Hepatitis C infection seroprevalence in pregnant women worldwide: a systematic review and meta-analysis.

Background: Monitoring progress towards the WHO global target to eliminate hepatitis C virus (HCV) infection by 2030, entails reliable prevalence estimates for HCV infection in different populations. Little is known about the global burden of HCV infection in pregnant women. Here, for the first time to our knowledge, we estimated the global and regional seroprevalence of HCV antibody (Ab) and determinants in pregnant women. Methods: In this systematic review and meta-analysis study, we searched PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO databases for peer-reviewed observational studies between January 1, 2000 and April 1, 2023, without language or geographical restrictions. Pooled global seroprevalence (and 95% confidence interval, CI) were estimated using random-effects meta-analysis and seroprevalences were categorised according to World Health Organization regions and subregions, publishing year, countries' income and human development index (HDI) levels. We used sensitivity analysis to assess the effect of four large sample size studies on pooled global prevalence through the "leave-one-out" method. We also investigated the association of potential risk factors with HCV seropositivity in pregnant women by subgroup and meta-regression analyses. The Protocol was registered in PROSPERO CRD42023423259. Findings: We included 192 eligible studies (208 datasets), with data for 148,509,760 pregnant women from 53 countries. The global seroprevalence of HCV Ab in pregnant women was 1.80% (95% CI, 1.72-1.89%) and 3.29% (3.01-3.57%) in overall and sensitivity analyses, respectively. The seroprevalence was highest in the Eastern Mediterranean region (6.21%, 4.39-8.29%) and lowest in the Western Pacific region (0.75%, 0.38-1.22%). Subgroup analysis indicated that the seroprevalence of HCV Ab among pregnant women was significantly higher for those with opioid use disorder (51.94%, 95% CI: 37.32-66.39) and HIV infection (4.34%, 95% CI: 2.21-7.06%) than for the general population of pregnant women (1.08%, 95% CI: 1.02-1.15%), as confirmed by multivariable meta-regression (p < 0.001). A significant decreasing trend was observed with increasing human development index levels. Other important risk factors for HCV seropositivity included older age, lower educational levels, poly sexual activity, history of blood transfusion, hospitalization, surgery, abortion and sexual transmitted diseases, having scarification/tattoo or piercing, and testing hepatitis B positive. Interpretation: This meta-analysis showed relatively high burden of exposure to HCV infection (2.2-5.3 million) in pregnant women globally. However, due to substantial heterogeneity between studies, our estimates might be different than the true seroprevalence. Our findings highlighted the need to expand HCV screening for women of reproductive age or during pregnancy, particularly in countries with high prevalence; as well as for more studies that assess safety of existing therapeutic drugs during pregnancy or potentially support development of drugs for pregnant women. Funding: There was no funding source for this study.

Trichomonas vaginalis infection and risk of cervical neoplasia: A systematic review and meta-analysis.

OBJECTIVES: The evidence in the literature regarding the relationship between Trichomonas vaginalis (TV) infection and cervical neoplasia is conflicting. The main aim of this study was to evaluate the magnitude of the risk of cervical neoplasia associated with TV infection. METHODS: A meta-analysis of observational studies, which provided raw data on the association of TV infection with cervical neoplasia, was performed. For this aim, we searched scientific databases (PubMed/Medline, Scopus, the Web of Sciences, and Embase) from inception to March 15, 2023. A random-effects model was applied by Stata 17.0 to calculate the pooled and adjusted odds ratios (ORs) with 95% confidence intervals (CI), including subgroup, sensitivity, and cumulative analyses to explore sources of heterogeneity. RESULTS: Of the 2584 records initially identified, 35 eligible studies contributed data for 67,856 women with cervical neoplasia, and 933,697 healthy controls from 14 countries were included. The pooled (2.15; 1.61-2.87; I2 = 87.7%) and adjusted (2.17; 1.82-2.60; I2 = 31.27%) ORs indicated a significant positive association between TV infection and the development of cervical neoplasia. There was no significant change in pooled and adjusted ORs by applying sensitivity and cumulative analyses, indicating the robustness of our findings. The pooled OR was significant in most sub-group analyses. There was no publication bias in the included studies. CONCLUSION: Our findings indicated that women with a TV infection are at significantly greater risk of cervical neoplasia. Future research, particularly longitudinal and experimental studies, should be done to better understand the various aspects of this association.

Assessing the risk factors and management outcomes of ectopic pregnancy: A retrospective case-control study.

Background: Ectopic pregnancy (EP) is the implantation of a fertilized egg outside the uterine cavity or in an unusual location. According to the clinical case reports, hormonal contraceptive failures may be related to emergency contraceptives and EP. EP may be treated medically, surgically, or expectantly. Currently, there is no consensus regarding whether a multiple- or double-dose regimen with methotrexate (MTX) or an additional dose could be more effective than a single-dose regimen. Objective: This study aimed to assess risk factors and treatment outcomes for EP. Materials and Methods: This case-control study was conducted in Tehran, Iran from March 2020 to March 2021. The case group was comprised of all EP-diagnosed cases (n = 191). Based on the levels of ß-human chorionic gonadotropin, MTX was administered to stable individuals with no surgical indications. Risk factors were assessed through 2 control groups: intrauterine pregnancy (n = 190) and nonpregnant groups (n = 180). Results: The medical treatment significantly improved with an extra dose of MTX, especially in individuals with higher ß-human chorionic gonadotropin concentrations and gestational age > 7.5 wk (p = 0.002). Considering risk factors, it is assumed that hormonal contraceptive failures, including both oral and emergency contraceptives, may increase the EP likelihood (p < 0.001). Conclusion: Based on our findings, we recommended an additional dose of MTX for subjects who are further along in their pregnancy. It is also concluded that failure of contraceptive pills increases the chances of EP.

Preterm Birth and Breast Cancer Risk: A Systematic Review and Meta-Analysis.

BACKGROUNDS: Changes in estrogen levels during pregnancy as well as histologic changes in breast tissue can justify the relationship of preterm birth (PTB) and the risk of BC. Therefore, there is a hypothesis that the duration of pregnancy can be associated with BC, so the aim of this study was to find out whether PTB is a risk factor for BC. METHODS: Published studies were located back to the earliest available publication date (1983), using the Medline/PubMed, Embase, Scopus, and Web of Science bibliographic databases. This review included the cohort or case control studies that assessed the association between PTB and BC. Pooled effect sizes with corresponding 95% confidence intervals (CI) were calculated using random-effects models. RESULTS: Thirteen studies including a total of 2,845,553 women were included in this meta-analysis. Pooled results suggested that PTB could increase the risk of BC (RR: 1.03, 95% CI: 1.00, 1.07; I2= 62.5%). The risk was significantly increased in women who delivered at 37-39 (RR: 1.03, 95% CI: 1.01, 1.06) and 26-31 weeks of gestation (RR: 1.25, 95% CI: 1.04, 1.47) compared to women who delivered at 40-41 weeks of gestation. A significant increment in the risk of BC was observed in primiparous (RR: 1.05, 95% CI: 1.01, 1.08) and women older than 45 years (RR = 1.12, 95% CI: 1.01, 1.24). There was no difference between other gestational age categories. CONCLUSIONS: Our findings add to evidence that short gestation pregnancies may increase the risk of BC, especially in primiparous and women older than 45 years. Considering the methodological weaknesses existed in included studies, minor clinical differences, and the complexity of the exact pathophysiology of PTB on BC, the precise position of PTB as a risk factor for BC in clinical practice is undetermined. Further studies are still needed.
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How Does Platelet-Rich Plasma Injection in Ovaries of Poor Responders Affect the Retrieved Oocytes, and Anti Mullerian Hormone: A Clinical Trial.

Objective: Platelet Rich Plasma (PRP) is proposed to have important role in cell division and proliferation, angiogenesis and health. This study evaluates the effect of a single injection of autologous PRP on ovarian response markers in women with poor ovarian response (POR). Materials and methods: This non-randomized clinical trial was conducted between August 2020 and September 2021. Fifty six women with Bologna criteria for POR willingly chose to participate in one of the following groups: PRP for one cycle in the time of oocyte pickup (OPU) (intervention group, n= 34) or control group (n=22).The primary outcomes were: number and quality of oocytes in coming 2 cycles of ICSI, and Anti Mullerian Hormone (AMH) level two months after PRP injection. The secondary outcomes were the number and quality of embryos and chemical pregnancy rate after embryo transfer. Results: A total of 45 participants continued the study, of which 23 were in the intervention group and 22 in control group. There were no demographic differences between two groups. At a two cycle follow up, PRP group experienced a significant improvement in AMH level and there was no respective change in control group. In one year follow up the overall pregnancy rates were same in both groups (3% Vs. 0, p=.60), while there was no difference in cumulative number and quality of embryos. Conclusion: PRP injection can improve ovarian reserve marker without adverse effects. Further evidence is required to evaluate the impact of PRP on assisted reproduction outcomes.

Human Papillomavirus Infection during Pregnancy and Childhood: A Comprehensive Review.

Human papillomavirus (HPV), the most prevalent sexually transmitted disease worldwide, is the causative agent for several genital and oropharyngeal cancers and a suspected agent for many malignancies. HPV is associated with several adverse health outcomes during pregnancy. Infants are also at risk of HPV infection via different transmission routes: vertically from an infected mother and horizontally through sexual or non-sexual contact with infected individuals. Several HPV manifestations have been identified during childhood, ranging from common skin infections to severe complications such as juvenile recurrent respiratory papillomatosis. This review aims to provide a comprehensive overview of the epidemiology, manifestations, and treatment strategies of HPV infection during pregnancy and childhood. Moreover, we underline the role of vaccination in preventing complications.

In Situ Measurement of Airborne Particle Concentration in a Real Dental Office: Implications for Disease Transmission.

Aerosols generated during dental procedures are one of the most significant routes for infection transmission and are particularly relevant now in the context of COVID-19 pandemic. This study aimed to assess the effectiveness of an indoor air purifier on dental aerosol dispersion in dental offices. The spread and removal of aerosol particles generated from a specific dental operation in a dental office are quantified for a single dental activity in the area near the generation and corner of the office. The effects of the air purifier, door condition, and particle sizes on the spread and removal of particles were investigated. The results show that, in the worst-case scenario, it takes 95 min for 0.5-µm particles to settle and that it takes a shorter time for the larger particles. The air purifier expedited the removal time at least 6.3 times faster than the case with no air purifier in the generation zone. Our results also indicate that particles may be transported from the source to the rest of the room even when the particle concentrations in the generation zone dropped back to the background. Therefore, it is inaccurate to conclude that indoor purifiers help reduce the transmission of COVID-19. Dental offices still need other methods to reduce the transmission of viruses.

The effect of cinnamon supplementation on glycemic control in women with polycystic ovary syndrome: A systematic review and meta-analysis.

Several clinical trials have identified glycemic-lowering effects of cinnamon, while other studies have reported conflicting findings. A comprehensive systematic search on Embase, PubMed, Scopus, Web of Science, and Cochrane Library was conducted using defined keywords in any language through June 2020. Studies that compared the effect of cinnamon with placebo on insulin resistance (IR) indices, as the primary outcome, in women with polycystic ovary syndrome (PCOS) were considered eligible. Standard Mean difference (SMD) (with 95% confidence intervals) for endpoints were calculated using the random-effects model. Finally, five RCTs which met the criteria were included in the meta-analysis. After pooling data, cinnamon supplementation significantly reduced homeostatic model assessment for insulin resistance (HOMA-IR) scores in women with PCOS (SMD: -0.84, 95% CI: -1.52, -0.16, p = .010). Cinnamon supplementation likely improves certain IR markers in patients with PCOS. PRACTICAL APPLICATIONS: There are controversies reports for cinnamon intake, which animal models have suggested that it decreases IR via promotion of insulin action, stimulating insulin signaling pathways, and enhancing insulin sensitivity. This study provides comprehensive information about the effect of cinnamon on insulin resistance (IR) indices in women with PCOS. In this regard, our results indicated that cinnamon supplementation significantly reduced homeostatic model assessment for insulin resistance (HOMA-IR) scores in women with PCOS. Therefore, consumption of cinnamon can be safe and this can be a useful recommendation for improving IR and promotion of healthy life which indeed are the potential or actual uses of this research.

A diagnostic profile on the PartoSure test.

Introduction: Preterm birth (PTB) is common, occurring in over 10% of all live births globally, and is increasing worldwide. The limitations of traditional biomarkers of PTB, such as fetal fibronectin (fFN) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as placental alpha macroglobulin-1 (PAMG-1); PartoSure, has the potential to improve disease monitoring and the best interventions. Areas covered: The present expert opinion evaluates the utility and limitations of PAMG-1; PartoSure as a biomarker for PTB in light of the current literature. Expert opinion: Although fFN, phIGFBP-1 and PAMG-1; PartoSure test had similar negative predictive value (NPV) and negative likelihood ratio (LR-), the PAMG-1; PartoSure test had the highest specificity, positive predictive value (PPV), and positive likelihood ratio (LR+) across all at-risk pregnant women. Although findings of this review may be encouraging, the PartoSure test should not be interpreted as absolute evidence for prediction of PTB. The PartoSure test result should always be used in conjunction with information available from the clinical evaluation of the pregnant woman and other diagnostic procedures such as cervical examination, assessment of uterine activity, and evaluation of other risk factors.

Response to Letter to the Editor Entitled: Concerning the Article by Arezoo Maleki-Hajiagha et al. Entitled Serum Prostate-Specific Antigen Level in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.

Dear Editor,We thank Kunicki et al. 1 for their interest in our paper 2 and for taking the time to give relevant and important comments regarding the inclusion of hirsutism or hyperandrogenism cases in our study. We agree with Kunicki et al. that the title is not appropriate, and it was better if the title of the article was: Serum Prostate-Specific Antigen Level in Women with Polycystic Ovary Syndrome and Hyperandrogenism: A Systematic Review and Meta-Analysis. Also, we should make some minor editing in the manuscript text.

Intrauterine infusion of autologous platelet-rich plasma in women undergoing assisted reproduction: A systematic review and meta-analysis.

Prior studies have provided conflicting results regarding the use of platelet-rich plasma (PRP) in women undergoing in-vitro fertilization (IVF) or intracytoplasmic injection (ICSI). The objective of this study was to evaluate the effect of the intrauterine infusion of PRP on the outcome of embryo transfer (ET) in women undergoing IVF/ICSI. We searched databases, including PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Clinical Trials (CENTRAL). Meta-analysis using a random-effects model was performed to calculate the pooled estimates. Seven studies involving 625 patients (311 cases and 314 controls) were included. The probability of chemical pregnancy (n = 3, risk ratio (RR): 1.79, 95 % confidence intervals (CI): 1.29, 2.50; P < 0.001, I2 = 0 %), clinical pregnancy (n = 7, RR: 1.79, 95 % CI: 1.37, 2.32; P < 0.001, I2 = 16 %), and implantation rate (n = 3, RR: 1.97, 95 % CI: 1.40, 2.79; P < 0.001, I2 = 0 %) was significantly higher in women who received PRP compared with control. There was no difference between women who received PRP compared with control group regarding miscarriage (RR: 0.72, 95 % CI: 0.27, 1.93; P = 0.51, I2 = 0 %). Following the intervention, endometrial thickness increased in women who received PRP compared to control group (SMD: 1.79, 95 % CI: 1.13, 2.44; P < 0.001, I2 = 64 %). The findings of this systematic review suggest that PRP is an alternative treatment strategy in patients with thin endometrium and recurrent implantation failure (RIF). Further prospective, large, and high quality randomized controlled trials (RCTs) are needed to identify the subpopulation that would most benefit from PRP.

The effect of body mass index on sperm DNA fragmentation: a systematic review and meta-analysis.

BACKGROUND: Current evidence supports the association between the high sperm DNA fragmentation (SDF) and the poor fertilization rate following either natural conception or assisted reproductive techniques (ART). On the other hand, there are conflicting results regarding the decreased sperm DNA integrity in men with high body mass index (BMI). OBJECTIVE: We aimed at the present systematic review and meta-analysis at evaluating the association between BMI and SDF. METHODS: We searched databases of Medline, Embase, Scopus, and Web of Science up to May 2019, to identify observational studies that assessed the associations between BMI and SDF. BMI was classified, according to the standard BMI classifications, into six categories including underweight (<18.5), normal weight (18.5-24.99), overweight (25-29.99), class I obesity (30-34.99), class II obesity (35-39.99), and class III obesity (≥40). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) of SDF were calculated by using a random-effects model for BMI categories. RESULTS: The initial extensive literature search yielded 33,739 potentially relevant articles (3,917 from Medline, 781 from Embase, 12,685 from Scopus, and 9,348 from Web of Science). Fourteen studies (nine cross-sectional, four cohort, and one case-control studies), with a total number of 8,255 participants, were included in the meta-analysis. Finally, three studies reported higher SDF levels in obese men (BMI = 30-34.99) compared with normal-weight men (BMI < 25) (SMD: 0.23, 95% CI: 0.01, 0.46, P = 0.05, I2 = 0%), but there was no difference between other categories. CONCLUSIONS: There is insufficient data to demonstrate a positive association between BMI and SDF. Our findings provide a rationale for conducting further cohort studies for evaluation of the association between BMI and SDF, considering potential confounders.

The effect of GPx-1 rs1050450 and MnSOD rs4880 polymorphisms on PE susceptibility: a case- control study.

Preeclampsia (PE) is a serious pregnancy complication whose etiology is not fully understood. However, previous reports have suggested that oxidative stress and genetic variants may contribute to the development of PE. This study aimed to examine the relationship between the Glutathione peroxidase-1(GPx-1) and Manganese Superoxide dismutase (MnSOD) polymorphisms and preeclampsia (PE) risk in Iranian women. Genotyping of the studied women, including 179 preeclamptic cases and 202 controls, for GPx-1 rs1050450 and MnSOD rs4880 polymorphisms was conducted using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Our results showed a 1.7- to 1.6-fold increased risk of PE in the rs1050450 CT and CT + TT (dominant model) genotypes compared to CC genotype (OR = 1.7, 95%CI 1.1-2.7; P = 0.01 and OR = 1.6, 95%CI 1.1-2.4; P = 0.02; respectively). We also found a marked correlation between TC and CC genotypes of MnSOD rs4880 polymorphism and a 1.9- to 2.3-fold increase risk of PE (OR = 1.9, 95%CI 1.2-2.9; P = 0.005 and OR = 2.3, 95%CI 1-5.1; P = 0.04, respectively). The rs4880 MnSOD polymorphism was correlated with increased risk of PE in the allelic and dominant models (OR = 1.8, 95% CI 1.2-2.5, P = 0.002; OR = 1.9, 95%CI 1.3-3, P = 0.002, respectively). High frequency of TC/CC genotype of MnSOD rs4880 and CT genotypes of rs1050450 polymorphism in PE patients compared to controls showed the contribution of these variants to PE susceptibility.

Up-regulation of long non-coding RNA-PCAT-1 promotes invasion and metastasis in esophageal squamous cell carcinoma.

Long non-coding RNA prostate cancer associated transcript-1 ncRNA (lncRNA-PCAT-1) plays an important role in the progression of prostate cancer. The present investigation was aimed to evaluate the potential roles of the lncRNA-PCAT-1 gene expression changes in esophageal squamous cell carcinoma (ESCC) between Iranian population. In the case-control investigation, we have analyzed a total of 150 fresh tissue samples, compromising of 75 cancerous tissues and 75 adjacent normal tissues from patients with ESCC. We used quantitative Real-time polymerase chain reaction (qRT-PCR) to evaluate the lncRNA-PCAT-1 gene expression levels in ESCC patients and correlation between the lncRNA-PCAT-1 expression changes and clinical characteristics. Our findings showed that the lncRNA-PCAT-1 gene was up-regulated in cancerous tissues compared with the adjacent non-cancerous tissues (p=0.0016). In addition, the results revealed a significant correlation between up-regulating of lncRNA-PCAT-1 and hot liquid drinking (p =0.017). These findings offer the potential roles of lncRNA-PCAT-1 in the pathogenesis of ESCC and may consider as a candidate prognostic biomarker for ESCC in an Iranian population.

Serum Prostate-Specific Antigen Level in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis.

We undertook a comprehensive search of all published original articles evaluating the diagnostic value of prostate-specific antigen (PSA) for the detection of polycystic ovary syndrome (PCOS). Finally, 25 studies with a total of 1865 participants (1104 cases and 761 controls) met the inclusion criteria. Mean serum PSA levels were significantly higher in PCOS women compared to healthy women [Standardized mean difference (SMD)=1.73 ng/ml, 95% CI=1.22 to 2.25, p<0.001]. Only 5 studies reported accuracy indicators and were included in the bivariate random-effects model; with a total of 509 samples that included 332 (65.22%) confirmed PCOS women. The sensitivity of serum PSA for the diagnosis of PCOS varied between 66.3 and 90.6%, and, the specificity ranged from 62.5-86.7%. Meta-analysis revealed a pooled sensitivity of 72.3% (95% CI 67.1-77.00%) and specificity of 74.6% (95% CI 67.5-80.8%) with an area under the summary ROC curve equal to 0.82 (95% CI 0.75-0.83). The summary estimates were 2.92 (95% CI 1.98-4.31) for positive LR and 0.37 (95% CI 0.26-0.51) for negative LR. The pooled estimate of diagnostic odds ratio (DOR) of serum PSA was 9.01 (95% CI 4.35-18.64). Considering the methodological weaknesses existed in studies, lack of sufficient data regarding the accuracy indicators, and the complexity of the exact pathophysiology of PSA secretion in women, the precise position of PSA, as a diagnostic test for the detection of PCOS, in clinical practice is undetermined, and further studies are still needed.

Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis.

BACKGROUND: Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results. OBJECTIVE: To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis. SEARCH STRATEGY: PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018. SELECTION CRITERIA: Observational studies with medically confirmed pregnancy outcomes as endpoints. DATA COLLECTION AND ANALYSIS: Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta-analysis by using a random-effects model. MAIN RESULTS: Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta-analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08-4.47; P˂0.001), small for gestational age (OR, 3.22; 95% CI, 1.71-6.08; P˂0.001), and pre-eclampsia (OR, 4.35; 95% CI, 1.07-17.72; P=0.042). CONCLUSION: Adenomyosis seems to have a detrimental impact on pregnancy outcomes, resulting in a higher likelihood of preterm birth, small for gestational age, and pre-eclampsia.

Intrauterine administration of autologous peripheral blood mononuclear cells in patients with recurrent implantation failure: A systematic review and meta-analysis.

Intrauterine administration of autologous peripheral blood mononuclear cells (PBMC) has been proposed to improve implantation rates in women with recurrent implantation failure (RIF). The objective of this study was to evaluate whether intrauterine administration of PBMC improves clinical pregnancy and live birth in couples with RIF. Various databases were searched including Medline, Embase, Scopus, Web of Science and Cochrane Central Register of Controlled Trials up to April 2018. This review included all studies that compared intervention of PBMC in infertile women undergoing any form of assisted reproductive technology (ART). Two independent reviewers assessed eligibility; methodological quality; and extracted data. Meta-analysis using a random-effects model was performed to calculate the pooled estimates. Eight studies involving 886 patients were included. The probability of clinical pregnancy was significantly higher in women who received PBMC compared with control (RR: 1.92, 95% CI: 1.48-2.49; P < 0.001). No difference was observed in the studies that transmitted the embryo at blastocyst (RR: 2.44, 95% CI: 1.42-4.20; P = 0.001), or cleavage stage (RR: 2.01, 95% CI: 1.36-2.96; P < 0.001). There was no difference between studies that transmitted the embryo in fresh (RR: 2.14, 95% CI: 1.38-3.32; P < 0.001), or frozen condition (RR: 1.79, 95% CI: 1.32-2.43; P < 0.001). The probability of live birth was significantly higher in women who received PBMC compared with control (RR: 1.93, 95% CI: 1.35-2.76; P < 0.001). Administration of PBMC, irrespective of embryo stage and cycle type, increases clinical pregnancy and live birth in patients experienced RIF. However, these overall estimates should be considered with caution due to the small number, quasi-experimental design and poor quality of most included studies.

The Effects of Probiotics or Synbiotics Supplementation in Women with Polycystic Ovarian Syndrome: a Systematic Review and Meta-Analysis of Randomized Clinical Trials.

We searched bibliographic databases from inception through May 2018 to evaluate the effect of probiotics (or synbiotics) supplementation in women suffering from polycystic ovary syndrome (PCOS). Seven trials involving 236 women with PCOS and 235 controls were included in the meta-analysis. Comparing with the control group, probiotics (or synbiotics) may improve Quantitative insulin sensitivity check index (QUICKI) (standardized mean difference (SMD) 0.41, 95% confidence intervals (CI) 0.01 to 0.82, P = 0.04), decrease triglyceride (TG) level (mean difference (MD) - 17.51 mg/dL, 95% CI - 29.65 to - 5.36); fasting insulin: (MD - 2.14 µIU/mL, 95% CI - 4.24 to - 0.04), and increase high-density lipoprotein (HDL) (SMD 1.55 mg/dL, 95% CI 0.28 to 2.81). No significant effect of probiotics (or synbiotics) on homeostatic model assessment-insulin resistance (HOMA-IR), fasting plasma glucose (FPG), low-density lipoprotein (LDL), total cholesterol (TC), and anthropometric indices was found in women with PCOS. Although probiotic (or synbiotics) supplementation was effective on some metabolic indices, the effect was negligible and not clinically significant.

The Effects of Supplementation with Chromium on Insulin Resistance Indices in Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Recently, the effects of nutritional supplementation on improvement or prevention of polycystic ovary syndrome (PCOS) have been considered. Several studies have been carried out on the effect of chromium supplementation in improving PCOS patients. This study aimed to summarize the available findings regarding the effect of chromium on improving the polycystic ovary syndrome. The review includes randomized controlled trials (RCTs) comparing chromium treatment with placebo or other treatments in women with PCOS. Women with PCOS diagnosed according to the ESHRE/ASRM or NIH criteria in reproductive age were eligible. Electronic searches using the MeSH terms were conducted in the following databases: Medline, Embase, Scopus, Web of Science, and The Cochrane Library. Effects were measured as weighted mean difference (WMD) and 95% confidence intervals (CI) for studies of PCOS and control subjects were calculated by using random-effects model. The initial search yielded potentially 100 relevant articles of randomized clinical trials on dietary chromium supplements: 16 from Pubmed, 36 from Embase, 29 from Scopus, and 19 from Web of Science. After studying these publications, 5 were potentially eligible and retrieved in full text. The five studies included in the meta-analysis reported data on 137 women with PCOS and 131 controls. A meta-analysis of 5 studies showed a non-significant difference in fasting insulin between chromium, and placebo or other treatment (mean difference (MD): -1.14; (95% CI: -4.11 to 1.83, p=0.45). We retrieved two randomized controlled trials, in which Quantitative Insulin Sensitivity Check Index (QUICKI) was compared between chromium, and placebo or other treatment in 156 women with PCOS. Meta-analysis of two RCTs showed no significant difference in QUICKI score between chromium and placebo (MD: 0.01; 95% CI: -0.01 to 0.04, p=0.34). Two randomized controlled trials compared Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) between chromium, and placebo or other treatment in 81 women with PCOS. After combining the data, there was a significantly lower HOMA-IR in the chromium group (MD: -1.68; 95% CI: -2.42 to -0.94, p<0.001). One RCT reported a significant difference in Homeostatic Model Assessment-beta-cell function (HOMA-B) between chromium and placebo groups (-15.5±32.3 vs. +13.6±23.1, p<0.001). No significant effect of chromium on fasting insulin and QUICKI score was found in women with PCOS. Chromium supplementation significantly improved HOMA-IR and HOMA-B among patients with diabetes. The magnitude of the effect is small, and the clinical relevance is uncertain. Future trials in well characterized studies that address the limitations in the current evidence are needed before definitive claims can be made about the effect of chromium supplementation.

The prevalence of menstrual disorders in Iran: A systematic review and meta-analysis.

BACKGROUND: Understanding the prevalence of menstrual disorders has important implications for both health service planning and risk factor epidemiology. OBJECTIVE: The aim of this review is to identify and collate studies describing the prevalence of menstrual disorders in Iran. MATERIALS AND METHODS: Studies with original data related to the prevalence of menstrual disorders were identified via searching six electronic databases and reviewing citations. All abstracts or titles found by the electronic searches were independently scrutinized by two reviewers. The Meta-analysis was performed with a random effects model, considering the remarkable heterogeneity among studies. A total of 35 eligible epidemiological studies were included in this review. RESULTS: Overall, the pooled prevalence of primary dysmenorrhea was 73.27% (95% CI=65.12-81.42). The mean proportion of women with oligomenorrhea was 13.11% (95.5%, 95% CI: 10.04-16.19). We identified 16 studies that reported polymenorrhoea with a random effect of pooled prevalence estimate of 9.94% (95% CI 7.33%-12.56%). The prevalence estimate of hypermenorrhea was 12.94% (95% CI 9.31%-16.57%). Overall prevalence of hypomenorrhea was 5.25% (95% CI 3.20%-7.30%), ranging from 0.9- 12.90%. Pooling six studies that reported estimates for menorrhagia, the overall prevalence was 19.24% (95% CI 12.78-25.69). Overall, 6.04% (95% CI: 1.99-10.08) of the women were shown to have metrorrhagia. CONCLUSION: This systematic review suggests that the average prevalence of menstrual disorders in Iran is substantial. It has been neglected as a fundamental problem of women's reproductive health. Diagnosis and treatment of these disorders should be included in the primary health care system of reproductive health.