Corrigendum to "The effect of intrauterine human chorionic gonadotropin injection before embryo transfer on the implantation and pregnancy rate in infertile patients: A randomized clinical trial" [Int J Reprod BioMed 2016; 14: 657-664].

[This corrects the article on p. 657 in vol. 14.].

Comparing the pregnancy outcomes of cleavage and blastocyst stage in frozen embryo transfer cycles: A cross-sectional study.

Background: In vitro fertilization has advanced in many ways, and new techniques are challenging. Blastocyst transfer is an alternative method for embryo transfer (ET) to improve in vitro fertilization outcomes. Objective: The present study was performed to determine the effect of pregnancies resulting from ET in the blastocyst stage compared to the cleavage stage in frozen cycles to select a better method of assisted reproduction. Materials and Methods: This cross-sectional study was conducted on 194 women who referred to the Yazd Reproductive Sciences Institute, Yazd, Iran, between April 2019 and December 2020. They had a frozen ET as either cleavage or blastocyst (n = 97/each group). The study compared the pregnancy and fetal outcomes in the 2 groups of ET at the cleavage and blastocyst stages. Results: The results showed that the blastocyst stage group had higher levels of anti-Mullerian hormone, ovule number, 2 pronuclear number, and embryo number than the cleavage stage group. The frequency of chemical pregnancies was 52.6% and 36.1% in blastocyst and cleavage group respectively (p = 0.02). Also, the frequency of clinical pregnancies was 41.2% and 22.7% in blastocyst and cleavage group respectively (p < 0.001). No statistically significant difference was observed between 2 groups in abortion, preterm delivery, multiple births, preterm premature rupture of membranes, gestational diabetes and preeclampsia, ectopic pregnancy, neonatal hospitalization in Neonatal Intensive Care Unit, and fetal abnormalities (p > 0.05). Conclusion: The results showed that transmission in the blastocyst stage compared to the cleavage stage is associated with an increase in chemical and clinical pregnancy, while other pregnancy outcomes are the same in both groups.

Representation of a `positive experience' of surrogacy in Yazd, Iran: A qualitative study.

Background: The social and cultural challenges facing surrogate mothers have been explored in several studies. However, few studies have discussed the motivations of surrogate mothers, their expressions and interpretations of their lived experiences, and their feelings of personal and spiritual satisfaction. Objective: This study aims to present the positive experiences of surrogate mothers from a phenomenological perspective. Materials and Methods: Using a phenomenological approach, this study was conducted from September 2020 to January 2021 in the city of Yazd, Iran. Participant observation and semi-structured interviews were used to collect the data among 12 participants with at least 1 experience of surrogate motherhood. Results: Our findings showed that, despite having had harsh physical and socio-cultural experiences such as fear of social labeling and stigma, participants felt a kind of inner satisfaction and a positive view of their actions. A core theme found in the study was mothers' satisfaction. The main categories included feminine self-sacrifice and positive rewards. Feminine self-sacrifice included 2 sub-categories: creating happiness and conveying motherly feelings, while positive rewards included good childbirth, family acceptance, and halal income. Conclusion: This study showed that surrogate mothers experience conflicting feelings of inner satisfaction and social stigma during surrogacy. Some of those interviewed were willing to go through surrogacy again, but they feared social labeling and stigma, being misunderstood by others who are not fully informed about surrogacy, and being subjected to family and social disapproval.

Corrigendum to "Efficacy of 17 α- hydroxy progestrone on decreasing preterm labor in ART pregnancies: A randomized clinical trial" [Iran J Reprod Med 2013; 11: 785-790].

[This corrects the article on p. 785 in vol. 11 PMCPMC3941339.].

Maternal and neonatal outcomes among pregnant women with different polycystic ovary syndrome phenotypes: A cross-sectional study.

BACKGROUND: Pregnancy is a process associated with various metabolic and hormonal changes, and polycystic ovary syndrome (PCOS) can affect this process. OBJECTIVE: This study aimed to evaluate and compare the maternal and neonatal outcomes among pregnant women with different polycystic ovary syndrome phenotypes. MATERIALS AND METHODS: In this cross-sectional study, 200 pregnant women with PCOS according to the 2003 ESHRE/ASRM criteria were categorized into four phenotype groups (A-D). The maternal outcomes include gestational diabetes mellitus, pregnancy-induced hypertension, premature rupture of membranes, preterm labor, small-for-gestational age birth, intrauterine growth restriction, intrauterine mortality, preeclampsia, abortion, amniotic fluid disorders, delivery method, and cause of cesarean section were studied between groups. Additionally, neonatal outcomes such as neonatal weight, neonatal recovery, 5-min Apgar score, neonatal icter, the need for NICU admission, the cause of hospitalization, and infant mortality rate were investigated and compared among the groups. RESULTS: According to the results, phenotype D (37%) was the most common phenotype among the participants. The risk of gestational diabetes was more common in phenotype A than in the other phenotypes, whereas pregnancy-induced hypertension was most common in phenotype B. No significant differences were observed in the neonatal complications among the PCOS phenotypes. CONCLUSION: Considering the higher risk of gestational diabetes mellitus and pregnancy-induced hypertension in PCOS phenotypes A and B, women with these phenotypes need more precise prenatal care.

Relationship between MspI polymorphism of CYP1A1 gene and the risk of endometriosis in an Iranian population: A case-control study.

BACKGROUND: Endometriosis is a disease that affects women of reproductive age. This disease is characterized by the presence of endometrial-like tissues (endometrial or stromal glands) outside the uterus and shows significantly elevated prevalence in industrial regions. Additionally, an interaction between genetics and environmental factors is assumed for the disease. Enzymes belonging to the cytochrome P450 (CYP) family are participated in detoxification process of a wide range of environmental toxins and carcinogens. Thereby, they are good link for the interaction. CYP1A1 which belong to cytochrome P450 (CYPs) superfamily, is a very important gene for the metabolism of carcinogens. OBJECTIVE: The aim of this study was to analyze the frequency of the MspI polymorphism of CYP1A1 gene and its relation to endometriosis. MATERIALS AND METHODS: Genomic DNA was isolated from 93 endometriosis women and 139 healthy controls. Genotyping was performed using polymerase chain reaction followed by restriction fragment length polymorphism analysis. RESULTS: Frequencies of the TT, TC, and CC genotype of CYP1A1 gene polymorphism in patients were 73.1%, 22.6%, and 4.3%, while frequencies in controls were 74.1%, 22.3%, and 3.6%, respectively. So there was no significant differences between the genotypes in two groups (p=0.961). CONCLUSION: According to our study, MspI polymorphism of CYP1A1 gene appears to be not associated with the risk of endometriosis in the studied population. However, additional studies, especially with larger sample size are needed to validate these findings.

The prevalence of infertility in 20-49 years women in Yazd, 2014-2015: A cross-sectional study.

BACKGROUND: Infertility is a serious health problem that affects the individual, her/his family, and the community. Infertility is defined as failure to achieve clinical pregnancy after at least 12 months of unprotected coitus. OBJECTIVE: The purpose of this study was to investigate the prevalence of primary and secondary infertility and the associated factors in Yazd Greater Area during 2014-2015. MATERIALS AND METHODS: This is a cross-sectional analytic study using Yazd Health Study data which was conducted on 10,000 people. We studied 2611 women between 20-49 yr old who lived in Yazd Greater Area. Data were collected using a validated questionnaire. Anthropometrics were collected using standardized instruments. RESULTS: Among women participating in the study, 135 cases of infertility were documented and the overall prevalence of infertility was 4.73% (95% CI: 3.94%-5.59%), among them 2.6% (95% CI: 2.4-3.8%) had primary and 2.1% (95% CI: 1.8-3.4%) had secondary infertility. In this study, infertility was significantly correlated with age (r=0.051, p=0.032), educational level (r=-0.41, p=0.001), body mass index (r=-0.012, p=0.018), waist circumference (r=0.027, p=0.022), history of abortion (r=0.099, p=0.026), and family history of infertility (r=0.121, p=0.001). CONCLUSION: The results of our study showed that the prevalence of infertility among women living in Yazd was lower compared to the other regions in Iran. Female factors were the main cause of infertility in central part of Iran.

The effects of different types of media on in vitro maturation outcomes of human germinal vesicle oocytes retrieved in intracytoplasmic sperm injection cycles.

OBJECTIVE: Optimizing in vitro maturation (IVM) media to achieve better outcomes has been a matter of interest in recent years. The aim of this prospective clinical trial was to investigate the effects of different media on the IVM outcomes of immature oocytes at the germinal vesicle (GV) stage. METHODS: A total of 400 immature oocytes at the GV stage with normal morphology were retrieved from 320 infertile women aged 31±4.63 years during stimulated intracytoplasmic sperm injection (ICSI) cycles. They were divided into groups of homemade IVM medium (I, n=100), cleavage medium (II, n=100), blastocyst medium (III, n=100), and Sage IVM medium (IV, n=100) and cultured for 24 to 48 hours at 37℃. ICSI was performed, and the rates of fertilization and embryo formation were compared across the four groups. RESULTS: In the 400 retrieved GV oocytes, the total maturation rates showed significant differences in groups I to IV (55%, 53%, 78%, and 68%, respectively, p<0.001). However, there were no significant differences in the fertilization, embryo formation, or arrest rates of metaphase II oocytes across these groups. In all groups, GV maturation was mostly completed after 24 hours, with fewer oocytes requiring 48 hours to mature (p<0.01). Moreover, the rate of high-quality embryos was higher in group IV than in the other groups (p=0.01). CONCLUSION: The quality of the IVM medium was found to affect clinical IVM outcomes. Additionally, blastocyst medium may be a good choice in IVM/ICSI cycles as an alternative IVM medium.

Frequency of chromosomal aneuploidy in high quality embryos from young couples using preimplantation genetic screening.

BACKGROUND: Selection of the best embryo for transfer is very important in assisted reproductive technology (ART). Using morphological assessment for this selection demonstrated that the correlation between embryo morphology and implantation potential is relatively weak. On the other hand, aneuploidy is a key genetic factor that can influence human reproductive success in ART. OBJECTIVE: The aim of this lab trial study was to evaluate the incidence of aneuploidies in five chromosomes in the morphologically high-quality embryos from young patients undergoing ART for sex selection. MATERIALS AND METHODS: A total of 97 high quality embryos from 23 women at the age of 37or younger years that had previously undergone preimplantation genetic screening for sex selection were included in this study. After washing, the slides of blastomeres from embryos of patients were reanalyzed by fluorescence in-situ hybridization for chromosomes 13, 18 and 21. RESULTS: There was a significant rate of aneuploidy determination in the embryos using preimplantation genetic screening for both sex and three evaluated autosomal chromosomes compared to preimplantation genetic screening for only sex chromosomes (62.9% vs. 24.7%, p=0.000). The most frequent detected chromosomal aneuploidy was trisomy or monosomy of chromosome 13. CONCLUSION: There is considerable numbers of chromosomal abnormalities in embryos generated in vitro which cause in vitro fertilization failure and it seems that morphological characterization of embryos is not a suitable method for choosing the embryos without these abnormalities.

Association of -460C/T and +405 G/C polymorphisms of vascular endothelial growth factor gene and susceptibility to ovarian hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is one of the most important complications of assisted reproduction treatment. Many substances are involved in the regulation of the vascular permeability, which have been concerned to cause OHSS. Vascular endothelial growth factor (VEGF) has emerged as one of the main angiogenic factors, which could be responsible for increased vascular permeability. OBJECTIVE: In this study the association of vascular endothelial growth factor -460C/T and +405 G/C polymorphisms and susceptibility to ovarian hyperstimulation syndrome was evaluated. MATERIALS AND METHODS: In this cross sectional study, VEGF gene polymorphisms were amplified by Polymerase chain reaction- Restriction Fragment Length Polymorphism in 75 women with established OHSS (case group) and 85 normoresponder (control group) which received conventional ovarian stimulation regimen. RESULTS: There was no significant difference in the frequency of -460 C/T polymorphism between cases and controls (p=0.85). The frequency of +405 G/C polymorphism was significantly higher in the OHSS women (p=0.03, OR=2.44; 95% CI=1.23-4.82). CONCLUSION: In women who developed OHSS, VEGF gene polymorphism +405 could be effective. Two of the polymorphisms -460 C/T and +405 G/C were reported to be associated with increased VEGF basal promoter activity. However, only +405 G/C gene polymorphisms were more frequent in cases than controls.

Lack of Association between Cu T-380A Intrauterine Device and Secondary Infertility in Iran.

BACKGROUND: The appropriate choice of a contraceptive method has been a major issue in reproductive health research. Cu T intrauterine device (Cu T IUD) has been introduced as one of the most effective contraceptive methods in the world, however, the relationship between prior use of Cu T IUD and secondary infertility has not been evaluated in Iran. To examine the association of Cu T-380A IUD and secondary infertility in Iran. MATERIALS AND METHODS: A retrospective cohort study was conducted from December 2010 to September 2011 in the Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. A total of 750 married women (15-49 years old) with at least one parity, whom were referred to four educational healthcare centers of Shahid Sadoughi University of Medical Sciences, were selected as participants. They were divided into two groups (case and control) based on previous history of using Cu T-380A IUD. Data were gathered using a standard reliable questionnaire along with a face-to-face interview and were analyzed with descriptive and analytical (χ²) tests. RESULTS: Mean period of Cu T-380A IUD usage in the case group was 57.46 ± 47.74 months and mean time length from Cu T-380A IUD removal to pregnancy was 14.87 ± 5.18 months in this group. We observed no relationship between the use of Cu T-380A IUD and frequency of secondary infertility (3.5% in the case group versus 2.7% in the control group, P=0.52). CONCLUSION: Given the relatively large sample size studied here, it is unlikely that Cu T-380A IUD results in secondary infertility and may be used by Iranian women as a safe contraceptive method.

The effect of intrauterine human chorionic gonadotropin injection before embryo transfer on the implantation and pregnancy rate in infertile patients: A randomized clinical trial.

BACKGROUND: Implantation is one of the essential steps for the success of assisted reproductive techniques (ART). Their success depends on three main factors: embryo quality, endometrial receptivity (ER), and synchrony between embryo and endometrium. There are various factors that regulate the complex process of implantation. In this regard, one may refer to human chorionic gonadotropin (hCG) as the most important factor. OBJECTIVE: This study aims to investigate the effect of intrauterine hCG injection before embryo transfer (ET) on pregnancy outcome in infertile couples. MATERIALS AND METHODS: A total of 159 patients undergone In vitro Fertilization/ Intracytoplasmic Sperm Injection (IVF/ICSI) with an antagonist protocol were evaluated. Patients were divided into three groups (n=53). Group 1 received 500 IU of hCG, group 2 received 1000 IU of hCG intrauterine injection before ET, and the control group underwent ET without hCG preceding intrauterine injection. RESULTS: There was no significant difference among the groups. The implantation rates were 18.86%, 13.52%, and 14.37%, chemical pregnancy rates were 34%, 32.1%, and 35.3%, and clinical pregnancy rates were 34%, 32.1%, and 31.4% respectively. CONCLUSION: The pregnancy outcome in IVF/ICSI /ET cycles cannot be improved through hCG intrauterine injections before ET.

Effect of Omega-3 Supplementation on Visfatin, Adiponectin, and Anthropometric Indices in Women with Polycystic Ovarian Syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a multifactorial, metabolic disorder. Characteristics are chronic anovulation, polycystic ovaries and hyperandrogenism. The aim of this study was to determine the effect of omega-3 supplementation on visfatin, adiponectin, and anthropometric indices in PCOS women. METHODS: The study was a randomized double blind placebo-controlled clinical trial. It was conducted on 84 women with polycystic ovary syndrome (26.92±5.05 years, BMI=31.69 Kg/m (2)) who referred to the fertility and infertility research center and Shahid Sadoughi hospital in Yazd. After the examination, evaluation and para-medical assessment by obstetrician, they were recruited. They took 3 capsules of omega-3 (each one contained 180 mg EPA and 120 mg DHA) or placebo (each contained 1 g paraffin) daily for 8 weeks. Statistical analysis was paired T-test and student T-test, and a p<0.05 was considered statistically significant. RESULTS: After the intervention, visfatin concentration did not change in neither groups. But, at the end of the study, the mean of adiponectin concentration increased (p<0.001) in omega-3 group. Moreover, the mean of changes in this factor was significantly different between groups (p<0.005). FSH did not change in two groups of the study. However, the mean of LH decreased about 1.74 mlU/ml in omega-3 group (p<0.005). The mean of change of LH/FSH ratio between groups was significant (p<0.05). After the intervention, prolactin did not meaningfully change in both groups. CONCLUSION: Our results showed that 8 weeks of supplementation of omega-3 may have some beneficial effects on PCOS biochemical characteristics such as LH, LH/FSH, and adiponectin.

Results from adding recombinant LH for assisted reproductive technology treatment: A randomized control trial.

BACKGROUND: Based on classical two-cell, two-gonadotropin theory, in the follicle, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) put on their main effects on the granulosa and theca cells. LH is essential for androgens production. Androgens are used for estradiol production by granulosa cells. Profound suppression of LH concentrations in some normogonadotropic patients can cause several adverse effects. OBJECTIVE: The main clinical purpose of this study was that normoresponder women treated with controlled ovarian super ovulation for IVF or ICSI may benefit from co-administration of rLH. MATERIALS AND METHODS: 40 patients who were candidates for assisted reproductive technology (ART) were randomly selected. In all patients long luteal protocol was used for ovulation induction. Patients were randomly divided into two groups: Group 1 (n=20) with standard long protocol (GnRH agonist) and r-FSH alone, Group 2 (n=20) with standard long protocol (GnRH agonist) and r-FSH with r-LH. RESULTS were statistically analyzed and compared in two groups. RESULTS: The number of retrieved oocytes, mature oocytes, cleaved embryos, transferred embryos, estradiol levels in Human chorionic gonadotropin (hCG) administration day, implantation rate and clinical pregnancy rate in group 2 were higher but not significantly different. CONCLUSION: Administration of rLH in late follicular phase had no beneficial effect on outcomes in young women with mean age of 31 years. Maybe a greater sample size should be used to see the effects more accurately; also it is possible that rLH will be useful in older patients. Registration ID in IRCT: IRCT201304302575N4.

Comparing the roles of sperm chromatin integrity and apoptosis in intrauterine insemination outcomes of couples with mild male and female factor infertility.

BACKGROUND: Intrauterine insemination (IUI) is one of the therapeutic approaches for infertility. The objective of this study was to evaluate DNA integrity and apoptosis role in success of IUI in both mild male and female factor infertility. METHODS: PATIENTS WERE DIVIDED INTO TWO GROUPS: M (mild male factor; n = 29) and F (female factor; n = 31) undergoing single IUI. Ejaculates were analyzed and chromatin quality was assessed using chromomycin A3 (CMA3) staining. In addition, spermatozoal apoptosis was recognized using TUNEL assay. Statistical analyses were done using t-test and Mann Whitney test for sperm apoptosis and sperm chromatin by SPSS. Data were expressed in mean±SD for variables. P < 0.05 was considered statistically significant. RESULTS: Sperm concentration and progressive motility were higher in F than M group. Sperm with normal morphology were statistically similar in M and F infertile patients (32.7±15.6% vs. 35.5±9.07%, p = 0.39). Sperm chromatin immaturity was higher in patients with mild male infertility, when compared with the other group (p < 0.01). Also, 32.0±5.6% and 30.8±6.1% of the spermatozoa showed signs of apoptosis in groups M and F, respectively (p = 0.49). Very low (3.4%) clinical pregnancy rates were noticed in patients with mild male factor infertility. CONCLUSION: Defect in sperm motility as well as high rates of DNA damage and apoptosis may be involved with very low rate of pregnancy outcomes in patients with mild male factor infertility. Therefore, it seems the application of IUI may have better outcomes in patients with female infertility compared to mild male factor infertility.

Dilatation and curettage effect on the endometrial thickness.

BACKGROUND: Endometrial receptivity is required for successful implantation and pregnancy. Despite the remaining controversy, many studies have shown that ultrasonographic endometrial thickness can be considered as an indicator of endometrial receptivity. OBJECTIVE: The study objective was to investigate the effect of dilatation and curettage on the endometrial thickness. MATERIALS AND METHODS: Enrolled in the study were 444 patients visited in Obstetrics & Gynecology clinic of Shahid Sadoughi hospital between Jan. 2011 to Sep. 2012. Only patients whose menstrual cycle was regular were included in study. Patients with myoma, adenomyosis, endometrial polyps or other uterine anomaly, those who smoked, whose BMI was greater than 30 and who were taking medications that could affect endometrial thickness were excluded. Endometrial thickness was measured one day before evolution (n = 444) and 5-7 days after it (n = 444) using transvaginal ultrasonography. The endometrial thicknesses were correlated to the patients' history of dilatation and curettage. Data analysis was done through SPSS software version 16 and using descriptive statistics, independent T-test and Anova. RESULTS: Endometrial thickness in patients who had 0, 1, 2, 3 and 4 D&C were 10.00 ± 0.58, 9.83 ± 0.47, 8.90 ± 0.92, 7.42 ± 0.18 and 7.40 ± 0.07, respectively one day before ovulation (spearman's correlation coefficient = -0.33) and 10.62 ± 0.68, 9.64 ± 0.49, 8.48 ± 0.96, 6.32 ± 0.15 and 6.90 ± 0.04, respectively, 5-7 days after ovulation (spearman's correlation coefficient = -0.66) estradiol and progesterone levels, measured in the day of 2nd ultrasonography had not statistic relation with endometrial thickness (P = 0.27 and 0.31). The relation of endometrial thickness and age was not significant (P = 0.54 and 0.06). CONCLUSIONS: Dilatation and curettage has a significant effect on the endometrial thinning.

Comparison of growth parameters of 5-year-old singleton children born in assisted versus natural conception.

INTRODUCTION: At present, about 1% of newborns are delivered through assisted reproductive technologies (ART) worldwide. This study aimed to evaluate and compare the growth parameters of children born in assisted and natural conception at 5 years of age. MATERIALS AND METHODS: In a cross-sectional case control study, weight, height and head circumference of 5-year old children were assessed. The case group consisted of term, singleton babies who were products of ART in the Center for Infertility of Shahid Sadoughi University, Yazd, Iran in 2005. The control group consisted of term, fi rst child, singleton and spontaneously conceived 5-year-old children who were referred for vaccination to primary health care center of Shahid Akbari in 2010. RESULTS: Fifty-eight girls (47.5%) and 64 boys (52.5%) "with equal numbers in each of the 2 groups" were evaluated. Sex distribution, mean ages of fathers and mothers were not statistically significant different in both groups. Children born after ART tend to have lower birth weight, smaller birth head circumference and lower weight at 5 years of age. Having low birth weight (<2500 g), being underweight and having short stature at the age of 5 were more common in babies born through ART. CONCLUSION: Growth retardation is more prevalent in babies born through ART. Thus, growth assessment, parents' knowledge about child physical development, and timely and accurate follow-up of these children are necessary for early detection of any growth disorders.

Efficacy of 17α- hydroxy progestrone on decreasing preterm labor in ART pregnancies: A randomized clinical trial.

BACKGROUND: Preterm labor (PTL) is one of the most important causes in neonatal mortality and morbidity. Late preterm labor (34-36w) includes 75% of such birth. Assisted reproductive technology (ART) pregnant women are at increased risk of PTL. OBJECTIVE: The study has been undertaken to determine whether beginning and continuing 17-α hydroxy progesterone caproate can reduce risk of PTL or change neonatal mortality. MATERIALS AND METHODS: In a double-blind clinical randomized control trial, 106 women were treated by ART technique for their infertility and in gestational age at 16 weeks entered in our study. In one group, 17-α hydroxy progesterone caproate (Femolife) was injected intramuscularly every week until 36 weeks of gestation and in another group; placebo was injected from 16 until 36 weeks of gestetion. Data collected from pregnancy outcomes, infancy, and subsidiary problems were statistically analyzed by a questionnaire. RESULTS: The risk of PTL in placebo group was 2.48 higher than control group that was not significant (Cl: 0.81-9.94). Femolife side effect in case group was gestational diabetes and local complication was not frequent. NICU admission was not significantly different between groups. CONCLUSION: Although it seems that 17-α hydroxy progesterone caproate does not cause significantly decrease in PTL in singleton ART gestations but any reduction of PTL in such high risk pregnancies may improve final gestational outcome. There is critical need for larger clinical trials to better understanding causes of PTL, specifically late preterm labor, to prevent mortality and morbidity in ART gestation. This article extracted from Residential thesis. (Hoora Amouzegar) REGISTRATION ID IN IRCT: IRCT2012101611132N1.

Effect of sildenafil citrate on endometrial preparation and outcome of frozen-thawed embryo transfer cycles: a randomized clinical trial.

BACKGROUND: Sildenafil citrate may increase endometrial thickness and affect the outcome of frozen-thawed embryo transfer cycles. OBJECTIVE: The aim of this study was to estimate the effect of sildenafil citrate on ultrasonographic endometrial thickness and pattern and to investigate the estrogen level on the day of progesterone administration, the implantation rate and chemical pregnancy rate in frozen embryo transfer cycles. MATERIALS AND METHODS: This randomized controlled trial was conducted on 80 patients who had an antecedent of poor endometrial response and frozen embryos. 40 patients were given estradiol by a step up method with menstruation to prepare the endometrium, and the other 40 were given sildenafil citrate tablets (50 mg) daily in addition to the above treatment protocol from the first day of the cycle until the day progesterone was started. This was discontinued 48-72 hours prior to the embryo transfer. RESULTS: The endometrial thickness was significantly higher in the sildenafil citrate group (p<0.0001), the triple line patterns of the endometrium were significantly higher in the sildenafil citrate group (p<0.0001), while the intermediate patterns of the endometrium were not significantly different in the two groups. The echogen patterns of the endometrium were significantly higher in control group (p<0.0001). Finally, implantation rate and the chemical pregnancy rates were higher in the sildenafil citrate group but not significantly. CONCLUSION: As our study shows, the oral use of sildenafil citrate is a good way to improve the endometrial receptivity. We recommend the routine use of oral sildenafil citrate in patients with a previous failure of assisted reproduction technology cycles due to poor endometrial thickness.

Comparison of developmental status of 5-year-old singleton children born through assisted and natural conceptions.

BACKGROUND: Approximately one percent of current live births of the world are conceived via assisted reproductive technologies (ART). OBJECTIVE: The purpose of this study was to compare the developmental status of children born through assisted and natural conceptions at the age of five years. MATERIALS AND METHODS: In a retrospective cohort study, developmental status of 5 years old children was evaluated via Persian version of 60-month Ages and Stages Questionnaires. Case group consisted of 61 singletons, term babies whom were born through ART in the Research and Clinical Center for Infertility, Yazd, Iran in 2005. Control group consisted of 61 term, first child, singleton and spontaneously conceived born five years old children whom were referred to Shahid Akbari primary health care center in 2010. RESULTS: 58 girls (47.5%) and 64 boys (52.5%) were evaluated. Frequency of developmental delay in domains of fine motor (47.5% vs. 24.6%, p=0.008) and problem solving (60.6% vs. 34.4%, p=0.004) were more in ART born children. On logistic regression, fine motor development state was independently affected by maternal educational level (OR: 5.3, 95% CI: 1.67-16.30, p=0.004) and developmental status in problem solving domains was independently affected by maternal educational level (OR: 4.88, 95% CI: 1.25-19.07, p=0.02) and birth weight (OR: 7.1, 95% CI: 1.78-29.01, p=0.006) CONCLUSION: Maternal educational level and birth weight are important factors that influenced developmental outcome of ART born children.