Efficacy of Dry Cupping versus Counselling with Mindfulness-based Cognitive Therapy Approach on Fertility Quality of Life and Conception Success in Infertile Women due to Polycystic Ovary Syndrome: A Pilot Randomized Clinical Trial.

Background: Physical and psychological interventions could affect the quality of life (QoL) of women with infertility. The purpose of this study was to compare the effectiveness of dry cupping and counselling with the mindfulness-based cognitive therapy (MBCT) approach on fertility QoL and conception success in infertile women due to polycystic ovary syndrome (PCOS). Methods: This was a two-arm pilot randomized clinical trial from first January 2021 to the end of November 2022. In this regard, 19 women with infertility who were referred to the health centers affiliated with Shiraz University of Medical Sciences and met the inclusion criteria were enrolled in the study. Participants were randomly divided into two groups (10 in the virtual MBCT group and 9 in the cupping group). All participants completed the fertility quality of life (FertiQol) tool before the intervention and three months after the end of the intervention. In addition, after the end of the intervention, a human chorionic gonadotropin test was performed monthly for three months, too. We used ANOVA/ANCOVA and its related effect sizes, including mean difference (MD) and standard mean difference (SMD: Hedges's g), and chi-square tests to compare the study group outcomes in Stata 14.2. P-values equal to or less than 0.10 were considered significant. Results: The intervention resulted in significant differences in the mean overall scores of FertiQol between the counseling and cupping groups (61.76±14.28 and 50.65±12.53, respectively) [P=0.091, MD=11.11 (90% CI: 0.33 to 21.89), SMD=1.07 (90% CI: 0.279 to 1.84)]. No significant difference was found in conception rates between the groups after the intervention. Conclusion: This pilot study found that MBCT improved the fertility QoL in PCOS-related infertility patients better than cupping therapy. Trial registration: IRCT201706110334452N1.

Safety of COVID-19 vaccination in pregnant women and their neonatal outcome: a narrative Review.

BACKGROUND: Even through the fact that pregnant women are more and more severely infected with COVID-19 disease, there are still doubts about vaccinating these people due to the lack of sufficient evidence base information. So in this systematic review, we decided to study vaccinated and unvaccinated pregnant women regarding maternal, fetal and neonatal complications and outcomes. THE STRATEGY OF SEARCHING: Between 30 December 2019 and 15 October 2021, electronic searches were performed on the databases of PubMed, Scopus, Google Scholar, and Cochrane library by searching in English and free full text. Keywords searched included these: maternal outcome, neonatal outcome, pregnancy, and COVID-19 vaccination. Among 451 articles, finally, seven studies were included to study pregnancy outcomes in vaccinated women compared to unvaccinated for systematic review purposes. RESULTS: In this study 30257 vaccinated women in their third trimester compared to 132339 unvaccinated women in terms of age, the root of delivery, neonatal adverse outcomes. There were no significant differences between two groups in terms of: IUFD, and 1 min Apgar score, C/S rate, and NICU admission between the two groups, however, the rate of SGA, IUFD, and also neonatal jaundice, asphyxia, and hypoglycemia was more significant in the unvaccinated group comparing to the vaccinated group as a result. Among them, the chance of preterm labor pain was reported more among vaccinated patients. Emphasizing that, except 7.3% of the case population, everyone in the second and third trimesters had been vaccinated with mRNA COVID-19 vaccines. CONCLUSION: COVID-19 vaccination during the second and third trimesters appears to be the right choice due to the immediate impact of COVID-19 antibodies on the developing fetus and formation of neonatal prophylaxis, as well as the absence of adverse outcomes for both the fetus and mothers.

Intimate partner violence during pregnancy in COVID-19 pandemic: a cross-sectional study from South-west of Iran.

BACKGROUND: Intimate partner violence (IPV) against pregnant women can cause several complications for the mother and her baby, which are life-threatening. Thus, we aimed to find the prevalence of IPV and its associated factors in pregnant women in Shiraz, Iran. METHODS: This cross-sectional study was conducted among pregnant mothers in Shiraz between July 2020 and January 2021. The questionnaire consisted of four parts: demographic data, socio-economic status (SES), obstetric and medical history, and questions about IPV. Univariate analysis was performed using Chi-square, McNemar, or Fisher's exact test, and variables with p-value < 0.20 were included in Logistic regression. The odds ratio and CI 95% for variables with p-value < 0.05 were considered statistically significant. RESULTS: The overall prevalence of IPV was 93.1% among 830 pregnant women in Shiraz. Psychological violence was the most prevalent type (92.9%), followed by sexual (11%) and physical (7.7%) violence. High SES (OR = 3.21, (CI:1.61-6.41)) was the only risk factor for overall violence, and the age group, 30-34, was a risk factor for physical violence. Mother-desired pregnancy (OR = 26 (Cl:0.09-0.79)) and father-desired pregnancy (OR = 0.91, (CI:0.22-3.80)) were protective factors against physical and sexual violence, respectively. Furthermore, Psychological violence and sexual violence increased during COVID-19 Pandemic (P.value < 0.05). CONCLUSION: According to the obtained results, the prevalence of IPV during pregnancy in Shiraz was very concerning, especially psychological violence. Improving conflict-solving skills among family members and addressing economic problems could be considered by health policymakers when designing interventional programs and policies to reduce IPV during pregnancy.

Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy.

BACKGROUND: Ectopic pregnancy is one of the leading causes of pregnancy-related mortality; the treatment strategies associated with this condition entail complications, such as recurrence of ectopic pregnancy or infertility. The objective of this study was to evaluate the recurrence and fertility rate after salpingostomy in patients with tubal ectopic pregnancy. METHODS: This cross-sectional retrospective study was conducted at four referral centers of Obstetrics and Gynecology, under the supervision of Shiraz University of Medical Sciences (Iran). The medical records of 125 patients with tubal pregnancy were reviewed. These patients underwent laparoscopic salpingostomy from April 2009 to March 2016.Data on maternal age, BMI, history of previous EP, genital tract infection, IUD insertion, history of previous surgery, and infertility were further obtained. The patients were followed up for approximately 1 to 7 years. The recurrence of EP and subsequent pregnancy rate were assessed during the follow-up period. RESULTS: There was no statistically significant relationship between post-salpingostomy recurrence and maternal age, previous abdominopelvic surgery, and history of infertility(P = .425); however, the post-salpingostomy recurrence of EP was correlated with BMI (P = 0.001), previous history of EP (P = 0.001), genital tract infection (P = 0.001), and IUD insertion (P = 003). Among 95 women who had no contraception, pregnancy occurred in 51 cases (53.6%) and recurrence of EP was observed in 16 patients (12.8%). CONCLUSIONS: Our results suggest that salpingostomy is a safe method with a low risk of recurrence and good fertility outcomes for women who consider future pregnancy.

The effect of endocervical and catheter bacterial colonisation during in vitro fertilisation and embryo transfer (IVF-ET) on IVF success rate among asymptomatic women: a longitudinal prospective study.

The adverse effects of bacterial contamination during in vitro fertilisation and embryo transfer (IVF-ET) have been studied previously. However, data on asymptomatic women with positive bacterial culture and their IVF outcome are lacking. This prospective longitudinal study was conducted on 74 women undergoing IVF-ET, of whom specimens from the endocervix and ET catheter were taken and sent to a laboratory for microbiological assessment. Then, patients were followed up for evaluation of chemical pregnancy (ß-HCG > 25 mIU/mL) and clinical pregnancy (detected foetal heartbeat). The findings revealed that there was no significant difference in terms of biochemical (35.4% vs. 19.2%, p= .116) and clinical pregnancy rate (25.0% vs. 15.4%, p= .257) among ET catheter culture positive and negative women. This finding allows us to conclude that the positive culture in the absence of clinical signs of infection may not increase the risk of implantation failure.Impact StatementWhat is already known on this subject? There is growing evidence indicating that endometritis may decrease the endometrial receptiveness in in vitro fertilisation (IVF) cycles; however, there is a paucity of knowledge regarding IVF outcomes when the bacterial culture of embryo transfer (ET) catheter is positive.What the results of this study add? The present study demonstrates that positive ET catheter culture in asymptomatic women does not increase the risk of IVF failure.What the implications are of these findings for clinical practice and/or further research? Positive-culture, per se, may not be associated with poor IVF outcomes and further studies should be undertaken on this topic in various clinical settings using different protocols.

Term Spontaneous Heterotopic Pregnancy (Abdominal and Intrauterine): A Case Report.

Spontaneous heterotopic pregnancy is a potentially life-threatening condition rarely considered when a patient with an intrauterine pregnancy is asymptomatic or presents with complaints such as abdominal pain. An advanced abdominal pregnancy is even more unusual as the form of the ectopic component outside the context of assisted reproduction and is difficult in diagnosis with very few cases reported in the literature. We report such a case in a 31-year-old primigravida with heterotopic pregnancy which is a fetus in the uterine cavity and the other in the abdominal cavity. Her pregnancy was initially misdiagnosed and managed as a di-amniotic di-chorionic gestation. The correct diagnosis was only made after term delivery of the intrauterine pregnancy. The patient was complicated with severe bleeding which led to disseminated intravascular coagulopathy and massive transfusion. Two other operations were imposed on the patient because of bleeding. The clinical risk factor for ectopic pregnancy was only previous pelvic inflammatory disease in this woman.

Assisted reproductive technique outcomes in patients with endometrioma undergoing sclerotherapy vs laparoscopic cystectomy: Prospective cross-sectional study.

PURPOSE: The authors compared assisted reproductive technique (ART) outcomes and the recurrence rate of endometrioma in the infertile patients undergoing sclerotherapy vs laparoscopic ovarian cystectomy. METHODS: In this prospective cross-sectional study, a total of 101 infertile patients, with unilateral endometriomas, were divided into two groups. The first group (n = 57) underwent ART after 1 year of unsuccessful spontaneous pregnancy after laparoscopic ovarian cystectomy; the second group (n = 44) had ethanol sclerotherapy (EST) at the time of oocyte retrieval. The authors measured the number of oocytes, clinical pregnancy rate (CPR), live birth rate (LBR), complication, and recurrence of endometriomas as the primary and secondary outcomes. RESULTS: The two groups had no significant differences in baseline characteristics and ovarian stimulation markers and also total number of oocytes. 42.1% and 34.1% of the patients (n = 24 and 15) had clinical pregnancy, and 38.6% and 29.5% (n = 22 and 13) had live birth following ART cycles in the surgery group and sclerotherapy group (P = .41, 0.34). The recurrence rates were 14.0% and 34.1% in the surgery and sclerotherapy groups (P = .017, X 2 = 5.67). CONCLUSIONS: Ethanol sclerotherapy can be a good alternative to surgery concerning the treatment of endometrioma; however, the recurrence of the disease in this group is significantly higher.

Comparing four different methods for the management of ectopic pregnancy: A cross-sectional study.

Background: Ectopic pregnancy (EP) is one of the major causes of maternal mortality during the first trimester of pregnancy. Objective: Four treatment methods for EP including single-dose methotrexate (SD-MTX), double-dose methotrexate, expectant and surgical management were considered. Materials and Methods: In this cross-sectional study, the clinical characteristics of 365 women aged 15-44 yr who had been diagnosed with EP were reviewed from March 2017 to March 2019 in hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Receiver operating characteristics curves were plotted to determine the cut-off points for size of ectopic mass and beta-human chorionic gonadotropin (ß-hCG) that suitably discriminated between double-dose methotrexate and surgery management. Results: The most common site of EP was adnexa. According to the receiver operating characteristics analysis, surgery was the best plan for the women with an ectopic mass > 34.50 mm in diameter or with an initial ß-hCG level > 6419 mIU/ml. The ß-hCG levels in the women successfully treated with SD-MTX were significantly lower than in those with failed treatment (p = 0.02). The SD-MTX group had a higher success rate and significantly shorter duration of hospitalization, and so this was a more effective medical treatment in comparison with the double-dose protocol. Conclusion: Surgery is proposed as the best option for the cases with large ectopic mass or high ß-hCG level. SD-MTX had a higher success rate and shorter hospital stay than the double-dose protocol, and so was found to be an efficient and safe alternative. Further randomized clinical trials with larger sample sizes are recommended to validate the current results.

Women with Autoimmune Thyroiditis have Lower Reproductive Life Span or Not? A Cross- Sectional Study.

BACKGROUND: Autoimmune diseases are a main cause of primary ovarian insufficiency. This study was designed to elucidate the relationship between ovarian reserve and anti-thyroid peroxidase antibodies in women of different ages. METHODS: 98 women in a cross-sectional study was conducted at the infertility Center of Shiraz University of Medical Sciences, Hazrate Zeinab Hospital, from September 2018 to March 2019. Women with infertility and thyroid-stimulating hormone (TSH) > 3mIU/L were included in the study with convenience sampling. Data were collected by a form containing demographic characteristics, thyroid hormones, and ovarian reserve data. Participants were categorized based on the negative or positive anti-thyroid peroxidase (anti-TPO) antibodies. According to a pilot sample, and possible dropout of 20%, the sample size was determined to be 49 cases in each group. The results were compared between groups using SPSS, version 22. All statistical comparisons were performed using the t-test, and the data are presented as the mean±SD. P-values less than 0.05 were considered significant. RESULTS: 49 women were analyzed in each group. There was no significant difference between the groups in the mean age (P=0.42), body mass index (BMI) (P=0.34), duration of infertility (P=0.99), mean prolactin (P=0.66), TSH (P=0.17), thyroxine (T4) (P=0.87) and follicle-stimulating hormone (FSH) levels (P=0.14). Ovarian reserve characteristics: antral follicular count (AFC) and anti-Müllerian hormone (AMH) levels in anti-TPO positive group were 10.61±7.29 and 1.98±2.38, respectively, and AFC and AMH in anti- TPO negative group were 16.46±6.38 and 2.94±2.22, respectively. There were significant differences between the two groups on AFC (P <0.001) and AMH (P=0.04). CONCLUSION: Patients with autoimmune thyroiditis were at higher risk for decreased ovarian reserve. They should consider their lower reproductive life span during their childbearing years.

Gonadotropin-Resistant Ovary Syndrome Presented with Secondary Amenorrhea and Infertility: A Case Report.

Resistant ovary syndrome (ROS) is a presentation of hypergonadotrophic hypogonadism condition with very low incidence. Infertility is one of the most common complaints of women with this syndrome. We herein present a case of a 27-year-old woman with all features of secondary amenorrhea and secondary sexual characteristics. In 2018, the patient was referred to the Hazret-e-Zeinab Infertility Center affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. She was diagnosed with secondary amenorrhea and increased gonadotropin secretion after menopause. However, the patient had a normal antral follicle count, anti-Müllerian hormone level, 46, XX karyotype, and thyroid function. After taking oral contraceptives her menstruation started, but she showed no response to high doses of exogenous gonadotropins. She was advised to have an embryo derived from in vitro maturation. By using patients' own oocyte maturation, this technique could be a better treatment for infertile women with ROS. This case report is particularly interesting due to the rarity of its prevalence and similarity with primary ovarian insufficiency.

Complex Twisted Knots of Umbilical Cord in a Monochorionic-Diamniotic Twin Gestation: A Case Report.

BACKGROUND: True knots and tight loops of umbilical cord can cause serious fetal complications in monochorionic-monoamniotic twins but are usually unexpected in Monochorionic-diamniotic twins because of the presence of the intertwin membrane. This report presents a case of monochorionic-diamniotic twin gestation with a complex cord knots. CASE REPORT: A 31-year-old G2Ab1 with monochorionic-diamniotic twin pregnancy in the gestational age of 30 weeks presented with ruptured membrane since 3weeks before delivery. At the delivery time, multiple umbilical cord knots was found. CONCLUSION: Premature ruptured membrane can cause septostomy of the intertwin membrane, multiple umbilical cord knots and its complications. Therefore, these cases should be considered for evaluation of the presence of intertwin membrane and umbilical cord knots in each sonography examination.

Frozen embryo transfer: Endometrial preparation by letrozole versus hormone replacement cycle: A randomized clinical trial.

BACKGROUND: The endometrial preparation with stimulating natural cycles for frozen embryo transfer (FET) have benefits like lower cost and ease of use. OBJECTIVE: Comparing the clinical outcome of letrozole versus hormone replacement (HR) for endometrial preparation in women with normal menstrual cycles for FET in artificial reproduction techniques. MATERIALS AND METHODS: A total of 167 participants who had frozen embryos and regular ovulatory cycles were randomly divided into two groups for endometrial preparation. One group (82 women) was stimulated with letrozole 5mg/day and the other group (85 women) was hormonally stimulated by oral estradiol valerate (2 mg three times a day). All participants were followed serially by ultrasonography. Any patient who did not reach optimal endometrial thickness was excluded from the study. Implantation, biochemical and clinical pregnancy and abortion rate were reported. RESULTS: There was no significant difference in the mean age, duration, and primary or secondary infertility, cause of the infertility, number, and quality of transferred embryos between the groups. The mean estradiol level on the day of transfer was 643 ± 217 in the HR group and 547 ± 212 in the letrozole group (P = 0.01), which was significantly different. The clinical pregnancy rate was 38.7 in the letrozole group, higher than the HR group (25.3) but not significantly different (P = 0.06). CONCLUSION: For endometrial preparation in women with a normal cycle, letrozole yields higher pregnancy rate although it is not significant; due to its cost, ease in use, and lower side effects, letrozole is a good choice.