[Show abstract][Hide abstract] ABSTRACT: Background: The largest percentage of failed invitro fertilization (IVF (cycles, are due to lack of implantation. As hereditary thrombophilia can cause in placentation failure, it may have a role in recurrent IVF failure. Objective: Aim of this case-control study was to determine whether hereditary thrombophilia is more prevalent in women with recurrent IVF failures. Materials and Methods: Case group comprised 96 infertile women, with a history of recurrent IVF failure. Control group was comprised of 95 healthy women with proven fertility who had conceived spontaneously. All participants were assessed for the presence of inherited thrombophilias including: factor V Leiden, methilen tetrahydrofolate reductase (MTHFR) mutation, prothrombin mutation, homocystein level, protein S and C deficiency, antithrombin III (AT-III) deficiency and plasminogen activator inhibitor-1 (PAI-1) mutation. Presence of thrombophilia was compared between groups. Results: Having at least one thrombophilia known as a risk factor for recurrent IVF failure (95% CI=1.74-5.70, OR=3.15, p=0.00). Mutation of factor V Leiden (95% CI=1.26-10.27, OR=3.06, P=0.01) and homozygote form of MTHFR mutation (95% CI=1.55-97.86, OR=12.33, p=0.05) were also risk factors for recurrent IVF failure. However, we could not find significant difference in other inherited thrombophilia's. Conclusion: Inherited thrombophilia is more prevalent in women with recurrent IVF failure compared with healthy women. Having at least one thrombophilia, mutation of factor V Leiden and homozygote form of MTHFR mutation were risk factors for recurrent IVF failure.
Iranian Journal of Reproductive Medicine 07/2014; 12(7):467-470. · 0.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the outcomes of adding low-dose hCG (human chorionic gonadotropin), as an LH active supplement, to a GnRH antagonist protocol in patients undergoing assisted reproduction techniques. In this parallel-group randomized clinical trial, 137 infertile female outpatients aged 20 - 39 years were randomized into two groups: hCG group and non-hCG group. All patients received r-FSH (150-300 IU) and then a GnRH-antagonist, Cetrorelix (0.25 mg/day). Concomitantly with Cetrorelix, patients in the hCG group received low-dose hCG (200 IU daily), but the patients in the non-hCG group did not. 10,000 IU Urinary hCG (10,000 IU) was injected to all patients, and ICSI was performed after oocyte retrieval. The primary outcome of this study was comparing the pregnancy rates between two study groups. Other differences between two groups such as serum estradiol concentration, fertilization rate, etc. were considered as secondary outcomes. A total of 130 patients completed this trial. No significant difference was detected between pregnancy rates of the two groups (P=0.52) as well as the fertilization, implantation and ongoing pregnancy rates (P=0.11, P=0.75 and P=0.06 respectively). The only significant difference between two groups was a higher concentration of estradiol in the hCG-treated patients (P<0.05). HCG-treated patients experienced a shorter treatment duration and a lower r-FSH required dose than the non-hCG group, but none of these differences were statistically significant (P=0.19 and P=0.10, respectively). The findings of the current study did not support advantages of adding low-dose hCG to GnRH antagonist plus r-FSH protocol in an unselected population of patients. Well-designed trials with a larger sample size for specific patients' subgroups are warranted.
[Show abstract][Hide abstract] ABSTRACT: AimRepeated implantation failure (RIF) is still a problem for many patients and their physicians. Some interventions have been practiced to overcome the problem; one is uterine cavity assessment before assisted reproductive technology (ART) cycles. This study aimed to evaluate the effect of hysteroscopy in women experiencing recurrent implantation failure with apparently normal uterine cavity before assisted reproductive techniques. Material and Methods
This was a cohort study with historical controls conducted in a university hospital. A total of 353 women with RIF undergoing ART with normal hysterosalpingography and transvaginal ultrasound were evaluated. The intervention group underwent hysteroscopy with a rigid, 30°, 4-mm hysteroscope in the menstrual cycle just before ART; in the control group hysteroscopy was not performed. Basal characteristics, stimulation parameters and pregnancy rates were compared between the two groups. ResultsChemical pregnancy occurred in 58.5% of women in the hysteroscopy group versus 34.1% of control women (odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.7–4.2; P < 0.001). Clinical pregnancy occurred in 50.7% and 30.3% of women in the hysteroscopy and control groups, respectively (OR: 2.4; 95%CI: 1.5–3.7; P < 0.001). Delivery rate was 35.5% in hysteroscopy women and 21.1% in control women (OR: 1.9; 95%CI: 1.2–3.1; P = 0.008). The results of hysteroscopy were normal in 103 women (72.5%), and they revealed inflammation in 22 (15.5%), polyp in 16 (11.3%) and Asherman syndrome in one patient (0.7%). Conclusions
Hysteroscopy in the menstrual cycle before ovarian stimulation in fresh cycles and before endometrial preparation in frozen thawed cycles in women experiencing recurrent implantation failure with apparently normal uterine cavity significantly increases the pregnancy rates in fresh and frozen cycles, respectively.
Journal of Obstetrics and Gynaecology Research 04/2014; · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Post-operative nausea and vomiting (PONV) is considered as one of the most disturbing sequels of surgeries under general anesthesia, which if not controlled appropriately increases post-operative morbidity, nursing burden, and general healthcare costs. In this study, we compared granisetron with its brand Kytril(®) and also with metoclopramide regarding PONV management.
A total of 180 obstetrics and gynecology patients who underwent surgeries under general anesthesia participated in this prospective study at the Dr. Shariati Teaching Hospital, Tehran, Iran. The patients were randomly assigned to single-dose generic granisetron (40 mcg/kg), Kytril(®) (40 mcg/kg), or metoclopramide (0.2 mg/kg) at the end of the surgery. Two episodes of emetic symptoms (nausea and vomiting) were recorded by a gynecologist who had no knowledge of which treatment each patient had received. This gynecologist observed the patients at three different intervals: 0-6, 6-12, and 12-18 h post-surgery.
One hundred and thirty-seven patients (76.1 %) underwent hysterectomy and 40 patients (22.2 %) underwent myomectomy. Each group consisted of 60 patients (33 %). The incidence of vomiting in the first 6, 12, and 18 h post-surgery was 22, 15.2, and 13.3 % for granisetron; 18.6, 10, and 8.3 % for Kytril; and 22, 11.9, and 5 % for generic metoclopramide, respectively. There was no significant difference in the incidence of PONV with any of these agents.
All three anti-nausea and vomiting agents, granisetron, its brand (Kytril), and generic metoclopramide, have a similar effect to manage PONV in obstetrics and gynecological surgeries. Trial registration This trial is registered with www.irct.ir, number IRCT201010134927N1.
Journal of Obstetrics and Gynecology of India 02/2014; 64(1):59-62.
[Show abstract][Hide abstract] ABSTRACT: Objective: This novel study describes an effective outpatient treatment for ovarian hyperstimulation syndrome (OHSS) that results in rapid normalization of symptoms. Study design: A total of twenty-seven infertile women undergoing assisted reproductive technique with early-onset OHSS were enrolled in this non-randomized clinical trial in an academic infertility center. In all patients, after complete desensitization with long-term protocol ovarian stimulation with gonadotropins was commenced. Final oocyte maturation was triggered with human chorionic gonadotrophin. Oocytes were collected 36-38 h later using transvaginal-guided follicle aspiration under general anaesthesia. All embryos were frozen and study group patients received two consecutive doses of GnRH antagonist (Cetrotide) and the control group received daily dose of cabergoline for a week. Results: The research revealed that moderate and severe OHSS, hospitalization or acute care for OHSS and ascites tap were significantly lower in the antagonist (Cetrotide) group. The Patients' satisfaction with Cetrotide was noticeable. No side effect was reported in either group. Conclusion: GnRH antagonists seem to be an effective outpatient treatment with rapid onset activity and minimal side effects for the management of early OHSS.
[Show abstract][Hide abstract] ABSTRACT: Chromosomal aneuploidy is a well-known phenomenon in human gametes including spermatozoa. Success rate of fertilisation and implantation in subfertile patients with male factor has always been shown to be very low. We tried to relate the possible impact of sex chromosomal aneuploidy in spermatozoa used for intracytoplasmic sperm injection (ICSI) on fertilisation and implantation rate. To evaluate the frequency of disomy for X and Y chromosomes in sperm samples retrieved from normal and oligozoospermic individuals, primed in situ labelling (PRINS) technique was used. Following ICSI, the rate of eight-cell embryos for each category was determined and followed up for successful implantation. Results showed a statistically significant higher frequency of disomy for all chromosomes under study in spermatozoa of oligozoospermic patients compared with normal men (P < 0.01). The rate of eight-cells embryo formation was significantly lower than in normal group (P < 0.01). The number of embryos transferred for both groups were nearly similar. Implantation rate for oligozoospermic patients was much lower than that of the normal group but was not significantly different (P > 0.05). These results demonstrate that men especially with severe oligozoospermia have an elevated risk for chromosome abnormalities in their spermatozoa. These abnormalities might affect fertilisation and pre-embryo formation with less impact on implantation.
[Show abstract][Hide abstract] ABSTRACT: Detection of best predictor of ovarian reserve in patients with temporarily or consistently elevated early follicular phase serum levels of FSH is one of the most important goals in assisted reproductive technique (ART).
Iranian Journal of Reproductive Medicine 05/2012; 10(3):201-8. · 0.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Granisetron is a first-generation 5-HT3-receptor antagonist that has shown efficacy in preventing postoperative nausea and vomiting (PONV). In this randomized double-blind parallel-group clinical trial, we assessed the efficacy of generic granisetron versus Kytril®, in the prevention of PONV in patients undergoing general anesthesia for gynaecological surgeries. Method One hundred and twenty patients who were supposed to undergo major gynaecological surgeries (myomectomy and hysterectomy) in Dr. Shariati Teaching Hospital, Tehran, Iran were randomly assigned to either single dose generic granisetron (40 mcg/kg), or Kytril® (40 mcg/kg) at the end of the surgery. Two episodes of emetic symptoms (nausea and vomiting) were recorded by a gynaecologist who had no knowledge of which treatment each patient had received. This gynaecologist observed the patients at three different intervals: 6, 12 and 18 h post surgery. At the end of the observation period each patient evaluated the satisfaction with the study drug, and the gynaecologist evaluated sedation of the patients. Results In the generic granisetron group 47 and 13 patients, and in the Kytril® group 45 and 15 patients underwent hysterectomy and myomectomy respectively. No difference was observed between two treatment groups regarding postoperative nausea and vomiting control during 18 hours after the drugs administration. Also there were no differences in the satisfaction with the study drug between the generic granisetron and Kytril®. No difference in sedation scores was observed between two groups. Conclusion Generic granisetron exerts efficacy against PONV after gynaecological surgeries which is non-inferior to that of Kytril®.
Iranian journal of pharmaceutical research (IJPR) 01/2012; 11(4):1059-64. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to assess the relationship between the serum levels of anti-mullerian hormone (AMH) and other hormonal markers and results of assisted reproductive techniques (ART) in polycystic ovary syndrome (PCOS) patients. This cohort study was conducted on 60 PCOS patients who were candidates for assisted reproductive techniques. In all patients the serum levels of AMH, follicle stimulating hormone (FSH) and luteinizing hormone (LH), estradiol (E2), free testosterone (fT), testosterone (T) and inhibin B were measured in the 3(rd) day of menstrual cycle. The relationship between serum level of measured hormonal markers with retrieved oocytes, mature oocytes, the number of transferred fetus and pregnancy rate were assessed. The cut-off value for the serum level of AMH and retrieved oocytes were determined. There was a significant direct correlation between the serum mullerian inhibiting substance (MIS) level with number of total picked up oocytes (r = 0.412), mature oocytes (r = 0.472) and embryo transfer (r = 0.291). There was a linear and significant correlation between inhibin B and fertilization (r = 0.283) Cut-off point for AMH level according to presence or absence of pregnancy was 4.8 ng/ml and it was not statistically significant (P = 0.655). Area under curve (AUC) was 0.543. Cut-off point for MIS according to picked up oocytes was 2.7 ng/ml with area under the curve (ROC curve) of 0.724 (CI = 0.591-0.831) (P = 0.002). Patients with PCOS who had AMH more than 2.7 ng/ml, the number of retrieved oocytes (6 or more) was higher than MIS/AMH <2.7 ng/ml (P = 0.002). As a marker of ovarian responsiveness to controlled ovarian hyperstimulation (COH) and despite a small sample size of our study, it is revealed that pretreatment MIS/AMH is highly associated with the number of mature oocytes retrieved during COH in PCOS women.
[Show abstract][Hide abstract] ABSTRACT: Type 2 receptors for vascular endothelial growth factor are believed to be involved in the pathophysiology of ovarian hyperstimulation syndrome (OHSS). The objective of this study was to examine the preventive effects of cabergoline on OHSS and its complications. The study is a non randomized clinical trial conducted in 2006-2008 on 75 patients, which were at risk of OHSS and underwent assisted reproductive techniques. The diagnosis and severity of OHSS were determined using standard criteria. The study included an intervention and a control group. The intervention group comprised of 50 women at risk of OHSS, who were treated with cabergoline (1 mg every other day for 8 days) commencing from the day of ovum pick up. The control group comprised of 25 historical cases, which were similar to the case group. The latter group did not receive cabergoline, and their OHSS, if occurred, were managed conservatively after hospital admission. The rates of OHSS, baseline characteristics, ovarian stimulation parameters, and pregnancy occurrence were compared. There was no significant difference between baseline characteristics or ovarian stimulation parameters form the two groups. The incidence of OHSS in the cabergoline-treated group, was significantly (P=0.01) lower than that in the control group (12% vs 36%). Embryo freezing was significantly (P=0.001) lower in the control group, but cycle cancellation was significantly (0.03) lower in the cabergoline group. The findings of the study indicate that cabergoline reduces the incidence of OHSS, and is not associated with adverse effects on pregnancy.
Iranian Journal of Medical Sciences 09/2011; 36(3):207-12.
[Show abstract][Hide abstract] ABSTRACT: To assess the correlation between the levels of vitamin D in follicular fluid and serum, and to determine whether the level of 25-hydroxyvitamin D (25OH-D) in follicular fluid of infertile women undergoing assisted reproductive technology (ART) is associated with the outcome.
Eighty-two infertile women undergoing ART at an academic tertiary care centre were recruited for a prospective cohort study. Levels of 25OH-D in follicular fluid and serum were measured. Standardized regimens for pituitary downregulation and controlled ovarian hyperstimulation were employed. Patient and cycle parameters, and clinical pregnancy (defined as evidence of intra-uterine gestation sac plus heart rate on ultrasound) were determined.
A significant correlation was found between the levels of vitamin D in follicular fluid and serum (r=0.767, p=0.001). The overall rates of chemical, clinical and ongoing pregnancy were 35.5% (n=29), 29.3% (n=24) and 23.2% (n=19), respectively. No significant difference was found in these pregnancy rates between the tertiles of 25OH-D level in follicular fluid (p=0.959, 0.995 and 0.604, respectively). The median serum level of vitamin D was 8.13 (range 5.37-13.62)ng/ml in the clinically pregnant group and 8.29 (range 5.93-21.23)ng/ml in the non-pregnant group (p=0.235). Interestingly, the median level of vitamin D in follicular fluid was 9.19 (range 5.25-19.51)ng/ml in the clinically pregnant group and 10.34 (range 5.89-29.69)ng/ml in the non-pregnant group (p=0.433). The fertilization rate decreased significantly and the implantation rate increased (not significantly) with increasing tertiles of 25OH-D level in follicular fluid.
The level of 25OH-D in follicular fluid is reflective of body stores of vitamin D. Most subjects in this study were deficient in vitamin D, but this study found that vitamin D deficiency does not play a pivotal role in the outcome of ART.
European journal of obstetrics, gynecology, and reproductive biology 08/2011; 159(1):132-7. · 1.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Induced chromosomal instability and micronucleus (MN) formation in blood lymphocytes of infertile men in comparison with fertile men exposed to gamma radiation was investigated.
Blood samples of healthy and infertile donors were irradiated by 2 and 4 Gy Co-60 gamma-rays, then cultured in RPMI-1640 complete medium containing 1% phytoheamaglutinin (PHA) and incubated in a CO(2) incubator. Cytochalasin-B was added to the cultures at a final concentration of 4 μg/ml. Finally, harvesting, slide making, and analysis were performed according to standard procedures.
We observed a statistically significant difference between the frequencies of micronuclei in lymphocytes of infertile individuals, compared to healthy donors, before and after exposure to gamma rays. Although higher in azoospermia patients, the frequency of MN was not statistically different between infertile groups.
This study indicates that genomic instability in infertile men could probably contribute to the development of an impaired reproductive capacity.
Journal of Assisted Reproduction and Genetics 03/2011; 29(1):89-94. · 1.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gonadotropin-releasing hormone (GnRH) antagonists have reduced the incidence of severe ovarian hyper stimulation syndrome (OHSS) and rate of hospitalization due to severe OHSS, especially in polycystic ovarian syndrome (PCOS) patients. The present study aimed to compare the outcomes of patients with PCOS undergoing controlled ovarian hyperstimulation (COH) with GnRH agonist versus GnRH antagonist protocols for assisted reproduction cycles.
The present clinical trial compared GnRH antagonist (cetrorelix) and GnRH agonist (buserelin) protocols during COH of 112 infertile PCOS patients entering assisted reproduction cycles. The primary outcome measure was pregnancy occurrence. Basal characteristics of the participants, stimulation cycle responses, pregnancy outcomes, incidence of OHSS and types of OHSS were considered in both groups.
Regarding chemical and clinical pregnancy rates, the number of retrieved oocytes was significantly higher and OHSS was significantly lower in the antagonist group. Follicle stimulating hormone (FSH), luteinizing hormone (LH) levels, number of follicles, number of follicles >18 mm, relative frequency of mature oocytes, number and days of gonadotropin injections, day of human chorionic gonadotropin (HCG) administration, estradiol level and abortion were similar between the two groups.
GnRH antagonists are more effective, safe and a well tolerated alternative to agonists for assisted reproduction cycles in PCOS patients. GnRH antagonists are associated with a reduction in the incidence of OHSS in these patients.
Journal of Obstetrics and Gynaecology Research 06/2010; 36(3):605-10. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Some complications of pregnancy such as abortion, gestational diabetes mellitus, preeclampsia, and preterm delivery are more common among women with polycystic ovary syndrome (PCOS). Recently it has been reported that metformin treatment during pregnancy reduces pregnancy complications, so this study was conducted to demonstrate the possible effects of metformin on the uteroplacental circulation and pregnancy complications.
Methods: Seventy pregnant women with polycystic ovary syndrome (PCOS) from 1386 to 1388 were enrolled in a randomized, double-blind, placebo-controlled trial of metformin during pregnancy in Shariati hospital. Doppler ultrasound examinations of the uterine arteries and umbilical artery were performed at 12th and 20th weeks of gestation. All patients were followed up to the end of pregnancy, then the effect of metformin on the uteroplacental circulation was evaluated by the comparison of the pulsatility index (PI) of uterine arteries and prevalence of obstetric complications between two groups.
Results: The mean reduction of PI in metformin group from 12th to 20th weeks of gestation was 0.38 versus 0.16 in placebo group (p=0.016). Gestational diabetes mellitus, pre-eclampsia and preterm delivery, were more common in pregnant women in placebo group but the difference was not statistically significant.
Conclusions: Metformin treatment in pregnancy accompanied with reduced uterine artery impedance between 12 and 20 weeks of gestation but this reduction showed no effect on the pregnancy complications such as preterm delivery, preeclampsia and gestational diabetes.
Tehran University Medical Journal 01/2010; 68:238-242.
[Show abstract][Hide abstract] ABSTRACT: Endometriosis is an estrogen dependent disease. Levels of Cancer antigen-125 are significantly higher in women with moderate to severe endometriosis. However, patients with unruptured endometriosis rarely have serum CA-125 levels more than 1000 U/mL. This case report presents a diffuse, unruptured ovarian endometrioma in a 29- year-old woman, leading to an extraordinary high serum CA-125 and CA19-9 levels; usually typical of advanced ovarian carcinoma. Our experience emphasizes on benign gynecologic conditions such as endometrioma, which should be taken into account as a possible differential diagnosis in women with exaggerated elevation of the serum CA-125 level
Journal of Family and Reproductive Health. 05/2009; 3:67-70.
[Show abstract][Hide abstract] ABSTRACT: To compare the extent of sperm DNA damage with the degree of protamine deficiency in spermatozoa of normal and subfertile individuals, 30 semen samples from three groups of subfertile individuals (oligozoospermic, asthenozoospermic and oligoasthenozoospermic) and 14 samples from normal individuals were collected from men referred to the Fertility and Infertility Centre of Shariati Hospital, Tehran. DNA damage was measured using the alkaline Comet assay, and protamine deficiency was measured using chromomycin A3 (CMA3) staining. Results indicated a significant difference in the extent of DNA damage in spermatozoa of subfertile patients compared with normal patients (P < 0.01). Spermatozoa from oligoasthenozoospermic patients showed a higher level of DNA damage compared with the other two study groups of subfertile men. The percentage of CMA3-positive spermatozoa was also higher in subfertile individuals compared with normal patients (P < 0.01), with the highest level occurring in oligoasthenozoospermic patients. A direct correlation between protamine deficiency and sperm DNA damage was found for all subfertile patients studied.
[Show abstract][Hide abstract] ABSTRACT: Polycystic ovary syndrom (PCOS) is characterized by infertility, oligomenorrhea, and hyperandrogenism. Clomiphene citrate (CC), an antiestrogen, is first-line treatment for PCOS, if CC fails to induce ovulation, laparascopic electrocautery of the ovaries is offered. In this prospective controlled study, 52 women with clomiphen-resistant PCOS (group 1) and 46 women with regular menstrual cycles as a control group (group 2) were included. Hormonal profile and doppler blood flow changes within the ovarian stroma befor and after laparascopic ovarian electrocautery (LOE) in women with clomiphen- resistant polycystic ovary syndrome assessed and compared between groups. The doppler indices (pulsatility index and resistance index) of ovarian stromal blood flow were significantly lower in group 1 befor LOE than in group 2. The serum levels of testosteron (T) and LH were significantly reduced in group 1 after LOE compared with in group 1 befor LOE (P < 0.05). Doppler indices (pulsatility index and resistance index) of ovarian stromal blood flow were significantly increased after LOE. Laparascopic electrocautery reduced serum T and LH and reduced ovarian blood flow velocities, which may explain the reduction of ovarian hyperstimulation syndrome in women with PCOS after LOE. Laparascopic electrocautery of the ovaries is now accepted as the preferred first-line treatment of women with PCOS who are resistant to clomiphen citrate. All affected women could be considered for this treatment.
[Show abstract][Hide abstract] ABSTRACT: Endometrial vasculature has been shown to play an important role in the early endometrial response to the implanting blastocyst, and vascular changes may contribute to uterine receptivity. The aim of this study was to investigate the role of endometrial and subendometrial vascularity and thickness in uterine receptivity in infertile women treated with assisted reproductive technologies (ART). A total of 175 women were recruited from our ART program from June 2005 to May 2006. In the first stage, down regulation was done using GnRH-a and then ovarian hyperstimulation was initiated with human menopausal gonadotrophin and in vitro fertilization (IVF) procedures were performed. Then, the endometrial-subendometrial blood flow distribution pattern was determined by color Doppler ultrasonography and its characteristics were compared between pregnant (n = 56) and non-pregnant (n = 119) women. Zones 1, 2 and 3 of vascular penetration were found in 15.4%, 22.3%, and 62.3% of patients, respectively. The number of implanted embryos was 62 and implantation rate was 11.61%. There was no significant association between implantation rate and endometrial thickness or zone of vascular penetration. Among all women, fertility occurred in 56 (32.2%) women. Zone 1 of vascular penetration was found in 10.71% and 10.08% (P = 0.898), zone 2 in 16.07% and 13.44% (P = 0.643), and zone 3 in 41.07% and 41.17% (P = 0.989) of pregnant and non-pregnant groups, respectively. Endometrial-subendometrial blood flow (according the findings of Doppler ultrasonography) in women undergoing ART could not predict endometrial receptivity and IVF outcome.