The effect of oral melatonin supplementation on MT-ATP6 gene expression and IVF outcomes in Iranian infertile couples: a nonrandomized controlled trial.

This study aims to evaluate the effect of melatonin supplementation on the outcomes of in vitro fertilization (IVF) and mitochondrial adenosine triphosphate production (MT-ATP6) gene expression in Iranian infertile couples. A single-blind nonrandomized controlled trial was conducted, recruiting 90 infertile couples who underwent IVF at an infertility center in Tehran, Iran. Patients who were assigned to the intervention group received melatonin as a supplementation to the standard controlled ovarian stimulation (COS). The control group received a COS protocol only. Primary outcome was the mRNA level of the MT-ATP6 gene in cumulus cells of ovarian follicles. Secondary outcomes were the mean number of mature oocytes retrieved, the embryo quality, and biochemical and clinical pregnancy rates. The mRNA level of the MT-ATP6 gene in cumulus cells between intervention and control groups was not statistically different (0.931 vs.1; P Ëƒ 0.05). The mean number of poor-quality embryos was significantly lower in the intervention group than that in the control group (0.27 vs. 0.80; P = 0.028). The biochemical and clinical pregnancy rates were higher in the intervention group (24% vs. 14%, P = 0.089, and 14% vs. 7%, P = 0.302, respectively); however, the difference was not significant. Melatonin supplementation did not increase the odds of clinical pregnancy and the number of mature oocytes retrieved, but significantly reduced the number of low-quality embryos. More extensive studies focusing on the level of MT-ATP6 gene expression in the oocyte or blastomere cells may further elucidate the effect of supplementation with melatonin in infertile couples who have poor clinical outcomes. Trial registration: Current Controlled Trials: IRCT2015042912307N4.

Oil-based or water-based contrast for hysterosalpingography in infertile women: a cost-effectiveness analysis of a randomized controlled trial.

OBJECTIVE: To determine the cost effectiveness of the use of oil-based versus water-based contrast in infertile women undergoing hysterosalpingography (HSG). DESIGN: Economic evaluation alongside a multicenter randomized trial. SETTING: Hospitals. PATIENT(S): Infertile women with an ovulatory cycle, 18-39 years of age, low risk of tubal pathology. INTERVENTION(S): Use of oil-based versus water-based contrast during HSG. MAIN OUTCOME MEASURE(S): Costs per additional ongoing pregnancy and per live birth within 6 months of randomization, incremental cost-effective ratios (ICERs). RESULT(S): A total of 1,119 women were randomized to HSG (oil-based contrast, n = 557; water-based contrast, n = 562). After HSG, most women had no additional treatment; a minority had IUI or IVF. In the oil group, 39.7% women had an ongoing pregnancy within 6 months of randomization versus 29.1% women in the water group. There was a 10.7% increase in the live birth rate in the oil group. For ongoing pregnancy, the mean costs per couple were US$2,014 in the oil group and US$1,144 in the water group, with a corresponding ICER of US$8,198 per additional ongoing pregnancy. For live birth, the mean costs per couple were US$11,532 in the oil group and US$8,310 in the water group, with a corresponding ICER of US$30,112 per additional live birth. CONCLUSION(S): Hysterosalpingography with oil-based contrast results in higher 6-month ongoing pregnancy and live birth rate. If society is willing to pay US$8,198 for an additional ongoing pregnancy, HSG with oil-based contrast is a cost-effective strategy compared with HSG with water-based contrast for infertile, ovulatory women at low risk for tubal pathology. CLINICAL TRIAL REGISTRATION NUMBER: Dutch Trial Register, NTR 6577 (www.trialregister.nl).

The impact of thyroid function on intrauterine insemination outcome--a retrospective analysis.

BACKGROUND: Hashimoto's thyroiditis is the most common endocrinopathy in premenopausal women, and is associated with various gynecological problems, including recurrent miscarriage and unexplained infertility. A possible influence of Hashimoto's thyroiditis on the success of intrauterine insemination seems likely, but has not been evaluated as yet. Therefore, the aim of our study was to retrospectively analyze the impact on intrauterine insemination outcome of thyroid function and markers suggestive for Hashimoto's thyroiditis. METHODS: Retrospective cohort study in a tertiary care center of 540 women who underwent Intrauterine Insemination. The clinical pregnancy rate was the main outcome parameters. The following possible influencing factors were tested: thyroid-stimulating hormone (TSH); thyroid autoantibodies; age; body mass index; type of sterility (primary/secondary); parity; male factor; presence of PCO syndrome; ovulation induction; ovarian stimulation; and current thyroid medication. RESULTS: The overall clinical pregnancy rate was 6.9% (37/540). Age, thyroid hormone supplementation for thyroid-stimulating hormone (TSH) levels>2.5 micro-IU/ml, and ovulation induction with HCG were significantly predictive in the multivariate analysis (p<0.05) as influencing factors for the pregnancy rate after intrauterine insemination. CONCLUSIONS: Women undergoing intrauterine insemination seem to benefit from a strict thyroid hormone supplementation regimen in order to achieve lower TSH levels.

Melatonin supplementation during controlled ovarian stimulation for women undergoing assisted reproductive technology: systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To examine the best evidence available regarding the effect of melatonin supplementation during controlled ovarian stimulation (COS) on the main assisted reproductive technology (ART) outcomes. DESIGN: Systematic review and meta-analysis of randomized clinical trials (RCT). SETTING: Not applicable. PATIENT(S): Women undergoing COS for ART. INTERVENTION(S): Melatonin supplementation during COS for women undergoing ART. MAIN OUTCOME MEASURE(S): Live birth rate, clinical pregnancy rate, number of retrieved oocytes, miscarriage rate, ovarian hyperstimulation syndrome (OHSS) rate, and number of congenital abnormalities. Comparisons were performed using risk ratio (RR) or mean difference (MD). RESULT(S): Five RCTs were considered eligible, and their data were extracted and included in a meta-analysis. No studies reported live-birth or congenital abnormalities. Our estimates were imprecise for distinguishing between no effect and benefit considering clinical pregnancy (RR, 1.21; 95% confidence interval [CI], 0.98-1.50, five studies, 680 women, low quality-evidence) and the number of oocytes retrieved (MD, 0.6; 95% CI, -0.2-2.2, five studies, 680 women, low quality-evidence). Our estimates were imprecise for distinguishing among harm, no effect, and benefit considering miscarriage (RR, 1.07; 95% CI, 0.43-2.68, two studies, 143 clinical pregnancies, low quality-evidence) and interventions to reduce the risk of OHSS (RR,1.01; 95% CI, 0.33-3.08, one study, 358 women, low quality-evidence). CONCLUSION(S): More studies investigating the role of melatonin supplementation are still needed before recommending its use in clinical practice.

Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study.

OBJECTIVE: To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on pregnancy rates (PR) in women undergoing ET. DESIGN: Prospective, randomized, single-blinded placebo-controlled clinical trial. SETTING: Research and laboratory facilities. PATIENT(S): A total of 309 patients, less than 45 years old, undergoing cryopreservation embryos transplant or fresh cycle IVF with or without intracytoplasmic sperm injection (ICSI). INTERVENTION(S): The subjects were randomly allocated to three groups: mock TEAS treatment: 30 minutes after ET (group I, n = 99); single TEAS treatment: 30 minutes after ET (group II, n = 110); and double TEAS treatments: 24 hours before ET and 30 minutes after ET (group III, n = 100). MAIN OUTCOME MEASURE(S): Clinical PR, embryos implantation rate, live birth rate. RESULT(S): The clinical PR, embryos implantation rate, and live birth rate of group I (29.3%, 15.0%, and 21.2%, respectively) were significantly lower than those in group II (42.7%, 25.7%, and 37.3%, respectively) and group III (50.0%, 25.9%, and 42.0%, respectively). CONCLUSION(S): Transcutaneous electrical acupoint stimulation, especially double TEAS, significantly improved the clinical outcome of ET.

Neural tube defects in Australia: trends in encephaloceles and other neural tube defects before and after promotion of folic acid supplementation and voluntary food fortification.

BACKGROUND: Use of periconceptional folic acid supplementation has been promoted in Western Australia since late 1992, and voluntary fortification of some foods with folic acid has been permitted in Australia since 1996. Reduced rates of neural tube defects (NTDs) have been observed since 1995. Aboriginal infants have a higher rate of NTDs, but no fall in rates has been documented. Encephaloceles have not been examined separately. METHODS: Data on anencephaly, spina bifida, and encephalocele were obtained from the Western Australian Birth Defects Registry. The prevalence ratio for each type of NTD was calculated, comparing 1993 to 1995 (promotion of supplements, no fortification) and 1996 to 2006 (promotion of supplements and voluntary fortification) with 1980 to 1992 (no promotion or fortification). RESULTS: From 1996 to 2006, there was a 32% reduction in anencephaly, 23% in spina bifida, and 34% in encephalocele compared with 1980 to 1992. There were no differences seen from 1993 to 1995 compared with 1980 to 1992. For Aboriginal infants, the rates were higher than for non-Aboriginal infants, for each type of NTD. The prevalence ratios, comparing 1996 to 2006 with 1980 to 1995, were 0.70 (CI, 0.61-0.79) for non-Aboriginal infants and 0.90 (CI, 0.61-1.32) for Aboriginal infants. CONCLUSIONS: Overall, the rates of encephalocele, anencephaly, and spina bifida have fallen to a similar extent in association with promotion of folic acid supplements and voluntary fortification. No such falls were seen for Aboriginal infants. These data will provide a useful baseline against which to monitor the effects of mandatory fortification on NTDs when it is introduced in Australia in September 2009.

Planes y programas de salud en Chile: con especial consideración de los de salud materno infantil y nutrición / Plan and programs of health in Chile: with particular reference to mother and child health and nutrition

En una breve historia de los logros de salud en el siglo pasado, en Chile, se reconoce el descenso de las tasas de mortalidades infantil, materna, como también por las enfermedades infecciosas prevenibles por vacunas, y el incremento de la esperanza de vida al nacer. Se señala además la participación de los líderes del cuerpo médico en las innovaciones favorables al sistema; ellos pertenecían a la Facultad de Medicina de la Universidad de Chile, a las Sociedades Médicas, al Parlamento, al Servicio Nacional de Salud o al Colegio Médico (por medio de su Departamento de Salud Pública). Se afirma que han sido requisitos sociales fundamentales para tales logros, los siguientes: 1) la conciencia de un pueblo de su derecho al bien más preciado que es la salud; 2) la decidida voluntad política de los gobernantes de otorgar la prioridad que se merece al desarrollo de las condiciones para que este derecho se otorgue en forma satisfactoria, y 3) la lucidez y capacidad de los profesionales del sector para proponer, en cada momento, las soluciones necesarias para satisfacer las expectativas en salud de la comunidad nacional y cumplir las metas de los planes destinados a controlar los problemas emergentes

Opinions of imams about family planning and their use of methods in Kayseri, Turkey.

OBJECTIVES: Imams are religious leaders who have significant influence on the social attitudes and behavior of a society. This study examined the views of imams on family planning and their personal preference of birth control methods. MATERIALS AND METHODS: Using a pre-prepared questionnaire, an on-site individual interview was conducted face-to-face with each of 164 imams at Kayseri, a city in Central Anatolia. RESULTS: All of the imams included in the study knew of at least one family planning method. Withdrawal was the most widely known method of family planning (84.2%). Among imams, 88.4% approved the use of birth control. While only 61.8% of the imams used at least one method of family planning, 20.1% used none at all. Of the family planning methods used, we considered 43.1% efficient (modem) and 18.7% inefficient (traditional). The most important factor affecting preference of traditional methods was religious suitability. CONCLUSION: Contrary to common belief, imams viewed family planning positively and used family planning methods at a rate similar to that of the general public. If provided with accurate information, we believe that imams may have a positive contribution to make in the development of family planning programs.