Factors Associated with Cesarean Section in Tehran, Iran using Multilevel Logistic Regression Model

OBJECTIVES: Over the past few decades, the prevalence of cesarean sections (CS) have risen dramatically worldwide, particularly in Iran. The aim of this study was to determine the prevalence of CS in Tehran, and to examine the associated risk factors. METHODS: A cross-sectional study of 4,308 pregnant women with singleton live-births in Tehran, Iran, between July 6–21, 2015 was performed. Multilevel logistic regression analysis was performed using demographic and obstetrical variables at the first level, and hospitals as a variable at the second level. RESULTS: The incidence of CS was 72.0%. Multivariate analysis showed a significant relationship between CS and the mother's age, socioeconomic status, body mass index, parity, type of pregnancy, preeclampsia, infant height, and baby's head circumference. The intra-class correlation using the second level variable, the hospital was 0.292, indicating approximately 29.2% of the total variation in the response variable accounted for by the hospital. CONCLUSION: The incidence of CS was substantially higher than other countries. Therefore, educational and psychological interventions are necessary to reduce CS rates amongst pregnant Iranian women.

Comparison of in vitro fertilization/intracytoplasmic sperm injection cycle outcome in patients with and without polycystic ovary syndrome: a modified poisson regression model

Background: Polycystic ovary syndrome [PCOS] is a frequent condition in reproductive age women with a prevalence rate of 5-10%. This study intends to determine the relationship between PCOS and the outcome of assisted reproductive treatment [ART] in Tehran, Iran

Materials and Methods: In this historical cohort study, we included 996 infertile women who referred to Royan Institute [Tehran, Iran] between January 2012 and December 2013. PCOS, as the main variable, and other potential confounder variables were gathered. Modified Poisson Regression was used for data analysis. Stata software, version 13 was used for all statistical analyses

Results: Unadjusted analysis showed a significantly lower risk for failure in PCOS cases compared to cases without PCOS [risk ratio [RR]: 0.79, 95% confidence intervals [CI]: 0.66-0.95, P=0.014]. After adjusting for the confounder variables, there was no difference between risk of non-pregnancy in women with and without PCOS [RR: 0.87, 95% CI: 0.72-1.05, P=0.15]. Significant predictors of the ART outcome included the treatment protocol type, numbers of embryos transferred [grades A and AB], numbers of injected ampules, and age

Conclusion: The results obtained from this model showed no difference between patients with and without PCOS ac- cording to the risk for non-pregnancy. Therefore, other factors might affect conception in PCOS patients