PTEN promoter methylation and expression in endometrial cancer tissues.

Introduction: Some gene expression regulation in cancers can be controlled by epigenetic change like methylation. PTEN promoter methylation and expression were evaluated in endometrial cancer. Methods: The study was run on 39 tumor tissues of endometrial cancer patients and 41 normal endometrial tissues. After total RNA extraction, cDNA synthesis was done by reverse transcription of the total (real-time PCR) using SYBER Green master mix. DNA extraction and bisulfite treatment were conducted and methylation was semiquantified by the methylation-sensitive high-resolution melting method. Finally, promoter methylation quantification of the total number of 25 tumors and 22 non-neoplastic tissues was done. Results: PTEN gene expression showed a significant decrease in endometrial cancer tissues. Promoter methylation was significantly lower in the non-neoplastic group (7.2; p < 0.001). In addition, PTEN promoter methylation was observed in 52.0% of tumor tissues compared with 13.6% in the non-neoplastic group (p = 0.06). There were no significant correlations between PTEN expression and methylation and clinicopathological features in endometrial cancer patients (p > 0.05). Conclusion: PTEN gene expression in endometrial cancer tissues decreased because of its promoter hypermethylation.

Maternal and neonatal outcomes of pregnancies of infertile women during the COVID-19 pandemic: a real world evidence.

OBJECTIVE: The COVID-19 pandemic began in Dec. 2019 and its effects on pregnancy outcomes are still unknown. This study aimed to evaluate the pregnancy outcomes of infertile women who conceived during the COVID-19 pandemic. METHODS: This cross-sectional study included infertile women who conceived during the COVID-19 pandemic. Infertile women referred to the infertility center at the Vali-e-Asr hospital who conceived spontaneously or with the aid of ART (IUI, ICSI) were included and followed until delivery or pregnancy termination. RESULTS: A total of 38 pregnant women (34 conceiving after ART and four spontaneously) were included. Seventeen (44.74%) of the 38 pregnant women developed COVID-19 symptoms. No significant difference was detected in maternal and neonatal outcomes, including miscarriage, PROM, low birth weight, or premature birth between pregnancies with and without COVID-19 symptoms. A significant difference was found between the two groups in delivery route. CONCLUSIONS: No associations were found with maternal and neonatal morbidity in women conceiving during the COVID-19 pandemic and in pregnant women with and without COVID-19 symptoms.

Infertility policy analysis: a comparative study of selected lower middle- middle- and high-income countries.

BACKGROUND: Infertility has recently become a salient but neglected global issue. Policies to address the sexual and reproductive health and rights (SRHR) are vital, especially in lower middle and middle-income countries (LMICs). Hence, the aim of this study was to compare the national infertility policies in the selected countries (LMICs comparing with high-income) to determine gaps or to confirm desirable policies in the given health systems. METHODS: This study has executed a comparative policy analysis of infertility services using the universal health coverage framework (financial protection, population coverage, and service features) in three scopes (prevention, treatment, and supportive care). Seven countries that had infertility programs in their health sectors were selected. RESULTS: The results showed that financial protection was good in high and middle-income countries, but in a lower middle income, and in one high-income country was poor. The findings also showed that health systems in the same countries had no infertility services for men. Preventive and supportive care services were neglected in LMICs by governments. CONCLUSION: The findings indicate that income is not the only factor that fulfills universal health coverage for infertility care services. Perhaps to achieve equity in infertility care services, it should be seen as a universal human right to accomplish the right to have a child and to have a life with physical and mental health for all men and women.

Effects of Selenium Supplementation on Asymmetric Dimethylarginine and Cardiometabolic Risk Factors in Patients with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is characterized by various reproductive and cardiometabolic disorders. Asymmetric dimethylarginine (ADMA) is associated with cardiovascular, metabolic, and hormonal status. Selenium, a micronutrient with antioxidant properties, could affect multiple physiological pathways. This study aimed to investigate the effect of selenium supplementation on ADMA, cardiometabolic risk factors, and hormonal status in women with PCOS. In this randomized, double-blind, placebo-controlled clinical trial, 66 women with PCOS, aged 18-45 years, were randomly assigned to receive either 200 µg/day selenium or placebo, for 12 weeks. Circulating concentrations of ADMA, testosterone, sex hormone-binding globulin (SHBG), lipid profiles, and glycemic parameters were assessed at baseline and following supplementation. ADMA concentration decreased significantly compared to baseline values (85.14 ± 75 to 56.4 ± 38.64 ng/l, p = 0.02) in the selenium group. This change was marginally significant compared with the placebo group (28.74 ± 68.63 vs. - 1.77 ± 52.88 ng/l, p = 0.056). Serum testosterone levels declined significantly in the intervention compared to the placebo group (0.01 ± 0.17 vs. - 0.08 ± 0.18 ng/ml, p = 0.038). Pre- to post-Apo-B100/Apo-A1 ratio declined considerably in the intervention group (0.72 ± 0.16 to 0.65 ± 0.16, p = 0.003). No further differences were observed in SHBG, lipid profiles, Apo-A1, Apo-B100, Apo-B100/Apo-A1 ratio, and glycemic control between the two groups at the end of the study. Selenium supplementation for 12 weeks had beneficial effects on reduction of circulating ADMA and total testosterone levels in women with PCOS. No significant improvements were seen in other cardiometabolic risk factors. The effects of selenium supplementation on hormonal, reproductive, and cardiometabolic disorders, considering the potential mediating role of ADMA, should be further investigated.

The sequential embryo transfer compared to blastocyst embryo transfer in in vitro fertilization (IVF) cycle in patients with the three repeated consecutive IVF. A randomized controlled trial.

The purpose of this study was to determine the pregnancy rate in the double sequential transfer of embryos on both day 3 and day 5 compared to day 5 alone, in in vitro fertilization-embryo transfer (IVF/ET) in patients with the three repeated consecutive IVF failures. In this controlled trial, women scheduled for IVF/ET with the three repeated consecutive IVF failures were randomized to either sequential transfer of embryos on day 2 and on day 5 after ovum pick-up (group 1, n = 60) or blastocyst ET on day 5 (group 2, n = 60) as a control group. The primary outcome measures were the chemical and clinical pregnancy rate. Baseline and cycle characteristics were comparable in both groups. Chemical and clinical pregnancy rate was similar in the sequential ET group (40%) compared to the day 5 of ET group (38.3%) (p value = .85). It seems that the double ET does not increase the chance of pregnancy rate compared to blastocyst ET on day 5 in the patients with the three repeated IVF-ET failures.

Association of vascular endothelial growth factor (VEGF) Gene polymorphisms and expression with the risk of endometriosis: a case-control study.

Endometriosis is a polygenic and multifactorial gynecology situation which might be associated with angiogenesis. In the current study we assess the role of vascular endothelial growth factor (VEGF) - 2578 A/C, and + 936 C/T polymorphisms in susceptibility to endometriosis and checking the expression of VEGF mRNA in eutopic tissue of endometrium with and without endometriosis. The study was comprised of 300 patients who underwent laparascopic or laparotomy surgery with 100 cases who had confirmed histological diagnosis of endometriosis, and 200 controls with no histological diagnosis of disease. The genotyping of VEGF polymorphisms was done by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique and the gene expression in tissue was determined using Real-Time PCR assay. There was no important difference of allele distribution of the - 2578 A/C (P = 0.7) and + 936 C/T (P = 0.5) polymorphisms among endometriosis cases and controls. Study of VEGF expression during the menstrual cycle, showed that endometrial tissue in cases group expressed more VEGF mRNA at the secretory phase compared to the proliferative phase (P = 0.03). Our results suggest that - 2578 A/C and + 936 C/T polymorphisms of VEGF did not seem to have impact on endometriosis predisposition in our study population. Also we did not find any link between VEGF mRNA expression and risk of endometriosis.

A case-control study of bisphenol A and endometrioma among subgroup of Iranian women.

BACKGROUND: Endometriosis is a multifactorial hormonally related complex disease with unknown etiology. Epidemiologic data were suggested the possible effects of endocrine disrupting chemicals such as bisphenol A (BPA) on endometriosis. BPA is similar to endogenous estrogen and has the ability to interact with estrogen receptors and stimulate estrogen production. Our aim was to evaluate the relationship between urinary BPA concentrations in women with endometrioma. MATERIALS AND METHODS: This case-control study consisted of fifty women who have been referred to gynecology and infertility center with endometrioma and were candidates for operative laparoscopy and ovarian cystectomy as cases. Fifty women who had not any evidence of endometrioma in clinical and ultrasound evaluation and came to the same clinic for routine check-up were selected as controls. One-time urine sample was collected after receiving informed consent before surgery and medical intervention. Total BPA in urine was measured with high-performance liquid chromatography method and detection limit was 0.33 ng/mL. RESULTS: Percentage of urine samples containing BPA was 86% of cases and 82.4% of control. Urinary BPA showed a right-skewed distribution. The mean concentration of BPA was 5.53 ± 3.47 ng/mL and 1.43 ± 1.57 ng/mL in endometriosis and control group, respectively (P < 0.0001, Mann-Whitney U-test). The logistic regression showed that the odds ratio of the BPA was 1.74 (95% confidence interval: 1.40-2.16) after adjustment of age, parity, body mass index <30, and educational status. CONCLUSION: This study showed a positive association between urinary BPA concentrations and endometrioma. However, further large-scale studies are needed to confirm this hypothesis.

Association of serum concentrations of persistent organic pollutants (POPs) and risk of pre-eclampsia: a case-control study.

BACKGROUND: There is increasing evidence that persistent organic pollutants (POPs) may contribute to pre-eclampsia. The objective of this study was to evaluate the association between Polychlorinated Biphenyls (PCBs) and Polybrominated Diphenyl Ethers (PBDEs) as POPs with pre-eclampsia. METHODS: This case-control study was performed in the three general university hospitals of Tehran University of Medical Sciences. Serum samples were collected from cases (n = 45) who had diagnosed with preeclampsia and from control samples (n = 70) with normal pregnancy and attended the same hospital for a routine prenatal visit at the third trimester of pregnancy. Pollutants levels were analyzed by Gas Chromatography Mass Spectrometry (GC/MS). RESULTS: Mean participant age was 27.3 ± 5.39 with median 27. As the main independent variable, total POPs manifested with adjusted OR equal to 1.54 (95 % CI: 1.26-1.87, p-value <0.0001), which was significantly associated with pre-eclampsia. The adjusted OR proved a statistically significant association between total PCBs 1.77 (95 % CI: 1.34-2.32) and total PBDEs (OR = 2.19; 95 % CI: 1.39-3.45, p-value = 0.001) with pre-eclampsia considering confounding variables (maternal age, pre-pregnancy body mass index (BMI), gestational age, weight gain during pregnancy and total lipids in maternal serum). Finally, pre-pregnancy BMI and weight gain during pregnancy had a positive association with pre-eclampsia and gestational age yielded a negative association with pre-eclampsia in all analysis. CONCLUSION: Our data indicate the association between total POPs, total PBDEs, and total PCBs with pre-eclampsia, even after controlling for the effects of a number of potentially confounding factors. Further investigation about route of exposure and the trend of POPs especially in pregnant women is needed.

Age related endocrine patterns observed in polycystic ovary syndrome patients vs. ovulatory controls: descriptive data from a university based infertility center.

Objective: To compare serum anti-Müllerian hormone (AMH) and other endocrine parameters between patients diagnosed with polycystic ovary syndrome (PCOS) and age-matched ovulatory women. Materials and methods: AMH, DHEAS, FSH, LH, PRL, TSH and total testosterone (TT) were prospectively measured in oligo-ovulatory PCOS patients (n = 595) and in ovulatory non-PCOS women (n = 157) referred to a tertiary infertility center. Mean BMI was similar across the two study populations and there were no smokers in the sample. Patients in both groups were further classified into three categories by age: < 25 yrs, 25-34 yrs, and ≥ 35 yrs. Selected clinical and demographic characteristics were tabulated for each group. Results: Serum AMH was significantly higher among PCOS patients compared to non-PCOS controls in the non-stratified sample (7.54 ± 5.8 vs. 2.49 ± 2.0 ng/mL, respectively; p < 0.0001), while serum FSH, DHEAS, TSH and prolactin were similar for both groups (p > 0.05). As expected, mean (total) testosterone levels were notably different between PCOS vs. non-PCOS controls (0.84 ± 0.76 vs. 0.43 ± 0.38 ng/mL, respectively; p < 0.001), and mean AMH level was significantly lower in the oldest age category (> 35 yrs) compared to both younger control groups (p < 0.0001). Both DHEAS and total testosterone decreased with age among PCOS patients, although mean serum DHEAS for women age > 35 yrs was significantly lower than DHEAS measured in younger women with PCOS (p < 0.02). For PCOS patients, AMH remained relatively stable irrespective of age. Conclusion: Although AMH can serve as a satisfactory marker of ovarian reserve, for PCOS patients the expected decline in AMH associated with reproductive aging appears attenuated despite ovarian senescence. In contrast, mean DHEAS levels were markedly lower among older PCOS women (> 35 yrs) compared to younger PCOS patients.

Age related endocrine patterns observed in polycystic ovary syndrome patients vs. ovulatory controls: descriptive data from a university based infertility center

ABSTRACT Objective To compare serum anti-Müllerian hormone (AMH) and other endocrine parameters between patients diagnosed with polycystic ovary syndrome (PCOS) and age-matched ovulatory women. Materials and methods AMH, DHEAS, FSH, LH, PRL, TSH and total testosterone (TT) were prospectively measured in oligo-ovulatory PCOS patients (n = 595) and in ovulatory non-PCOS women (n = 157) referred to a tertiary infertility center. Mean BMI was similar across the two study populations and there were no smokers in the sample. Patients in both groups were further classified into three categories by age: < 25 yrs, 25-34 yrs, and ≥ 35 yrs. Selected clinical and demographic characteristics were tabulated for each group. Results Serum AMH was significantly higher among PCOS patients compared to non-PCOS controls in the non-stratified sample (7.54 ± 5.8 vs. 2.49 ± 2.0 ng/mL, respectively; p < 0.0001), while serum FSH, DHEAS, TSH and prolactin were similar for both groups (p > 0.05). As expected, mean (total) testosterone levels were notably different between PCOS vs. non-PCOS controls (0.84 ± 0.76 vs. 0.43 ± 0.38 ng/mL, respectively; p < 0.001), and mean AMH level was significantly lower in the oldest age category (> 35 yrs) compared to both younger control groups (p < 0.0001). Both DHEAS and total testosterone decreased with age among PCOS patients, although mean serum DHEAS for women age > 35 yrs was significantly lower than DHEAS measured in younger women with PCOS (p < 0.02). For PCOS patients, AMH remained relatively stable irrespective of age. Conclusion Although AMH can serve as a satisfactory marker of ovarian reserve, for PCOS patients the expected decline in AMH associated with reproductive aging appears attenuated despite ovarian senescence. In contrast, mean DHEAS levels were markedly lower among older PCOS women (> 35 yrs) compared to younger PCOS patients.

Association between serum concentrations of persistent organic pollutants and gestational diabetes mellitus in primiparous women.

BACKGROUND: There is growing evidence that persistent organic pollutants (POPs) may play an important role in increasing the risk of gestational diabetes mellitus (GDM). OBJECTIVES: The aim of this study was to examine the association between polychlorinated biphenyls (PCBs, 10 congeners) and polybrominated diphenyl ethers (PBDEs, 8 congeners) and GDM in primiparous women with no family history of diabetes in first-degree relatives during the third trimester of pregnancy. METHODS: This case-control study was performed among the three university hospitals of Tehran University of Medical Sciences. Serum samples were collected from cases (n=70) that were diagnosed with GDM and from controls (n=70) with a normal pregnancy that attended the same hospital for a routine prenatal visit. Pollutant levels were analyzed by Gas Chromatography Mass Spectrometry (GC/MS). RESULTS: Logistic regression analyses manifested the positive association between total POPs (sum of total PCBs and PBDEs) (Odds ratio (OR)=1.61, 95% CI: 1.31-1.97, p-value <0.0001) and total PCBs (OR=1.75, 95% CI: 1.35-2.27, p-value<0.0001) and GDM considering confounding variables (age, gestational age, pre-pregnancy body mass index (BMI), and total maternal serum lipid). In addition, we found a positive association between total PBDEs and GDM (OR =2.21; 95% CI: 1.48-3.30, p-value <0.0001). Finally, we found a positive association between Ln PCB 187, 118 and Ln PBDE 99, 28 with GDM. Meanwhile a negative association between Ln PCB 28 and GDM was established. CONCLUSION: Our data suggest that exposure to certain POPs (PCBs and PBDEs) could be a potential modifying risk factor for GDM.

Altered FoxO3 expression and apoptosis in granulosa cells of women with polycystic ovary syndrome.

PURPOSE: To determine the level of apoptosis, and alteration of FoxO3 (forkhead box O3 transcription factor) expression and phosphorylation in human granulosa cells amongst polycystic ovary syndrome (PCOS) patients and control group. METHODS: We recruited infertile women with PCOS (n = 14) and compared them with infertile women due to tubal blockage or male factor infertility (n = 14, controls). GnRH agonist and gonadotropins were used for ovarian stimulation. Follicular fluids from large follicles (>16 mm) were pooled and granulosa cells (GCs) were isolated using cell strainer methodology. Apoptosis of purified GCs was measured by flow cytometry using Annexin V and propidium iodide. Quantitative real-time PCR and western blotting were performed to assess alteration of FoxO3 expression and phosphorylation in GCs. RESULTS: There were higher percentages of early and late apoptosis in GCs of PCOS patients than in the control group. FoxO3 mRNA level and total FoxO3 protein were significantly higher in PCOS group than in the control group. The ratio of p-FoxO3/total FoxO3 decreased significantly in PCOS than in the control group. It was inferred that unphosphorylated (active form) FoxO3 was higher in GCs of PCOS patients. Apoptosis was significantly and positively correlated with the total FoxO3 and negatively correlated with the p-FoxO3 protein levels in PCOS patients. CONCLUSIONS: Activation and overexpression of FoxO3 in granulosa cells of PCOS women correlated with higher apoptosis levels in these cells suggesting that FoxO3 may be a candidate for the higher apoptosis in granulosa cells from women with PCOS.

Considering the prominent complaint as a guide in medical therapy for overactive bladder syndrome in women over 45 years.

AIM: The aim of this study was to evaluate the response of women over 45 years with overactive bladder and detrusor overactivity to a 12-week course of oxybutynin or tolterodine treatment. MATERIAL AND METHODS: A total of 301 eligible Iranian women were studied. In this double-blinded trial, data were analyzed from 3-day urinary diaries from before and after 12 weeks of treatment in which patients were randomly assigned to receive oxybutynin or tolterodine in recommended doses. Patients' convenience and the drugs' side-effects were assessed by a monthly clinical appointment. End-points were changed from baseline to week 12 in bladder-diary variables and all observed or reported adverse events. The effectiveness of each drug was studied using the paired t-test and improvement after treatment between the two groups was compared by independent t-test. RESULTS: Mean improvements in the terms of urgency (P = 0.64) and urge incontinence (P = 0.75) showed an insignificantly larger score in patients who were treated by oxybutynin. Improvement in night-time urinary urgency and nocturia (41.2% and 54.3% vs 39.7% and 40.1% in oxybutynin vs tolterodine groups, respectively) were shown to be more improved by tolterodine in comparison to oxybutynin (P = 0.72 and 0.04 for night-time urinary urgency and nocturia, respectively). Discontinuation of treatment due to adverse events was not significantly different in the two groups. CONCLUSIONS: Oxybutynin and tolterodine showed similar efficacy on daytime symptoms of overactive bladder and similar side-effects in perimenopausal patients. For patients with the chief complaint of nocturnal frequency, prescription of tolterodine is preferably suggested.

Ovarian stimulation for emergency fertility preservation in cancer patients: A case series study.

•We used Random-Start for the IVF cycle in urgent settings of gynecological cancer.•Oocytes can be obtained at any time before cancer treatment efficiently.•Oocyte maturity rates were comparable with conventional antagonist protocol.•Random-Start protocol is promising in emergency fertility preservation.

Effects of Chlamydia trachomatis Infection on Fertility; A Case-Control Study.

BACKGROUND: Nowadays, Chlamydia trachomatis is known as a causative agent of infertility. Because of, asymptomatic nature of infection, many may suffer from its lasting complications such as infertility. This study was performed in Tehran during April 2007 to April 2008 to compare the prevalence of Chlamydia trachomatis infection in fertile and infertile women using ELISA and PCR methods. METHODS: Overall, 234 infertile and 223 pregnant women, as the fertile group, participated in this hospital-based case-control study. After completing an informed consent form and the questionnaire, first catch urine and blood sample were obtained for PCR and ELISA (IgG, IgM) tests, respectively. Logistic regression analysis was used to control possible confounding factors, and determine adjusted odds ratio of infertility due to the infection. RESULTS: PCR results revealed that 29 (12.4%) of the infertile and 19 (8.5%) of the fertile women were positive for C. trachomatis infection (p = 0.440). IgG was positive in 21 (9.0%) of the infertile and 11 (5.0%) in the fertile group (p = 0.093). IgM assays identified that 2 (0.9%) of the infertile and 4 (1.8%) of the fertile women were positive for the micro-organism (p = 0.375). CONCLUSION: We found no significant differences among fertile and infertile women for Chlamydia trachomatis infection. Nevertheless, molecular techniques which are more sensitive, more specific and non-invasive can be used to detect C. trachomatis infection.

Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome.

BACKGROUND: Different mechanisms have been described for the effects of acupuncture on fertility. Acupuncture may mediate neurotransmitter release, which results in the stimulation of gonadotrophin-releasing hormone secretion. The production of neurotransmitters such as endogenous opioids may also inhibit central nervous system outflow and biological stress response. Acupuncture may also stimulate blood flow to the uterus by inhibiting uterine central sympathetic nerve activity. Despite some evidence suggesting beneficial effects of acupuncture on in vitro fertilisation (IVF) success rates, recent clinical trials could not duplicate these effects, especially in patients who are infertile with polycystic ovarian syndrome (PCOS) who are undergoing IVF. METHODS: A total of 62 women with PCOS undergoing IVF/intracytoplasmic sperm injection (ICSI) at Shayamehr IVF Clinic in Tehran (Iran) participated in a randomised, controlled trial. Participants were randomly allocated to one of two groups: there were 31 women each in the acupuncture (group I) and control groups (group II). Acupuncture based on traditional Chinese medicine was performed in group I versus no adjunctive treatment in group II. All acupuncture procedures were performed in five sessions: start of downregulation, start of stimulation, 2 days before ovum pick-up, and immediately before and after embryo transfer. We measured the rate of oocytes in metaphase II, the fertilisation rate and the quality of embryos. RESULTS: Our results showed a statistically higher mean of good quality embryos in group I compared with group II (p=0.044). However, the mean number of metaphase II oocytes retrieved and fertilisation rate were similar between the two groups. We also could not find any significant differences among clinical, biochemical or ongoing pregnancy rates. CONCLUSIONS: Acupuncture at an early stage of oocyte recruitment may have a beneficial effect on embryo quality. However, it seems to have no significant effect on other IVF/ICSI outcomes of women with PCOS. TRIAL REGISTRATION NUMBER: (IRCT ID: 201011275181N4).

Appropriateness of cesarean sections using the RAND Appropriateness Method criteria.

BACKGROUND: The aim of this study was to identify the appropriateness of cesarean sections, performed in Tehran hospitals using standardized Rand Appropriateness Method (RAM) criteria. METHODS: In this study we used the RAM criteria. In order to prepare the list of cesarean scenarios, clinical guidelines were selected, and the Appraisal of Guidelines for Research and Evaluation was used to choose the most appropriate. Two panels were held with the participation of related specialists. The scenarios derived through this method were compared with data existing in the medical records of 250 women who underwent cesarean sections in selected hospitals affiliated with Tehran University of Medical Sciences. The appropriateness rate of the cesarean sections was calculated. RESULTS: Out of 250 cases of cesarean sections performed, 91 (36.4%) were inappropriate, 41 (16.4%) were equivocal and 118 (47.2%) were considered to be appropriate. Appropriateness differed between public and private hospitals, which were statistically significant. CONCLUSION: This study shows that as with many other health services, cesarean section has many scenarios that there are different opinions about them and no decision about presenting these scenarios as yet. Moreover the result of study showed the rate of inappropriate cesarean sections in this study is one of the highest reported rates from different communities.

Comparison of in vitro fertilisation success in patients with polycystic ovary syndrome and tubal factor.

PURPOSE: This study is designed to compare the results of in vitro fertilisation (IVF) in polycystic ovary syndrome (PCOS) and tubal factor disorders. MATERIALS AND METHODS: This was a cohort study performed in Royan Institute from 2007 to 2009. For this evaluation, 183 patients with PCOS and 183 patients with tubal factor (control group), whose ages ranged from 22 to 35 years underwent the long protocol of pituitary suppression and were included in the study. RESULTS: In a defined time cycle, the number of ampoules used was higher for the control group (24.6 ± 0.9 versus 33.4 ± 0.9; p<0.0001). The PCOS group produced more oocytes (9.6 ± 0.5 versus 6.4 ± 0.3; p ≤ 0.0001) and embryos (3.7 ± 0.2 versus 2.7 ± 0.1; p=0.001). There were no significant differences in cancellation rate, the occurrence of ovarian hyperstimulation syndrome (OHSS) and cycles that resulted in lacked efficient follicle in the PCOS group and control group. Comparisons for biochemical pregnancy, implantation, clinical pregnancy and ongoing pregnancy rates showed no statistical difference. No significant differences were detected in miscarriage rates and complications. CONCLUSION: The outcome of IVF in patients with PCOS and in patients with tubal infertility is similar.

Comparing serum basal and follicular fluid levels of anti-Müllerian hormone as a predictor of in vitro fertilization outcomes in patients with and without polycystic ovary syndrome.

BACKGROUND AND OBJECTIVES: The prediction of in vitro fertilization (IVF) outcomes by anti-Müllerian hormone (AMH) measurement is getting increasing attention from clinicians. This study compares the relationship between serum or intrafollicular AMH levels and IVF outcomes in women with and without polycystic ovary syndrome (PCOS). METHODS: This prospective study was carried out in two university-based fertility clinics. Serum samples were collected on cycle day 3 and follicular fluid (FF) was collected on the day of oocyte retrieval from 26 women with PCOS and 42 normo-ovulatory controls. AMH levels were measured in the samples using immunoenzymatic assay. The relationship between serum or FF AMH levels and IVF outcomes, including number of oocytes retrieved, oocyte maturation rate, fertilization rate, implantation rate, high quality grade embryo rate, and biochemical and clinical pregnancy rates were further assessed. RESULTS: Median serum basal AMH and FF AMH levels were significantly higher in the PCOS group as compared to controls, the values being 14.2 ng/mL vs. 3.2 ng/mL (P<.001) and 8.2 ng/g protein vs. 4.7 ng/g protein (P<.01), respectively. In both groups, serum basal AMH levels showed a positive correlation with number of oocytes retrieved (r=0.323; P=.037 in control vs. r=0.529; P=.005 in PCOS). In the control group, there was a positive relationship between serum basal AMH levels and percentage of matured oocytes (r = 0.331; P=.032) and implantation rate (r=0.305; P=.05). CONCLUSION: Serum basal, and not intrafollicular, AMH levels may be a good predictive factor for quantitative and qualitative IVF outcomes in normo-ovulatory, but not in PCOS patients.

Developing criteria for cesarean section using the RAND appropriateness method.

BACKGROUND: Cesarean section rates are increasing worldwide, and a rapid increase has been observed in Iran. Disagreement exists between clinicians about when to use cesarean section. We aimed to identify the appropriateness criteria for the use of cesarean section in Iran. METHOD: A consensus development study using a modified version of the RAND Appropriateness Method (RAM). We generated scenarios from valid clinical guidelines and expert opinions. A panel of experts participated in consensus development: first round via mail (12 members), second round face-to-face (9 members). We followed the RAM recommendations for the development of the scenario lists, rating scales, and statistical analyses. RESULTS: 294 scenarios relevant to cesarean section were identified. 191 scenarios were considered appropriate, of which 125 scenarios were agreed upon. The panel found cesarean inappropriate for 21% of scenarios, and 'equivocal' for 14% of scenarios. CONCLUSION: RAM is useful for identifying stakeholder views in settings with limited resources. The participants' views on appropriateness of certain indications differed with available evidence. A large number of scenarios without agreement may partly explain why it has been difficult to curb the growth in cesarean section rate.