Evaluation of oocyte quality in Polycystic ovary syndrome patients undergoing ART cycles.

BACKGROUND: To evaluate factors affecting oocyte/embryo quality in PolyCystic Ovary Syndrome (PCOS) patients undergoing Assisted Reproductive Technology (ART) cycles. METHODS: This case-control retrospective study was performed on PCOS patients referred to the infertility department of Imam Khomeini Hospital in Ahvaz from October 2017 to September 2019. Demographic and reproductive characterizations including age, gender, abortion history and infertility type (primary and secondary infertility) were extracted from patient's records. TSH, AMH, LH, FSH, prolactin, lipid profile and blood glucose was measured. Biochemistry pregnancy was checked by determination of serum ßHCG level and then, clinical pregnancy was confirmed by observing of pregnancy sac and fetal heart rate using Transvaginal USS. RESULTS: One-hundred thirty-five patients include 45 PCOS and 90 Non-PCOS patients with mean age of 31.93 ± 5.04 and 30.8 ± 5.38 (p = 0.24) were considered as case and control groups respectively. Retrieved oocyte numbers were significantly higher in PCOS patients (p = 0.024), but there was no significant difference in number of oocyte subtypes (MI, MII and GV) between two groups. The embryo numbers and its subtypes did not differ significantly in both groups. The clinical pregnancy rate was insignificantly lower in PCOS patients (p = 0.066) and there was a significant correlation between retrieved oocyte numbers with age(r= -0.2, p= 0.022) and AMH level (r = 0.433, p < 0.0001) respectively. Cholesterol level had shown a positive significant correlation with number of MI oocytes (r = 0.421, p = 0.026) and MII oocytes significantly affected by age (r= -0.250, p = 0.004) and AMH level (r = 0.480, p < 0.0001). Using Receiver operation characteristic (ROC) curve analysis, the cut-off value of total number of oocytes was > 10.5 with area under curve of 0.619±0.054(sensitivity 55.56% and specificity 69.66%) CONCLUSIONS: The results of this study showed that although the number of oocytes in PCOS patients was significantly higher than non-PCOS patients, the quality of oocytes was not statistically different. The number and quality of embryos were not significantly different in both groups. Our results indicated a significant relationship between the level of AMH and the number of retrieved oocytes and embryos. We found there is a significant correlation between cholesterol level and number of MI oocytes.

Evaluation of Isolated Vascular Response to 5HT1A, 5HT1B1D & 5HT2A Receptors Agonist & Antagonist in Chronic Endotoxemic Rats.

The main vascular feature in endotoxemia is impaired contractile responses to vasoactive agents. We study the aortic response to 5HT11 A, 5HT1B1D and 5HT2A receptors agonist and antagonist in chronic endotoxemic rats. Intraperitoneal injection of 1 mg/kg lipopolysaccharide for 5 days induced chronic endotoxemia. Control rats received intraperitoneal injection of 1 ml/kg saline for 5 days. Rats divided into 3 groups. In first, DOI2 hydrochloride used as an agonist and sarpogrelate hydrochloride as an antagonist of 5HT2A receptor. In second, (R)-(+)-8-OH-DPAT3 and WAY1001354 used as an agonist and antagonist of 5HT1A receptor respectively. In third, Zolmitriptan used as an agonist and GR127935 hydrochloride as an antagonist of 5HT1B1D receptor. Aorta Isolated for organ bath study. Real time-PCR5 and histopathological study examined receptors gene expression and protein localization. Cumulative 8-OH-DPAT caused relaxation in control aorta (EC506 7.79±21.35 and 8.53±10.74 with and without antagonist), which was enhanced in endotoxemia (EC50 6.35±8.48 and very wide±17.38 with and without antagonist). Cumulative zolmitriptan caused relaxation in control aorta (EC50 very wide±8.65 and 8.38±8.44 with and without antagonist), which was enhanced in endotoxemia (EC50 very wide±9.53 and 8.37±13.49 with and without antagonist). DOI hydrochloride contracted the control aorta (EC50 6.51±7.14 and 5.98±1.65 with and without antagonist), which was converted to relaxation in endotoxemic group (EC50 infinity±80.43 and 7.37±20.28 with and without antagonist). PCR studies revealed enhanced 5HT1A receptor and diminished 5HT1B1D and 5HT2A receptor genes expression, while histopathological studies showed inflamed, damaged endothelium in endotoxemic aorta. Our data supports enhanced vasodilation and impaired vasoconstriction during endotoxemia.

Comparison of Metformin and Simvastatin Administration in Women With Polycystic Ovary Syndrome Before Intra-Cytoplasmic Sperm Injection Cycle: A Prospective, Randomized, Clinical Trial Study.

BACKGROUND: Drugs administration as a pretreatment regiment before ICSI cycle in PCOs patients could enhance the success rate. OBJECTIVES: The aim of this study was to compare the effectiveness of metformin with Simvastatin in patients with polycystic ovary syndrome (PCOs) candidates for intra-cytoplasmic sperm injection (ICSI) before starting the cycle. PATIENTS AND METHODS: In this prospective, double blind, randomized clinical trial the efficacy of these drugs was evaluated in 40 women with PCO syndrome (20 patients in each group; A: simvastatin and B: metformin) candidates for ICSI. In the both groups, metformin and simvastatin administrated for eight weeks before starting the ICSI cycle. Endocrine, metabolic and clinical parameters were measured before and after drug therapy; also, the results of ICSI cycle evaluated in the both groups. RESULTS: Both drugs improved hirsutism score significantly, but simvastatin better than metformin (Group A, 24.5 ± 3.6 P: 0.0001 VS Group B, 22.9 ± 5.9 P: 0.003). The reduction in body mass index (BMI) was not significant in the groups. Simvastatin reduced some biochemical parameters such as FSH, LH, testosterone, total cholesterol, LDL and increased HDL level significantly, whereas metformin decreased FSH, TG, testosterone and total cholesterol significantly. Overall, respectively 35% and 30% of patients treated with metformin and Simvastatin became pregnant. There was no significant difference between the effects of these two drugs on ICSI cycle results like oocyte in meiosis2 (M2) phase (1.35 ± 1.6 vs. 2 ± 3.87, P value: 0.4) and the number of Grade A, embryo (1.2 ± 1.3 vs. 1.1 ± 1.4, P value: 0.7). CONCLUSIONS: Simvastatin effectively improved hyperandrogenism signs and symptoms in patients with PCO, but this effect as a pretreatment regiment was not more expressive than metformin in ICSI cycle outcome.

The Long Term Effect of Elective Colpoperineoplasty on Sexual Function in the Reproductive Aged Women in Iran.

Objective. Many women are suffering from sexual dysfunction followed by vaginal laxity in their reproductive age. The aim of this study was to evaluate the long term effect of colpoperineoplasty on sexual function in Iranian reproductive aged women. Methods. This was a prospective observational study in which 79 women with vaginal laxity who were candidate for selective colpoperineoplasty in Jahrom, Iran, were recruited. Data on sexual function was collected via the Female Sexual Function (FSFI) questionnaire preoperatively, six months and 18 months after colpoperineoplasty. The paired t-test, Wilcoxon, Mann-Whitney, and Repeated Measure test were utilized for statistical purposes. Results. Seventy-six women completed the study by 18 months. The mean FSFI score changed from 24.19 ± 3.09 in baseline to 26.92 ± 3.41 after six months (P < 0.001); however dyspareunia and vaginal dryness were increased significantly. After 18 months all areas of sexual function including pain and lubrication improved significantly compared to the 6th month (P < 0.001). Sexual satisfaction was increased significantly six and 18 months after surgery (P < 0.001), and the total score of sexual function increased to 32.61 ± 1.32 after 18 months (P < 0.001). Conclusion. The long term effect of colpoperineoplasty in women who suffer from vaginal laxity is promising. It seems that patient's dissatisfaction of sexual function can be a basis for colpoperineoplasty.

The effect of gabapentin on intensity and duration of hot flashes in postmenopausal women: a randomized controlled trial.

BACKGROUND: Menopause is the stage of time in which the menstruation stops following the loss of ovarian activity. The purpose of this study was to find out the effectiveness of gabapentin on hot flashes in postmenopausal women. MATERIALS & METHODS: A randomized controlled trial from Feb 2010 to 2011 was conducted. Sixty postmenopausal women who were referred to obstetrics and gynecology ward of two educational hospitals were recruited and divided into two groups (intervention and control). Intervention group received 300 mg gabapentin three times a day for three months, while control group received placebo. The Intensity and duration of hot flashes in women scored and recorded using visual analog scale. Independent, Paired t-test and chi-square test were used for analyzing data. RESULTS: Intensity of hot flashes in the beginning of research in the intervention group was significantly different with the first, second and third follow-up visit (P<0.05). Also at the end of intervention a significant difference between intervention and control groups were observed regarding the intensity, frequency and duration of hot flashes (P<0.05 and P=0.01 respectively). CONCLUSION: According to the findings of this study; it appears that the use of gabapentin could decrease the intensity, duration and frequency of hot flashes in postmenopausal women. For postmenopausal women who hormone therapy is contraindicated, gabapentine could be an acceptable alternative.

Ambulatory monitoring of blood pressure and pregnancy outcome in pregnant women with white coat hypertension in the third trimester of pregnancy.

Introduction: If the blood pressure of a pregnant woman is ≥140/90 mmHg at the clinic, but her ambulatory blood pressure is less <135/85 mmHg at daytime and <125/75 at night and her average ambulatory in 24 hours is <130/80 mmHg, her high blood pressure at clinic is considered white coat hypertension. Objectives: To evaluate the value of ambulatory blood pressure monitoring in pregnant women. Patients and Methods: This prospective cohort study was conducted in Imam-Khomeini hospital of Ahwaz, Iran between 2011 to 2012. A total of 105 pregnant women who had blood pressure of higher than 140/90 mmHg during the third trimester of pregnancy were monitored. Thirty five women with white coat hypertension, 35 women with gestational hypertension and 35 women with normal blood pressure were followed. The data were analyzed using the Kolmogorov-Smirnov test, Pearson correlation coefficient and Chi-square tests. Results: The prevalence of white coat hypertension was 31.3%. The maternal and neonatal outcomes and laboratory examinations in white coat hypertension were similar to the normal blood pressure, but the frequency of caesarean section was more than the other two groups. Conclusion: The findings of the study indicate the efficacy of 24 hour holter monitoring of blood pressure and using it more comprehensively , compared to the limited visits.

Effect of hysteroscopy before intra uterine insemination on fertility in infertile couples.

Uterine disorders like usual infertility factors (male factor, ovarian and tubal problems of women) may affect the outcome of infertility treatment in infertile patients. In our clinical trial, 110 couples diagnosed with infertility were candidate for intra uterine insemination (IUI). The patients were divided randomly into two equal groups (n = 55): In group one (control group), patients without hysteroscopy underwent ovulation induction by clomiphene citrate and hCG followed by intrauterine insemination. The second group (experiment group), patients were undergoing hysteroscopy before intra uterine insemination on the day 21 of the cycle and due to abnormal findings, going under surgical treatment if they needed. The rates of pregnancy complications in patients were evaluated. The age, BMI, kind of infertility, duration of infertility, number of previous trial, duration of stimulation, the type of procedures used and semen analysis (TMC, Motility and morphology of sperm) were similar for both groups and no statistically significant differences emerged at all between them. In experimental group, hysteroscopy revealed pathology in the uterine cavity in 26 out of 55 cases. The overall rates of clinical pregnancy were higher in experimental group compared to the control group. The findings from this study showed that the use of hysteroscopy as a diagnostic or therapeutic procedure before IUI, can increase the rate of pregnancy and finally decrease the failure rate of infertility treatment and perinatal complications in infertile couples.

A case of nephrotic syndrome associated with hydatiform mole.

The present case study is on a 16-year-old woman who was suffering from nephrotic syndrome after recovery from complete type of hydatiform mole. She was admitted in hospital because of proteinurea and hematuria. Then she was showing a generalized edema compatible with neprhotic syndrome. In her past medical history she had a suction curettage for hydatiform mole. After she received 4 courses chemotherapy, she completely recovered and ßhCG has fallen from 12127 IU/L to under 10 IU/mL. Then she showed generalized edema, proteinurea and hematuria compatible with nephritic syndrome. After six courses chemotherapy the symptoms of nephrotic syndrome and invasive mole diminished, she released from hospital and scheduled for follow-up.