 2.4 (0.83-6.9) CI = 95% (P = 0.10)], while in those with low ferritin levels, the risk of developing gestational diabetes was reduced to 82% [OR = 0.8 with (0.08-0.37) CI = 95% (P = 0.001)]. Using the logistic regression model, after adjustment for BMI, the OR was 2.37 [(0.80-7.01) CI = 95% (P = 0.11)] for low ferritin level and OR = 0.20 [(0.09-0.44) CI = 95% (P = 0.0001)] for high ferritin level, which was statistically significant. CONCLUSION: The serum ferritin level was markedly higher in women with gestational diabetes than in normal pregnant women; therefore, high ferritin can be regarded as a significant risk factor for the development of gestational diabetes.

Daily versus intermittent iron supplementation in pregnant women.

BACKGROUND: The purpose of this study was compare of daily iron supplementation in three time frames- daily, weekly and three time weekly supplementation in preventing anemia in healthy pregnant women. METHOD: The present study was a prospective simply randomized clinical trial. During January 2006- January 2008, 150 healthy pregnant women without anemia, in their 16th week of pregnancy were randomly allocated into three equal groups. The first group (n = 50) received a 50 mg-ferrous sulfate tablet daily, second group (n = 50) received a 50 mg-ferrous sulfate tablet three times a week, and the third group (n = 50) received two 50 mg-ferrous sulfate tablets (100 mg) weekly, respectively for 12 consecutive weeks. Serum hemoglobin, ferritin, and iron were measured before and after the supplementation. Paired t and ANOVA tests were used as appropriated. RESULTS: There were no significant differences between the pre- and post-treatment hemoglobin levels with iron supplementation in the three group (P = 0.518, P = 0.276, respectively). The mean serum iron level before and after treatment with iron supplementation in the three groups was not statistically significant (P = 0.962, P = 0.970, respectively). Although the mean serum ferritin level before and after treatment with iron supplementation was statistically significant in the three groups, no significant differences were found comparing the three groups (P = 0.827, P = 0.635 respectively). CONCLUSIONS: This results suggested, three times a week or weekly iron supplementation is as effective as daily supplementation for healthy pregnant women without anemia. TRIAL REGISTRATION: ISRCTN: IRCT201101093820N1.

Serum beta human chorionic gonadotropin levels at 16 days following embryo transfer in intra cytoplasmic sperm injection cycles to predict pregnancy outcome.

OBJECTIVE: To determine the prognostic value of beta human chorionic gonadotropin (B-hCG) concentration on the sixteenth day after embryo transfer to predict pregnancy outcome. METHODS: In this retrospective cohort study, B-hCG levels were measured in 97 pregnant women that underwent intra-cytoplasmic sperm injection (ICSI) in Fatemeh-Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran from January 2008 to December 2009. Type, duration, causes of infertility, and age of patients, B-hCG levels on the sixteenth day after embryo transfer, the number of embryos, and pregnancy outcome were assessed. RESULTS: Incidence of viable pregnancies in B-hCG levels less than 100 IU/L (n=18) was 38.9%, and in B-hCG levels more than or equal to 100 IU/L (n=79) was 84.4%. Correlation of B-hCG with pregnancy outcome was significant (p less than 0.001). Cut-off value of B-hCG to predict viable pregnancy was 100 IU/L (sensitivity - 91%, specificity - 48%, PPV - 85%, and NPV - 61%). The B-hCG levels less than or equal to 200 IU/L with a sensitivity of 88%, specificity of 45%, PPV - 37%, and NPV = 91% had predicted twin pregnancy. CONCLUSION: Serum B-hCG level on the sixteenth day after embryo transfer can be useful to predict the pregnancy outcome in ICSI cycles.

Efficacy of letrozole in ovulation induction compared to that of clomiphene citrate in patients with polycystic ovarian syndrome.

OBJECTIVE: To compare the efficacy of letrozole with clomiphene citrate for ovulation induction in patients with polycystic ovarian syndrome (PCOS). STUDY DESIGN: In this clinical trial, 107 infertile patients with PCOS received either 100 mg clomiphene citrate (n = 57) or 5 mg letrozole (n = 50) daily since day 3-7 of their menstrual cycle. Human chorionic gonadotropin (hCG) was administered at a dose of 10,000 IU when at least 1 mature follicle was detected. A single intrauterine insemination was performed 34 hours later. Then the size, number and growth rate of follicles, ovulation rate, endometrial thickness and pregnancy rate were measured in both groups. RESULTS: The number and the size of mature follicles were similar between the 2 groups. The pregnancy rate in letrozole group was higher than that in the clomiphene group (20% vs. 14%), but the difference was not significant (p = 0.286). In letrozole group, 86% of patients developed mature follicles, all showing ovulation, whereas 72% of patients in clomiphene citrate group developed mature follicles (p = 0.07). CONCLUSION: Letrozole might be an acceptable alternative to clomiphene citrate to induce ovulation and pregnancy in PCOS patients.

Serum beta human chorionic gonadotropin levels and preeclampsia.

OBJECTIVE: Preeclampsia is one of the most common complications of pregnancy. It is a trophoblastic disorder. Since human chorionic gonadotropin (hCG) is secreted by trophoblast, the purpose of the study was to determine the levels of beta (hCG) in preeclampsia and normal cases. METHODS: This study was conducted on 40 term pregnant women with preeclampsia (case group) and 40 normal pregnant cases (control group) in the Department of Obstetrics and Gynecology, Medical University, Babol, Iran, from 2004 to 2005. Serum beta-hCG in all cases were measured by radioimmunoassay. The mean beta-hCG level in preeclampsia (mild and severe) was compared with normal cases. RESULTS: The maternal serum, beta-hCG level in patients with preeclampsia (39840 +/- 24630 IU/L) was higher than in the control group (27460 +/- 25862 IU/L) (p=0.031). In mild preeclampsia (34 cases), the mean serum beta-hCG level was 31991 +/- 16758 IU/L while in severe preeclampsia (6 cases) 84312 +/- 9257 IU/L (p<0.0001). The mean serum beta-hCG level in mild and severe preeclampsia was higher compared to the normal cases. CONCLUSION: The results of this study show that the levels of beta-hCG in severe form of preeclampsia is higher compared to the milder ones.