Comparison of various aspects of women's lives between infertile and women with and without tubal ligation: a comparative cross-sectional study.

BACKGROUND: The aim of this study is to compare anxiety, depression, body image, self-esteem, sexual function, and quality of life (QoL) between infertile women and control fertile women undergoing tubal ligation (TL) and using condom. METHODS: This cross-sectional study was conducted on 600 women in three groups of infertile and control fertile women with or without TL (200 women in each group), who met the inclusion criteria. They were selected from Royan Institute and a number of health care centers in Tehran (Iran) from May 2017 to February 2019. The subjects were asked to fill out the Short Form Health Survey (SF-12), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), Body Image Concern Inventory (BICI), and Rosenberg' Self-Esteem Scale (RSES). One-way ANOVA was used to identify the possible statistical differences between the three groups of participants. RESULTS: The mean scores of all FSFI domains were lower in the control TL women, and the differences between the three groups in all dimensions were statistically significant. In addition, the TL group had more female sexual dysfunction (FSD) comparing to the infertile and condom group (22.43 ± 5.30, 24.79 ± 4.74, and 28.03 ± 3.29, respectively P < 0.001). There was a significant difference between the three groups in SF-12 scores (76.59 ± 13.14, 68.49 ± 14.47, and 78.87 ± 12.62, respectively P < 0.001). Also there was a significant difference between the three groups in anxiety, depression, and total scores of HADS (P < 0.001). Furthermore, infertile women had lower body image (P < 0.05) and the TL group had lower self-esteem comparing to the two other groups (P < 0.05). CONCLUSIONS: The findings revealed the adverse effects of using TL on the anxiety, depression, sexual life, body image, and QoL of women. It is recommended that health-care professionals should increase their awareness and knowledge regarding the side-effects of using TL on women's lives and share this information with the patients.

The influence of mode of delivery, anthropometric indices, and infant's sex on the maternal and cord blood orexin-A levels: A cohort study.

BACKGROUND: Orexin as an adipokin hormone plays an important role in appetite regulation, energy metabolism, obesity, diabetes, and cardiovascular disease. The main source of orexin secretion in nonpregnant and pregnant women is adipose tissue and placenta, respectively. This research was conducted to evaluate the association between orexin-A level and the mode of delivery, anthropometric indices, and sex of the infant. METHODS: This prospective cohort study was conducted on 69 normal pregnant women. The samples of umbilical cord blood were obtained at the time of delivery, and maternal blood was taken within 24 h of delivery. Serum orexin-A levels were measured by using enzyme-linked immunosorbent assay. Statistical analyses were performed using SPSS and p < 0.05 was considered as significant. RESULTS: We found a significant difference between postpartum maternal and umbilical cord orexin-A level both with the mode of delivery (p < 0.001). Also, a significant positive correlation was seen between maternal and umbilical cord serum orexin-A levels (r = -0.61, p < 0.001). There was no relationship between serum orexin-A levels with anthropometric indices and the sex of the neonate (p > 0.05). CONCLUSION: Both maternal and umbilical cord serum orexin-A levels were associated with the mode of delivery. Maternal and cord blood orexin-A levels in normal vaginal delivery are higher than cesarean section.

Development and psychometric evaluation of the Sexual Health Assessment Tool for Infertile Women (SEHAT-IW).

PURPOSE: This study aimed to develop a valid and reliable tool for evaluation of sexual health assessment in infertile women. METHODS: This was a mixed exploratory study consisting of two phases. At phase one, we reviewed the existing instruments and interviewed 20 infertile women to generate an item pool. Then, the research team examined items and invited a panel of experts (n = 15) and a group of infertile women (n = 10) to review the items to establish content and face validity. Accordingly, the provisional version of the questionnaire containing 62 items was provided. At phase two, a cross-sectional study was conducted to evaluate the questionnaire. The structural validity was examined by performing exploratory factor analysis. Internal consistency was estimated by the Cornbach's alpha coefficient and test-retest analysis was performed to assess stability. RESULTS: The final questionnaire consisted of 45 items and a total of 372 infertile women completed the questionnaire. The mean age of women was 30.8 (SD 6.0) years and this was 5.6 (SD 4.2) for duration of infertility. The results obtained from exploratory factor analysis indicated a five-factor solution for the questionnaire that jointly explained 51.39% of variance observed. At this stage, 15 items were deleted due to low factor loading. The analysis of internal consistency and stability yielded satisfactory results (Cronbach alpha: 0.93, ICC 0.97, respectively). Further analysis indicated that lower sexual health in infertile women was associated with education (OR for primary education 2.61, 95% CI 1.44-4.76, P = 0.002) and being housewife (OR 2.35, 95% CI 1.15-4.83, P = 0.01). CONCLUSION: The findings showed that the Sexual Health Assessment Tool for Infertile Women (SEHAT-IW) is a reliable and valid instrument to assess infertile women's sexual health.

The effect of endometrial scratch injury on pregnancy outcome in women with previous intrauterine insemination failure: A randomized clinical trial.

AIM: Endometrial scratch injury (ESI) has been recently proposed to enhance the implantation rate in assisted reproductive technology cycles. The present study was conducted to determine the effect of ESI on pregnancy rate in women with intrauterine insemination (IUI) failure. METHODS: This prospective randomized controlled study was carried out in Imam-Khomeini Hospital and Royan Institute, Tehran, during a 12-month period from January 2013 to January 2014. After assessment, 169 patients who had IUI failure twice or more (no chemical or clinical pregnancy) with normal uterine anatomy and hysterosalpingography, were enrolled. They were randomly assigned into two groups. In the experimental group, all patients underwent ESI at day 8 or 9 of stimulation phase in the present IUI cycle, whereas no intervention was performed on the control group. IUI outcome was then compared between the two groups. RESULTS: A total of 150 patients completed the IUI cycle during the study. The chemical pregnancy rate was 10.7% and 2.7% in the experimental and control groups, respectively, without significant difference (P = 0.09). Also no significant differences were detected in terms of clinical pregnancy and miscarriage rates between the two groups (P > 0.05). CONCLUSIONS: No significant beneficial effect of ESI on fertility outcome in patients with repeated IUI failure was detected when it was carried out on day 8 or 9 of the same IUI stimulation cycle. Also, however, no negative impact secondary to ESI was observed. Therefore, confirmation or refutation of this hypothesis requires further studies with a larger sample size. IRCT201507271141N19.

Association of acne, hirsutism, androgen, anxiety, and depression on cognitive performance in polycystic ovary syndrome: A cross-sectional study.

BACKGROUND: While polycystic ovary syndrome (PCOS) is often associated with psychological distress, its most frequent clinical characteristics include acne, hirsutism and increased level of androgen hormones. OBJECTIVE: To evaluate the level of depression and anxiety, hirsutism, acne, and level of androgen hormones in PCOS and control group and its association with cognitive function. MATERIALS AND METHODS: This cross-sectional study was conducted on 53 women with PCOS and 50 healthy women as a control group. Data were collected using a questionnaire including the samples' demographic information, clinical features, clinical findings of hyperandrogenism, and the Beck Depression and Anxiety questionnaire. In addition, the acne and hirsutism levels of the subjects were evaluated using the global acne grading system and the Ferriman-Gallwey scoring system, respectively. The Montreal Cognitive Assessment (MoCA) is a screening test for cognitive impairment that covers major cognitive domains. RESULTS: A significant difference was found between the two groups in the mean levels of acne, hirsutism, total testosterone, free androgen index, depression, and anxiety. However, some mean values of the MoCA were lower in the women of case group compared to the control group. Additionally, a significant difference was observed between the two groups in the domains of visual-spatial ability (p = 0.009), executive function (p = 0.05), attention (p = 0.03), and total MoCA scores (p = 0.002). CONCLUSION: The PCOS women demonstrated significantly lower performance on the tests of executive function, attention, and visual-spatial function than the healthy control women.

Prevalence of metabolic syndrome in four phenotypes of PCOS and its relationship with androgenic components among Iranian women: A cross-sectional study.

BACKGROUND: Polycystic ovary syndrome (PCOS) increases the risk of metabolic syndrome (MetS). Insulin resistance (IR) plays a major role in the pathophysiology of both PCOS and MetS. OBJECTIVE: This study was designed to compare the prevalence of MetS among different phenotypes of PCOS and its relationship with androgenic components. MATERIALS AND METHODS: 182 participants eligible for this five-group comparative study were selected by convenience sampling method. They were classified according to the Rotterdam criteria: clinical and/or biochemical hyperandrogenism (H) + PCOS on ultrasound (P) + ovulation disorders (O) (n = 41), clinical and/or biochemical H + PCOS on P (n = 33), PCOS on P + O (n = 40), clinical and/or biochemical H + O (n = 37), and control (without PCOS) (n = 31). MetS was measured based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Androgenic components included free-androgen-index (FAI), total-testosterone (TT) level and sex-hormone-binding-globulin (SHBG). RESULTS: A significant difference was observed between the study groups in terms of MetS prevalence (p = 0.01). In phenotype H+P+O, there was a statistically significant positive association between TG and TT, and a significant negative association between SBP and DBP with SHBG. In phenotype O+P, WC was inversely associated with SHBG. In phenotype H+O, FBS and TG were positively associated with FAI but HDL was inversely associated with FAI. Moreover, WC and DBP were positively associated with TT in phenotype H+O. No associations were detected between MetS parameters and androgenic components in other PCOS subjects (phenotype H+P) and in the control group. TT was significantly higher in the PCOS group suffering from MetS (p = 0.04). CONCLUSION: According to the research results, hyperandrogenic components are potent predictors of metabolic disorders. Thus, we suggest that MetS screening is required for the prevention of MetS and its related complications in PCOS women.

The association between estradiol levels and cognitive function in postmenopausal women.

BACKGROUND: Levels of estradiol decreases as women arrive the menopausal transition and enter to a low, steady level during the early postmenopause. In addition, memory dysfunction are highly prevalent during this period. OBJECTIVE: Our study was designed to determine whether endogenous levels of estradiol are related to cognitive function in postmenopausal. MATERIALS AND METHODS: The cross-sectional study was conducted between November 2015 to February 2016 on 209 healthy postmenopausal women. The women filled out the Montreal Cognitive Assessment (MoCA) scale. Then, estradiol level was tested for association with cognitive function adjusted for factors supposed to confound this association. RESULTS: The prevalence of cognitive dysfunction; MoCA points ≤26 in our participants was 62.7%, and mean±SD of estradiol level was 14.92±10.24pg/ml in participants with cognitive dysfunction in comparison with 21.67±14.92pg/ml in those with normal cognitive function (p<0.001). There were significant association between MoCA points with estradiol level (p<0.001) and educational status (p<0.001). CONCLUSION: Estradiol replacement therapy in postmenopausal women with low endogenous estradiol levels and decreased cognitive function might be necessary.

Menstrual Pattern following Tubal Ligation: A Historical Cohort Study.

BACKGROUND: Tubal ligation (TL) is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders. MATERIALS AND METHODS: A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group) and on 140 women using condom as the main contraceptive method (Non-TL group). They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC) was also used to measure the menstrual blood loss. RESULTS: Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002). Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006), hypermenorrhea (12.1 vs. 2.1%, P=0.002), menorrhagia (62.9 vs. 22.1%, P<0.0001) and menometrorrhagia (15.7 vs. 3.6%, P=0.001) than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001). According to logistic regression, age odds ratio [(OR=1.08, con- fidence interval (CI):1.07-1.17, P=0.03)], TL (OR=5.95, CI:3.45-10.26, P<0.0001) and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001) were significantly associated with menorrhagia. CONCLUSION: We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.

Evaluation of Risk Factors Associated with Endometriosis in Infertile Women.

BACKGROUND: Endometriosis affects women's physical and mental wellbeing. Symptoms include dyspareunia, dysmenorrhea, pelvic pain, and infertility. The purpose of this study is to assess the correlation between some relevant factors and symptoms and risk of an endometriosis diagnosis in infertile women. MATERIALS AND METHODS: A retrospective study of 1282 surgical patients in an infertility Institute, Iran between 2011 and 2013 were evaluated by laparoscopy. Of these, there were 341 infertile women with endometriosis (cases) and 332 infertile women with a normal pelvis (comparison group). Chi-square and t tests were used to compare these two groups. Logistic regression was done to build a prediction model for an endometriosis diagnosis. RESULTS: Gravidity [odds ratio (OR): 0.8, confidence interval (CI): 0.6-0.9, P=0.01], parity (OR: 0.7, CI: 0.6-0.9, P=0.01), family history of endometriosis (OR: 4.9, CI: 2.1-11.3, P<0.001), history of galactorrhea (OR: 2.3, CI: 1.5-3.5, P=0.01), history of pelvic surgery (OR: 1.9, CI: 1.3-2.7, P<0.001), and shorter menstrual cycle length (OR: 0.9, CI: 0.9-0.9, P=0.04) were associated with endometriosis. Duration of natural menstruation and age of menarche were not correlated with subsequent risk of endometriosis (P>0.05). Fatigue, diarrhea, constipation, dysmenorrhea, dyspareunia, pelvic pain and premenstrual spotting were more significant among late-stage endometriosis patients than in those with early-stage endometriosis and more prevalent among patients with endometriosis than that of the comparison group. In the logistic regression model, gravidity, family history of endometriosis, history of galactorrhea, history of pelvic surgery, dysmenorrhoea, pelvic pain, dysparaunia, premenstrual spotting, fatigue, and diarrhea were significantly associated with endometriosis. However, the number of pregnancies was negatively related to endometriosis. CONCLUSION: Endometriosis is a considerable public health issue because it affects many women and is associated with the significant morbidity. In this study, we built a prediction model which can be used to predict the risk of endometriosis in infertile women.

Comparison of 25-hydroxyvitamin D and Calcium Levels between Polycystic Ovarian Syndrome and Normal Women.

BACKGROUND: Given the relationship of vitamin D deficiency with insulin resistance syndrome as the component of polycystic ovary syndrome (PCOS), the main aim of this study was to compare serum level of 25hydroxyvitamin D [25(OH)D] between PCOS patients and normal individuals. MATERIALS AND METHODS: A cross sectional study was conducted to compare 25(OH)D level between117 normal and 125 untreated PCOS cases at our clinic in Arash Hospital, Tehran, Iran, during 2011-2012. The obtained levels of 25(OH)D were classified as follows: lower than 25 nmol/ml as severe deficiency, between 25-49.9 nmol/ml as deficiency, 50-74.9 nmol/ml as insufficiency, and above 75 nmol/ml asnormal. In addition, endocrine and metabolic variables were evaluated. RESULTS: Among PCOS patients, our findings shows 3(2.4%) normal, 7(5.6%) with insufficiency, 33(26.4%) with deficiency and 82(65.6%) with severe deficiency, whereas in normal participants, 5(4.3%) normal, 4(3.4%) with insufficiency, 28(23.9%) with deficiency and 80(68.4%) with severe deficiency. Comparison of 25(OH)D level between two main groups showed no significant differences (p= 0.65). Also, the calcium and 25(OH)D levels had no significant differences in patients with overweight (p=0.22) and insulin resistance (p=0.64). But we also found a relationship between 25(OH)D level and metabolic syndrome (p=0.01). Furthermore, there was a correlation between 25(OH)D and body mass index (BMI) in control group (p=0.01), while the C-reactive protein (CRP) level was predominantly higher in PCOS group (p<0.001). CONCLUSION: Although the difference of 25(OH)D level between PCOS and healthy women is not significant, the high prevalence of 25(OH)D deficiency is a real alarm for public health care system and may influence our results.

Evaluating The Effective Factors in Pregnancy after Intrauterine Insemination: A Retrospective Study.

BACKGROUND: Controlled ovarian hyperstimulation (COH) in conjunction with intrauterine inseminations (IUI) are commonly used to treat infertile couples. In this study we evaluated the relationship between IUI outcome and special causes of infertility. We also aimed to examine parameters that might predict success following IUI. MATERIALS AND METHODS: In this cross-sectional study, we included 994 IUI cycles in 803 couples who referred to the infertility Institute. All statistical analyses were performed by using SPSS program, t tests and chi-square. Stepwise multiple linear regression analysis was performed to compare the association between dependent and independent variables. Logistic regression was conducted to build a prediction model of the IUI outcome. RESULTS: Overall pregnancy rate per completed cycle (16.5%) and live birth rate per cycle (14.5%). The mean age in the pregnant group was significantly lower than that of the non-pregnant group (P=0.01).There was an association between cause of infertility and clinical pregnancies (P<0.001). Logistic regression identified four significant factors in determining the success of the IUI [menstrual irregularites (OR:2.3, CI:1.6-3.4, P<0.001), duration of infertility (OR:0.8, CI:0.8-0.9, P<0.001), total dose of gonadotropin (OR:1.02, CI:1.003-1.04, P=0.02) and semen volume (OR:1.1, CI:1.008-1.2, P=0.03)] which were the most predictive of IUI success. CONCLUSION: Our study defined prognostic factors for pregnancy in COH+IUI. These variables can be integrated into a mathematical model to predict the chance of pregnancy rate in subsequent COH+IUI cycles.