Diagnostic accuracy of body mass index and fasting glucose for the prediction of gestational diabetes mellitus after assisted reproductive technology

Background: The aim of the present study was to determine the maternal pre-pregnancy body mass index [BMI], first-trimester fasting blood sugar [FBS], and the combination of [BMI+FBS] cut-points for at-risk pregnant women conceived by assisted reproductive technology [ART] to better predict the risk of developing gestational diabetes mellitus [GDM] in infertile women

Materials and Methods: In this nested case-control study, 270 singleton pregnant women consisted of 135 [GDM] and 135 [non-GDM] who conceived using ART were assessed. The diagnosis of GDM was confirmed by a one-step glucose tolerance test [O-GTT] using 75 g oral glucose. BMI was classified base on World Health Organization [WHO] criteria. The relationship between BMI, FBS, and BMI+FBS with the risk of GDM development was deter- mined by logistic regression and adjusted for confounding factors. Receiver operating characteristic [ROC] curve analysis was performed to assess the value of BMI, FBS, and BMI+FBS for the prediction of GDM

Results: The GDM group had significantly higher age, BMI, family history of diabetes, and history of polycystic ovary syndrome in comparison with the non-GDM group [P<0.05]. Overweight and obese women had 3.27, and 5.14 folds increase in the odds of developing GDM, respectively. There was a 17% increase in the risk of developing GDM with each 1 mg/dl increase in fasting glucose level. The cut points for FBS 84.5 mg/dl [72.9% sensitivity, 74.4% specificity], BMI 25.4 kg/m2 [68.9% sensitivity, 62.8% specificity], and BMI+FBS 111.2 [70.7% sensitivity, 80.6% specificity] was determined

Conclusion: The early screening and high-quality prenatal care should be recommended upon the co-occurrence of high FBS [>/=84.5 mg/dl] in the first-trimester of the pregnancy and the BMI [=25.4 kg/m2] in pre-pregnancy period in women undergone ART. The combination of BMI and FBS is considered a better prediction value

Downregulation of extracellular matrix and cell adhesion molecules in cumulus cells of infertile polycystic ovary syndrome women with and without insulin resistance

Objective: The extracellular matrix [ECM] of the cumulus oocyte complex [COC] is composed of several molecules that have different roles during follicle development. This study aims to explore gene expression profiles for ECM and cell adhesion molecules in the cumulus cells of polycystic ovary syndrome [PCOS] patients based on their insulin sensitivity following controlled ovarian stimulation [COS]

Materials and Methods: In this prospective case-control study enrolled 23 women less than 36 years of age who participated in an intracytoplasmic sperm injection [ICSI] program. Patients were subdivided into 3 groups: control [n=8, fertile women with male infertility history], insulin resistant [IR] PCOS [n=7], and insulin sensitive [IS] PCOS [n=8]. We compared 84 ECM component and adhesion molecule gene expressions by quantitative real-time polymerase chain reaction array [qPCR-array] among the groups

Results: We noted that 21 of the 84 studied genes differentially expressed among the groups, from which 18 of these genes downregulated. Overall, comparison of PCOS cases with controls showed downregulation of extracellular matrix protein 1 [ECM1]; catenin [cadherin-associated protein], alpha 1 [CTNNA1]; integrin, alpha 5 [ITGA5]; laminin, alpha 3 [LAMA3]; laminin, beta 1 [LAMB1]; fibronectin 1 [FN1]; and integrin, alpha 7 [ITGA7]. In the IS group, there was upregulation of ADAM metallopeptidase with thrombospondin type 1 motif, 8 [ADAMTS8] and neural cell adhesion molecule 1 [NCAM1] compared with the controls [P<0.05]

Conclusion: Downregulation of ECM and cell adhesion molecules seem to be related to PCOS. Gene expression profile alterations in cumulus cells from both the IS and IR groups of PCOS patients seems to be involved in the composition and regulation of ECM during the ovulation process. This study highlights the association of ECM gene alteration as a viewpoint for additional understanding of the etiology of PCOS

Oral quercetin supplementation enhances adiponectin receptor transcript expression in polycystic ovary syndrome patients: a randomized placebo-controlled double-blind clinical trial

Objective: polycystic ovary syndrome [PCOS], an ovarian-pituitary axis androgen disorder, is a common endocrine disease in women. Obesity-induced androgenesis and imbalance of adipokine secretion may lead to some metabolic features of PCOS. The beneficial effects of polyphenolic compounds such as quercetin have been reported, however, the underlying molecular mechanism is not entirely understood. In the present study, we investigated the effect of quercetin supplementation on the expression of adiponectin receptors at the transcript level in peripheral blood mononuclear cells [PBMC] samples of PCOS patients

Materials and Methods: in this randomized clinical trial, 84 PCOS subjects were randomly assigned to two groups; the treatment group received 1 g quercetin [two 500 mg capsules] daily for 12 weeks and the control group received placebo. To examine the effect of quercetin supplementation on PCOS patients in addition to biochemical and anthropometric assessments, the expression of ADIPOR1 and ADIPOR2 at the transcript level and AMPK level were determined by quantitative reverse transcription-polymerase chain reaction [RT-qPCR] and ELISA assays respectively

Results: oral quercetin supplementation significantly increased ADIPOR1 and ADIPOR2 transcript expression by 1.32- and 1.46-fold respecetively [P<0.01]. In addition, quercetin supplementation enhanced AMPK level by 12.3% compared with the control group [P<0.05]

Conclusion: oral quercetin supplementation improves the metabolic features of PCOS patients by upregulating the expression of adiponectin receptors and AMPK [Registration Number: IRCT2013112515536N1]

rs1127354 polymorphism in ITPA is associated with susceptibility to infertility

Objective: Infertility is a common human disorder which is defined as the failure to conceive for a period of 12 months without contraception. Many studies have shown that the outcome of fertility could be affected by DNA damage. We attempted to examine the association of two SNPs [rs1127354 and rs7270101] in ITPA, a gene encoding a key factor in the repair system, with susceptibility to infertility

Materials and Methods: This was a case-control study of individuals with established infertility. Blood samples were obtained from 164 infertile patients and 180 ethnically matched fertile controls. Total genomic DNA were extracted from whole blood using the standard salting out method, and stored at -20 C. Genotyping were based on mismatch polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] method in which PCR products were digested with the XmnI restriction enzyme and run on a 12% polyacrylamide gel

Results: All genotype frequencies in the control group were in Hardy-Weinberg equilibrium. A significant association [in allelic, recessive and dominant genotypic models] was observed between infertile patients and healthy controls based on rs1127354 [P=0.0001], however, no significant association was detected for rs7270101. Also, gender stratification and analysis of different genotype models did not lead to a significant association for this single- nucleotide polymorphis [SNP]

Conclusion: ITPA is likely to be a genetic determinant for decreased fertility. To the best of our knowledge, this is the first report demonstrating this association, however, given the small sample size and other limitations, genotyping of this SNP is recommended to be carried out in different populations with more samples

association between ABO and Rh blood groups and risk of endometriosis in iranian women

Background: Endometriosis is a common gynaecological disease that affects quality of life for women. Several studies have revealed that both environmental and genetic factors contribute to the development of endometriosis. The aim of this study was to investigate the distribution of ABO and Rh blood groups in Iranian women with endometriosis who presented to two referral infertility centers in Tehran, Iran

Materials and Methods: In this case-control study, women who referred to Royan Institute and Arash Women's Hospital for diagnostic laparoscopy between 2013 and 2014 were assessed. Based on the laparoscopy findings, we categorized the women into two groups: endometriosis and control [women without endometriosis and normal pelvis]. Chi-square and logistic regression tests were used for data analysis

Results: In this study, we assessed 433 women, of which 213 patients were assigned to the endometriosis group while the remaining 220 subjects comprised the control group. The most frequent ABO blood group was O [40.6%]. The least frequent blood group was AB [4.8%]. In terms of Rh blood group, Rh+ [90.1%] was more frequent than Rh- [9.9%]. There was no significant correlation between ABO [P=0.091] and Rh [P=0.55] blood groups and risk of endometriosis. Also, there was no significant difference between the two groups with regards to the stage of endometriosis and distribution of ABO and Rh blood groups [P>0.05]

Conclusion: Although the O blood group was less dominant in Iranian women with endometriosis, we observed no significant correlation between the risk of endometriosis and the ABO and Rh blood groups. Endometriosis severity was not correlated to any of these blood groups

Effect of the estrus cycle stage on the establishment of murine endometriosis lesions

Background: Establishment of a standardized animal endometriosis model is necessary for evaluation of new drug effects and for explaining different ethological aspects of this disease. For this purpose, we need a model which has more similarity to human endometriosis

Objective: Our objective was to establish an autologous endometriosis mouse model based on endogenous estrogen level and analyze the influence of estrus cycle on the maintenance of endometriotic lesions

Materials and Methods: In this experimental study, endometriotic lesions were induced in 52 female NMRI mice by suturing uterine tissue samples to the abdominal wall. The transplantation was either performed at proestrus/estrus or at metestrus/diestrus cycles. Urine-soaked beddings from males and also male vasectomized mice were transferred to the cages to synchronize and maintenance of estrus cycle in female mice. The mice were sacrificed after different transplantation periods [2, 4, 6 or 8 wk]. The lesions size, macroscopic growth, model success rate, histological and immune-histochemical analyses were assessed at the end

Results: From a total of 200 tissue samples sutured into the peritoneal cavity, 83 endometriotic lesions were confirmed by histopathology [41.5%]. Model success rate for proestrus/estrus mice was 60.7% vs. 79.2% for metestrus/diestrus mice. The endometriotic lesions had similar growth in both groups. Number of caspase-3, Ki67-positive cells and CD31-positive micro vessels were also similar in endometriotic lesions of two groups

Conclusion: If we maintain the endogenous estrogen levels in mice, we can induce endometriosis mouse model in both proestrus/estrus and metestrus/diestrus cycle without any significant difference

Prevalence of premenstrual syndrome in Iran: a systematic review and meta-analysis

Background: premenstrual syndrome [PMS] is a common disorder characterized by physical, mental and behavioral changes in the luteal phase of the menstrual cycle in the reproductive age women

Objective: the present study aimed to determine the overall prevalence of PMS in Iran by a systematic review and meta-analysis study

Materials and Methods: in this systematic review and meta-analysis, we searched international databases included ISI Web of Knowledge, PubMed/Medline, Scopus, Google Scholar, and also local databases including Iranmedex, Scientific Information Database, and Magiran for articles in English and Persian language published up to September 2016. We carried out data analysis with Stata version 11. We examined heterogeneity in the results of studies through I[2] statistics and chi- square based Q test. Also, we investigated the effects of potential heterogeneity factors in the prevalence of PMS by meta-regression

Results: we studied a total of 9147 reproductive-age women from 24 articles which entered to meta-analysis. Based on the result of random effect model, we estimated the overall prevalence of PMS 70.8% [95% CI: 63.8-77.7]. The results of subgroup analysis revealed that prevalence of PMS was 80.4% [95% CI; 66.9-93.9] among high school students, 68.9% [95% CI; 59.2-78.6] among university students, and 54.9% [95% CI; 51.6-58.2] in general population. Univariate meta-regression model showed that prevalence of PMS was decreased by increasing the age of subjects but this was not statistically significant [p=0.155]

Conclusion: our finding showed that PMS was prevalent in Iranian reproductive age women especially among high school students. More epidemiological research for determining factors that affect PMS prevalence seems essential

Cervical gland area as an ultrasound marker for prediction of preterm delivery: a cohort study

Background: preterm labor is a major cause of perinatal morbidity and mortality and it might be predicted by assessing the cervical change

Objective: to assess the association between absences of cervical gland area [CGA] and spontaneous preterm labor [SPTL]

Materials and Methods: this prospective cohort study was performed on 200 singleton pregnant women with a history of SPTL, second-trimester abortion in the previous pregnancy or lower abdominal pain in current pregnancy. Each patient underwent one transvaginal ultrasound examination between 14-28 wk of gestation. Cervical length was measured and CGA was identified and their relationship with SPTL before 35 and 37 wk gestation was evaluated using STATA software version 10

Results: the mean of cervical length was 36.5 mm [SD=8.4], the shortest measurement was 9 mm, and the longest one was 61 mm. Short cervical length [

Conclusion: our study showed that cervical gland area might be an important predictor of SPTL which should be confirmed with further researches

Methylation status of H19/IGF2 differentially methylated region in in vitro human blastocysts donated by healthy couples

Backgrund: Imprinted genes are a unique subset of few genes, which have been differentially methylated region [DMR] in a parental origin-dependent manner during gametogenesis, and these genes are highly protected during pre-implantation epigenetic reprogramming. Several studies have shown that the particular vulnerability of imprinting genes during suboptimal pre- and peri-conception micro-environments often is occurred by assisted reproduction techniques [ART]. This study investigated the methylation status of H19/IGF2 DMR at high-quality expanding/expanded human blastocysts donated by healthy individuals to evaluate the risks linked to ART

Method: Methylation levels of H19/IGF2 DMR were analyzed by bisulfite conversion and sequencing at 18 CpG sites [CpGs] located in this region

Result: The overall percentage of methylated CpGs and the proportion of hyper-methylated clones of H19/IGF2 DMR in analyzed blastocysts were 37.85 +/- 4.87% and 43.75 +/- 5.1%, respectively. For validation of our technique, the corresponding methylation levels of peripheral human lymphocytes were defined [49.52 +/- 1.86% and 50%, respectively]

Conclusion: Considering the absence of in vivoproduced human embryos, it is not possible to conclude that the methylation found in H19/IGF2 DMR is actually normal or abnormal. Regarding the possible risks associated with ART, the procedures should be optimized in order to at least reduce some of the epigenetic risks

Oxidative stress statues in serum and follicular fluid of women with endometriosis

Objective: This study aimed to evaluate the levels of two oxidative stress [OS] markers including lipid peroxide [LPO] and total antioxidant capacity [TAC] in both serum and follicular fluid [FF] of women with endometriosis after puncture

Materials and Methods: In this cross-sectional study, a total number of sixty-three women younger than 40 years old with laparoscopy [gold standard for endometriosis diagnosis] indication underwent in vitro fertilization [IVF] program in the Royan Institute, Tehran, Iran from September 2013 to October 2014. About forty-three patients were diagnosed with endometriosis after laparoscopy. Blood and FF from the leading follicle in each stimulated ovary were obtained at the time of egg retrieval; samples were centrifuged and frozen until assessment. At the time of sample assessment, serum and FF samples were evaluated for the levels of LPO and TAC on spectrophotometery

Results: We observed that women with endometriosis had significantly higher LPO and lower TAC levels in the serum and FF as compared with the control group [P<0.05]

Conclusion: It has observed that FF of women with endometriosis, regardless of disease stage, increases the proliferation power of endometrial cells in vitro, we presume that inflammatory reactions-induced OS in ovary may be responsible for proliferation induction ability in FF obtained from women with endometriosis

review on various uses of N-acetyl cysteine

N-acetyl cysteine [NAC], as a nutritional supplement, is a greatly applied antioxidant in vivo and in vitro. NAC is a precursor of L-cysteine that results in glutathione elevation biosynthesis. It acts directly as a scavenger of free radicals, especially oxygen radicals. NAC is a powerful antioxidant. It is also recommended as a potential treatment option for different disorders resulted from generation of free oxygen radicals. Additionally, it is a protected and endured mucolytic drug that mellows tenacious mucous discharges. It has been used for treatment of various diseases in a direct action or in a combination with some other medications. This paper presents a review on various applications of NAC in treatment of several diseases

Relationships between serum luteinizing hormone level, endometrial thickness and body mass index in polycystic ovary syndrome patients with and without endometrial hyperplasia

Background: The endometrial hyperplasia measured by ultrasound in poly cystic ovary syndrome [PCOS] women is strongly related to pathologic endometrial thickness, but there is no consensus on the relation between serum luteinizing hormone [LH] and either of these factors: pathologic endometrial hyperplasia and body mass index [BMI]

Materials and Methods: In this observational cross-sectional study, three hundred fifty infertile PCOS women were involved in this research. An endometrial biopsy was taken by using a pipelle instrument, regardless of menstrual cycle's day and all samples were reported by the same pathologist. Basal serum LH level was compared between two subgroups [hyperplasia and non-hyperplasia]. The intended population was divided into three groups according to BMI and basal serum LH, later on the comparison was made in three groups. Chi-square test was applied to compare nominal variables between groups. Mann-Whitney U, and one way ANOVA tests were used to compare means on the basis of the result of normality test

Results: The frequency of endometrial hyperplasia was 2.6%. Endometrial thickness in the patients with endometrial hyperplasia was significantly higher than that of a normal endometrium [10.78 +/- 3.70 vs. 7.90 +/- 2.86 respectively, P=0.020]. There was no relation between endometrial hyperplasia and serum LH [P=0.600]. The ANOVA test showed serum LH levels were not the same among three BMI groups [P=0.007]. Post hoc test was also performed. It showed that the LH level in normal BMI group was significantly higher than those of other groups [P=0.005 and P=0.004], but there was no statistical difference between overweight and obese groups [P=0.8]. We found no relationship between BMI and endometrial thickness in PCOS patients [P=0.6]

Conclusion: Sonographic endometrial stripe thickness is predictive for endometrial hyperplasia in PCOS women. We could not find out any relationship between serum LH level and BMI with endometrial thickness in PCOS patients. However, our study confirmed a diverse relationship between serum LH level and BMI in PCOS patients

Comparison of 25-hydroxyvitamin D and calcium levels between polycystic ovarian syndrome and normal women

Given the relationship of vitamin D deficiency with insulin resistance syn-drome as the component of polycystic ovary syndrome [PCOS], the main aim of this study was to compare serum level of 25- hydroxyvitamin D [25[OH]D] between PCOS patients and normal individuals. 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. 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 pa-tients 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]. 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

MRNA expression of VEGF and its receptors in fallopian tubes of women with ectopic pregnancies

Establishment of viable pregnancy requires embryo implantation and placentation. Ectopic pregnancy [EP] is a pregnancy complication which occurs when an embryo implants outside of the uterine cavity, most often in a fallopian tube. On the other hand, an important aspect of successful implantation is angiogenesis. Vascular endothelial growth factor [VEGF] is a potent angiogenic factor responsible for vascular development that acts through its receptors, VEGF receptor 1 [VEGFR1] and VEGFR2. This study aims to investigate mRNA expression of VEGF and its receptors in fallopian tubes of women who have EP compared with fallopian tubes of pseudo-pregnant women. We hypothesize that expression of VEGF and its receptors in human fallopian tubes may change during EP. This was a case-control study. The case group consisted of women who underwent salpingectomy because of EP. The control group consisted of women with normal fallopian tubes that underwent hysterectomy. Prior to tubal sampling, each control subject received an injection of human chorionic gonadotropin [hCG] to produce a state of pseudo-pregnancy. Fallopian tubes from both groups were procured. We investigated VEGF, VEGFR1 and VEGFR2 mRNA expressions in different sections of these tubes [infundibulum, ampulla and isthmus] by reverse transcription polymerase chain reaction [RT-PCR] and quantitative PCR [Q-PCR]. RT-PCR showed expressions of these genes in all sections of the fallopian tubes in both groups. Q-PCR analysis revealed that expressions of VEGF, VEGFR1 and VEGFR2 were lower in all sections of the fallopian tubes from the case group compared to the controls. Only VEGFR2 had higher expression in the ampulla of the case group. Decreased expressions of VEGF, VEGFR1 and VEGFR2 in the EP group may have a role in the pathogenesis of embryo implantation in fallopian tubes

Gene expression analysis of VEGF and its receptors and assessment of its serum level in unexplained recurrent spontaneous abortion

Unexplained recurrent spontaneous abortion [URSA] is one of the main complications of pregnancy which is usually defined as three or more consecutive pregnancy losses before the 20[th] week of gestation without a known cause. Vascular endothelial growth factor [VEGF] is a potent angiogenic factor and shown, along with its receptors [VEGFR1, 2], to play important roles in several physiologic processes including reproduction. The aim of the present study was to analyze gene expression of VEGF and VEGF receptors in endometrium of patients with a history of URSA compared with normal fertile women. In addition, serum VEGF concentration was assessed and compared between the two groups at the same time. In this case control study, endometrial and blood samples were obtained between day 19[th] and 24[th] of menstrual cycle [window of implantation] from 10 women with a history of URSA [case group] and 6 fertile women who had at least one successful pregnancy [control group]. Expression of VEGF and VEGFRs was studied by reverse transcription- polymerase chain reaction [RT-PCR] and then quantified by real time PCR. Normalization of expression levels was done by comparison with beta-actin expression level as an internal control. Relative VEGF, VEGFR1 and VEGFR2 expression quantities were compared between the two groups. Enzyme linked immunosorbent assay [ELISA] was used for serum VEGF assay. VEGF, VEGFR1 and VEGFR2 gene expression was detected in endometrial samples of both groups. The mean relative expression of VEGF gene was lower in the case group compared with control women, however, both VEGF receptors were expressed higher in endometrium of the case group. In addition, the serum level of VEGF was significantly higher in the case group compared with the controls. Alteration in gene expression of VEGF and its receptors in endometrium and changes of serum VEGF might play important roles in pathogenesis of unexplained RSA

Unexpected outcome after expectant management of ectopic pregnancy in two persons

Ectopic pregnancy is one of the main problems in women in reproductive age that needs special attention and appropriate strategy should be managed. In some cases expectant management seems good strategy without any medicine or surgery and their possible side effects. But are the outcomes always the same? Which outcomes should we expect? We have reported 2 patients whose ectopic pregnancy had been managed conservatively and they had sustained pain for several months which needed surgery to resolve In the case of ectopic pregnancy, it is important for the clinician to select the patient meticulously and be aware of common and rare consequences of her treatment

Prevalence of metabolic syndrome in polycystic ovarian syndrome women in a hospital of Tehran

Polycystic ovarian syndrome [PCOS] is a condition associated with chronic anovulation, insulin resistance and androgen excess. Women with this syndrome are at increased risk of metabolic syndrome. The aim of the present study was to determine the prevalence of metabolic syndrome [MBS] in women with PCOS referred to Arash Hospital in different ages and body mass index [BMI]. A cross-sectional study was conducted in Gynecologic Clinic at Arash Hospital affiliated with Tehran University. A total of 282 women with PCOS ages between 15-40 years were included. The prevalence of Metabolic Syndrome and its components in this population were the main outcomes. Height, weight, waist circumference, blood pressure and laboratory tests [FBS, TSH, HDL-C, serum prolactin, triglycerides and total cholesterol] were measured in this population. The prevalence of MBS in PCOS women was 22.7% [64 cases]. The rate of central obesity, FBS more than 110 mg/dl, triglycerides more than 150 mg/dl, high-density lipoprotein cholesterol levels [HDL-C] less than 50 mg/dl, and blood pressure >/= 130/85 mmHg in PCOS women was 31% [87], 3.2% [9], 33% [93], 68.8% [194], and 10.6% [30], respectively. The risk of MBS was increased in older and the obese women [BMI >/= 30 kg/m[2]]. The present sample showed women with PCOS have a high prevalence of MBS and its individual components, particularly decreased HDL-C

Hysteroscopic findings in patients with a history of two implantation failures following in vitro fertilization

This study was designed to evaluate the incidence of uterine pathologies in infertile women with a history of two implantation failures after in vitro fertilization [IVF] and estimate the effect of hysteroscopic correction on achieving a pregnancy in these patients. The retrospective study population included 238 infertile women attended the outpatient infertility clinic between November 2007 and December 2008. Patients with at least two previous IVF failures were eligible for this study. All patients had normal findings on hysterosalpingography performed prior their first attempt for IVF. Standard transvaginal ultrasonography and diagnostic hysteroscopy were performed in patients before the subsequent IVF attempt. Out of 238 patients with previous IVF failure who underwent hysteroscopic evaluation, 158 patients [66.4%] showed normal uterine cavity. Abnormal cavity was found in 80 patients [33.6%]. We found polyp as the most common abnormality [19.7%] in the patients with previous history of IVF failure. The pregnancy rate was similar between IVF failure patients who treated by hysteroscopy for a detected uterine abnormality [24.6%] and similar patients with normal uterine cavity [21.2%] in hysteroscopic examinations. The intrauterine lesions diagnosed by hysteroscopy in patients with previous IVF failure ranges from 0.8%-19.7%. Correction of abnormalities such as myoma and polyp showed good outcome, similar to that achieved in patients with a normal hysteroscopy

Fertility outcome after operative laparoscopy versus no treatment in infertile women with minimal or mild endometriosis

Background: Endometriosis is the presence of endometrial glands and stroma in sites other than the uterine cavity, which is associated with infertility. The objective of this study was to evaluate the effect of laparoscopic surgical treatment on clinical pregnancy in infertile women with minimal or mild endometriosis

Materials and Methods: This clinical trial study was performed in infertile women who were referred to the gynecological clinic between April 2008 and March 2009. After confirmation of minimal or mild endometriosis by diagnostic laparoscopy, patients were randomly assigned into two groups using consecutively numbered, opaque sealed envelops. The first group consisted of women who only underwent diagnostic laparoscopy [no treatment] before randomization. The second group of patients underwent operative laparoscopies. T-test and chi-square test were used when appropriate. A p-value less than 0.05 was considered statistically significant

Results: Analysis with 38 patients in each group showed characteristics such as age, body mass index [BMI], and duration of infertility were statistically similar in both groups. At 9 months follow-up, 9 [24%] women who had operative laparoscopies became pregnant compared with 7 [18%] women in the diagnostic laparoscopy group. The pregnancy rate showed no statistically significant difference between both groups [p=0.49]. No complications were reported in either group

Conclusion: The present study suggested that laparoscopic surgical treatment was not superior to diagnostic laparoscopy in pregnancy occurrence in infertile women with minimal and mild endometriosis. [IRCT Number: IRCT201012311952N2]

Continous infusion of remifentanil plus ketamine compared with continous remifentanil for pain relief in labor

Pain relief during labour is an important determinant of a women's birth experience. There are numerous pain relief techniques which can be used either with or without pain medication. The aim of our study was to compare the effect of remifentanil alone and its effect in pain relief while using with ketamine during labour. After obtaining informed consent and approval of hospital ethics committee, 40 women with gestational age between 38 and 42 weeks gestation in early labour were recruited for this study. They were randomly allocated into two groups: group RK [20 cases] received 25 micro g remifentanil as a starting dose and continuous infusion of 0.06 micro g/kg/min remifentanil plus 0.5 mg/kg/h ketamine for 4 hours via pump and group R [20 cases] received 25 micro g remifentanil as a starting dose and continous infusion of 0.06 micro g/kg/min remifentanil. The baseline of pain scores were similar in both groups [5.75 +/- 2.51 vs 7 +/- 2.45, p= 0.12] but after 30 minutes to 120 minutes the VAS scores were significantly higher in R group [p< 0.001]. The rate of patients who were satisfied [excellent and very good] in RK was 80% but in R group was 45% [p = 0.03]. Nausea and vomiting were significantly higher in R group [p<0.05]. The remifentanil plus ketamine produced better pain relief during labour with continous monitoring than continous remifentanil with no adverse effects for mothers and infants