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Showing 931 results for Type of Study: Original Article

Ali A Movassagh-Pour, Mojdeh Salehnia, Ali A Pourfatollah, Sayed M Moazzeni,
Volume 1, Issue 1 (1-2003)
Abstract

Background: Embryonic stem cells (ESc) are pluripotent cells which have been used as a model to study the mechanism that control the embryogenesis and early mammalian development in vitro. The aim of this study was to isolate and produce embryonic stem cells from late blastocyst stage embryos in mice. Materials and Methods: Blastocyst stage embryos from pregnant NMRI mice were obtained and cultured for 24 h in DMEM medium. 4-6 days after hatching, the inner cell masses (ICM) formed colonies which were then collected mechanically and trypsinized. Several subcultures were prepared in the medium supplemented with 0.1 mM 2 Mercaptoethanol, 1000 U/ml Leukemia Inhibitory Factor (LIF) and 10% Fetal Bovine Serum (FBS). The (ESc) were recognized by alkaline phosphates histochemistry using azo-coupling method. Results: The results demonstrated that a highly pluripotent stem cell line was derived from the blastocyst stage embryos of NMRI mice; however, the rate of colonies was as low as 10%. Conclusion: The LIF is effective to culture and maintain the isolated ICM colonies in undifferentiated condition in the absence of feeder layer.
Abass Aflatoonian, Reza Aflatoonian, Zahra Khashavi,
Volume 1, Issue 1 (1-2003)
Abstract

Background: Ovarian functional cyst is one of the most common pelvic mass in reproductive age which mostly resolves spontaneously. Sonography is a valuable tool for diagnosis of benign cyst with high accuracy. The objective of this cross sectional study was to evaluate the accuracy of transvaginal sonography in detecting type of ovarian cyst and compare the results wieh cytological results. Materials and Methods: 82 women in reproductive age who have had simple ovarian cysts with benign criteria which unresolved after taking contraceptive pills for 3 months were considered for this clinical study. Transvaginal ultrasound-guided aspiration of cysts were done and were then sent to the pathological evaluation. Also, all data regarding the size of the cysts and aspirated fliud were recorded in charts for further statistical analysis. Results: The accuracy of transvaginal ultrasound comparing with cytology on diagnosis for functional cysts was 94.9%, for epithelial ovarian cyst was 97.5% and for endometrioma was 97.5% (P= 0.0001).The size of cysts with diameter of <10cm was not related to the quality of cysts. Conclusion: The results showed that sonography is a valuable and reliable tool for diagnosis of benign ovarian cyst. It seems that if a mass appears benign by ultrasound morphologic criteria, probability of it being malignant is near to zero, which can be aspirated by transvaginal route without any fear from missing of malignancy or complication
Mojdeh Salehnia,
Volume 1, Issue 1 (1-2003)
Abstract

Background: The aim of this study was to determine the correlation between ultrastructural studies for pinopodes expression after ovarian hyperstimulation and progesterone injection in mice. Materials and Methods: Adult NMRI mice were superovulated using human menopasual gonadotropic (hMG) and human chorionic gonadotropic (hCG) hormones; after that, daily injection of progesterone (1 mg/mouse) was performed. Animals were sacrificed by cervical dislocation 3.5 and 4.5 days after hCG injection. Tissues of uterine horns were obtained and processed for scanning (SEM) and transmission (TEM) electron microscopy studies. The pseudopregnant control samples were studied same as experimental groups. Results: The SEM and TEM observations showed that in control groups on 3.5 days of pregnancy, there were some pinopodes. All apical cell surfaces expressed these projections on the forth day. In progestrone-injected group, well developed pinopods were expressed 3.5 days after hCG injection and they were transformed to small projections on the fourth day following hCG injection. Also, the life span of pinopods was limited to a short time. At the TEM levels, the pinopods were seen as swelling process on the apical surface, which were more pronounced on day 3.5 of hCG injection in hyperstimulated and progestrone injection. Conclusion: The progestrone may cause premature expression of pinopodes and the implantation failure after ovarian induction may be due to these timing changes.
Mir-Mehrdad Farsi,
Volume 1, Issue 1 (1-2003)
Abstract

Background: While traditional semen parameters are of significant clinical value, total fertilization failure in IVF cycles is not uncommon. Sperm function testing such as; Hamster egg penetration test has severed limitations as a clinical test. The aim of this study was to evaluate the predictive value of semen parameters by using of intracellular calcium [Ca2+]I increase in response to progesterone. Materials and Methods: The [Ca2+]i response to progesterone was measured in spermatozoa of 86 patients referring to the Assisted Conception Unit for semen analysis. The patients were divided into 3 groups; according to their semen parameters and measured intracellular [Ca2+]i increasing in response to progesterone . Results: There was no significant correlation between each individual semen parameter and [Ca2+]i elevation in response to the progesterone, but most of the patients in each group had [Ca2+]i increasing as expected based on sperm parameters. However, there were cases in groups 1 and 2 (Normal and IVF) that demonstrated [Ca2+]i increases which were poor or lower than expected. Out of the 22 patients in the normal category, 8 cases had poor response to [Ca2+]I increase and out of the 47 patients in the IVF group, 9 patients were as well. In addition we measured [Ca2+]I increases in 6 fertile donor samples for comparison purposes. Conclusion: [Ca2+]i increase in response to progesterone is related to predicting value of sperm parameters in most cases. However, the response of sperm to progesterone could be different in some cases that are expected in normal or IVF category based on our semen analysis criteria. We suggest that the [Ca2+]i measurements may perfect the sperm fertility potential.
Marzieh Mehrafza, Nadia Nobakhti, Zahra Atrkar Roushan, Havva Dashtdar, Mane Oudi, Ahmad Hosseini,
Volume 1, Issue 1 (1-2003)
Abstract

Backgroud: Intrauterine insemination (IUI) is generally attempted before proceeding to more expensive and invasive assisted reproductive techniques such as invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This procedure is most commonly performed as a therapeutic method for couples with a wide variety of subfertility etiologies, such as low count or low motility of sperm, or an incompatibility between the sperm and the cervical mucus. The objective of this clinical trial study was to compare the correlation between the semen parameters and pregnancy rates in patients undergoing hyperstimulation and IUI. Materials and Methods: 336 infertile couples that underwent 336 cycles of IUI with washed husband�s semen were included in this study. All patients� charts were reviewed for age, etiology and duration of infertility, semen characteristics and pregnancy rates. The SPSS 9 software and Chi-square tests were applied for statistical analysis. P<0.05 was determined as statistical significance. Results: Total pregnancy rates were18.2% (61 out of 336 cycles). Postwash semen parameters including: sperm count ?10? 106 ,motility ?50% (grade III and IV >20%) had significant effect on pregnancy rates after IUI. The Outcome of this procedure was not significantly affected by female age, duration or etiology of infertility. Conclusion: Postwash semen quality was the most important factor for predication of successful pregnancy in this study.
Seyed M Kalnatar, Ahmad Ebrahimi, Mehrdad Solimani, Hossein Fazli,
Volume 1, Issue 1 (1-2003)
Abstract

Background: The high fertilization failure after IVF treatment cycles could be related to chromosomal abnormalities. This study was carried out to assess the frequency of chromosomal abnormality on human oocytes lacking signs of fertilization 18-20 h after insemination . Materials and Methods: On day one, 18-20 h after insemination (IVF), fertilization was confirmed when two pronuclei (normal IVF) or more pronuclei (poly pronucleus FR) were present. Chromosomal analysis of unfertilized oocytes was carried out within 20-24 h of collection. All oocyte did not sign of pronuclei were collected from total fertilization failure, TFF (FR=0) or partial fertilization failure, PFF (FR=10-90%). Chromosomal preparation was carried out as described by Tarkowski�s techniques. The average of finding between two groups was compared by X2 test. Results: Chromosome spreading permitted adequate analyzing in 348 unfertilized oocytes. In 33.6% chromosomal aneulpoidy was observed with the following frequencies; hypo-hyploidy, 22/348 (6.4%), hyper-hyploidy, 42/348 (12.2%) and diploidy, 52/348 (15%). The frequency of aneuoplidy was significantly higher in TFF group 33/80 (41%) than PFF group 83/268 (31%), p<0.01, X2. The most frequent numerical aberration was observed in chromosome group, G of the human karyotyped. Conclusion: Since cytogentic analysis of failed fertilized oocytes and sperm function tests are very helpful for direct information on low success rate of fertilization, further studies analyzing on both gametes function in TFF cycles will be needed.
Byron Asimakopoulos, Nikos Nikolettos, Safa Al-Hasani,
Volume 1, Issue 1 (1-2003)
Abstract

Spermatids are the earliest male germ cells with one set of haploid chromosomes. After experiments, mainly in rodents, the spermatid injection was introduced in human assisted reproduction to the treatment of men with non-obstructive azoospermia. Spermatid injection is a technique with particular difficulties that may negatively influence the outcome. The identification, isolation and the assessment of viability, especially for round spermatids, require intensive work and considerable experience. Up to date, it appears that the rates of fertilization and implantation with round spermatid injection are dramatically low and significantly less compared to the use of elongated spermatid injection. The extremely low fertilization potency of the round spermatids led to attempts for their in-vitro culture and maturation. The immaturity of round and elongated spermatids has raised concerns regarding the potential genetic risk for the offspring. Under these facts, a reconsideration of the use of spermatids in assisted human reproduction is necessary.
Mohammad A Khalili, Alexander G Rabchevsky,
Volume 1, Issue 1 (1-2003)
Abstract

Materials and Methods: Young adult Sprague-Dawley rats (200-250g) were assigned into one of the three different groups of control, SCI, and adenovirus transfer (Ad) (n=3/ group). Control rats received no injury, nor any surgery. For SCI rats, SCI was produced by a 10g brass rod with a tip diameter of 2 mm which was dropped from a height of 12.5 mm onto exposed spinal cord at level of T10 with NYU impactor. Animals were perfused transcardially 43 days post SCI. Both spinal cord and testicular tissues were cryo-sectioned and ultra thin-sectioned, respectively. Cellular morphology and morphometry were done for spinal cord tissues. The testicular samples were processed for both light and transmission electron microscopy (TEM). The third group of rats underwent SCI first, followed by microinjection of LacZ adenoviral vectors (5x106 p.f.u./ �l) along the T6-T10 dorsal root entry zone bilaterally. The immune system of animals were suppressed before the Ad administration. Each Ad injection was done using a glass micropipet and a Nonoject injector. Rats were killed 43 days after Ad injections, and the tissues were studied as for other groups.
Nosratollah Zarghami, Ali Khosrowbeygi,
Volume 2, Issue 1 (7-2004)
Abstract

Background: It has been proposed that oxidative stress plays an important role in male infertility. The aims of this study were to compare seminal plasma levels of 15-F2t-isoprostane (8-iso-PGF2?), malondialdehyde (MDA), and total (sum of free and bound) homocysteine (tHcy) in normozoospermic vs. asthenozoospermic men, and to examine the relationships between tHcy and lipid peroxidation products. Materials and Methods: The study was a case-control study with a simple random sampling. The case group consisted of 15 asthenozoospermic males. This group was compared with 15 normozoospermic men. Seminal plasma levels of 15-F2t-isoprostane and tHcy were measured using commercially available enzyme immunoassay (EIA) kits. MDA levels were determined by the thiobarbituric acid (TBA) assay. The Mann-Whitney U test was used to compare two groups. Coefficients of correlation were calculated using Spearman’s correlation analysis. All hypothesis tests were two-tailed with statistical significance assessed at the p value <0.05 level. Results: MDA levels were lower in asthenozoospermic subjects than in control subjects (0.72±0.06 µM vs. 0.40±0.06 µM; p<0.05). No differences were seen in 15-F2t-isoprostane levels in asthenozoospermic subjects and controls (65.00±3.20 pg/ml vs. 58.17±4.12 pg/ml; p>0.05). Interestingly, tHcy levels were slightly higher in asthenozoospermic subjects than in controls (6.18±1.17 µM vs. 4.8±0.52µM). Sperm motility was inversely correlated with seminal plasma 15-F2t-isoprostane and MDA levels, respectively (p<0.05). Conclusion: Seminal plasma levels of 15-F2t-isoprostane and tHcy showed no significant differences between normozoospermic and asthenozoospermic men. Sperm motility correlated inversely with seminal plasma levels of 15-F2t-isoprostane and MDA. No relationship was found between tHcy and lipid peroxidation. However, higher sample size is required to confirm these findings.
Ashraf Moini, Kiarash Riazi, Vida Amid,
Volume 2, Issue 1 (7-2004)
Abstract

Pelvic inflammatory disease (PID) is a rare complication of transvaginal oocyte retrieval. It may result in failure of assisted reproductive techniques (ART). During a 7 years period, 5958 transvaginal ultrasound-guided oocyte retrievals resulted in 10 cases of acute PID. Eight out of 10 patients were diagnosed infertile because of endometriosis. Two patients had mild ovarian, 3 had stage III, and 2 had stage IV endometriosis. One patient had a 3-4 cm ovarian endometrioma. After treatment, no mortality was encountered among the 10 patients, although none of them conceived. This observation supports the previous reports that endometriosis can raise the risk of PID after oocyte retrieval. More vigorous antibiotic prophylaxis and better vaginal preparation are recommended when oocyte pickup is performed in patients with endometriosis.
Valli A Dehghani, Mohammad A Khalili, Nahid Zamani, Fakhri Dreh-Zereshki,
Volume 2, Issue 1 (7-2004)
Abstract

Proper collections of human ejaculates are necessary for semen analysis and infertility treatment purposes. The objective of this study was to assess the seminal characteristics of ejaculates collected by patients via masturbation and coitus interruptus. Thirty individuals produced one sample via masturbation and one via incomplete coitus during a 3-days interval. The semen parameters were compared and analyzed with student t-test and Nemar test. The results showed that mean values for progressive motility of spermatozoa were increased from 46.81+15.7% to 58.76+13.5% in coitus interruptus and masturbation, respectively (P<0.01). Also, the mean values for normal sperm morphology was 54.03+25.1% in coitus interruptus and 63.36+13.4% in samples collected via masturbation (P<0.01). In addition, sperm concentration was significantly improved in ejaculates collected with masturbation (P<0.05). Although, insignificant, the concentration of round cells were lower in specimens collected via masturbation than coitus interruptus. Therefore, via masturbation method, better semen characteristics were yielded which subsequently may improve the infertility treatment outcome.
Behnaz Sheikholslami, Mojdeh Salehnia, Mojtaba Rezazadeh,
Volume 2, Issue 1 (7-2004)
Abstract

The cytokine of granulocyte macrophage colony stimulating factor (GM-CSF) is a glycoprotein, which is synthesized in the female reproductive tract and has embryonic trophic effect in mammals. The objective of this study was to examine the optimal dosage of GM-CSF to improve the mouse embryo development in vitro. To collect two and eight cells embryos, the pregnant NMRI mice were sacrificed by cervical dislocation at 48 h and 72 h post hCG injections, respectively. The embryos were cultured randomlly in T6 medium supplemented with 5 mg /ml bovine serum albumin (BSA) and 0, 2, and 10 ng / ml human rGM-CSF. The data of blastocyst formation and hatching in different groups of embryo culture were compared by chi-square analysis. The results showed that the developmental rates of 2 and 8 cells embryos to hatching blastocyst in the presence of 2 ng/ml of GM-CSF their control groups (51.5% and 49.7%, respectively) were more than those in the other groups, but insignificant. It seems more researches are necessary to confirm this suggestion that the GM-CSF with 2 ng/ml concentration may have a better potential, not only to enhance the developmental rates of 2 and 8 cells embryos but also for decreasing the degeneration of those embryos.
Mahmoud Hashemitabar, Babak Ghavamizadeh, Fatemea Javadnia, Esmaiel Sadain,
Volume 2, Issue 1 (7-2004)
Abstract

Background: The luteal phase defect is a common event following the ovarian stimulation. The aim of the present study was to evaluate the use of human chorionic gonadotropine (hCG) and progesterone hormones to improve the luteal phase defect. Materials and Methods: 60 mice were superovulated routinely with human menopausal gonadotropin (hMG) (7.5U) and hCG (10U). The mice were mated and divided into 3 groups: 1- control (n=20) 2- hCG treatment (n= 20), and 3-Progesterone treatment (n=20). Each group was divided again into two subgroups. The mice (10 from each group) had no injection in group one and were injected intraperiteneal (IP) by hCG (5U/day) and progesterone (1mg/day) subcutaneously (sc) in groups 2 and 3, respectively for four days. On the day 5, the animals were killed by cervical dislocation and the uterus were flushed to count the number of blastocyst and their quality. The above treatment were carried out for 12 days in the other 10 mice in each group. Similarly group one had no injection and groups 2 and 3 were injected by hCG and progesterone for 12 days respectively by the same manner as mention above. The animals were killed on day 13 and the implanted embryos were counted. The uterus and ovary were processed on days 5 and 13 of pregnancy for histological studies. Results: The mean number of blastocysts per mouse were: 12.2%, 2.6% and 3% in group 1 to 3, respectively. The nomber of implanted embryos were 29 as: 13 living fetus in one mouse and 16 resorption fetus in the other. The morphology of uterus on day 5 was as follow: no development in the stroma and endometrial gland in control group, the stroma and endometrial gland so developed to form the saw teeth appearance which indicated on receptivity of uterus in hCG treated group similar to progesterone treated group, but without the saw teeth appearance. The continuation of hCG injection maintained the receptivity of uterus; while, the continuation in progesterone caused metaplesia of epithelium. The morphology of ovaries in all three groups showed no changes in corpus luteum size on day 5, and showed the following changes on day 13: increasing the number of primary and secondary follicles in control group; while, reducing the size of corpus luteum in hCG group. Conclusion: Progesterone did not improve the uterus and implantation rate. The prolonged usage of progesterone can change the morphology of uterus to more abnormal state in conterast to the prolonged usage of hCG.
Mansour Ebrahimi,
Volume 2, Issue 1 (7-2004)
Abstract

Background: Enzyme Linked ImmunoSorbent Assay (ELISA) has been described as an alternative to radioimmunoassay for the mammalian and nonmammalian steroids detection. In this study, a simple and rapid ELISA is described and validated for 4-pregnen-3,20, dione (progesterone). Materials and Methods: A general procedure for preparation of the acetylcholinesterase labelled steroid is described which is applicable to any steroid. Use of acetylcholinesterase tracer increased the sensitivity of assay so that reliable measurements of each steroid could be achieved with only 10 ?l of plasma. Results: Typical standard curves for progesterone steroids showed a workable range (detection limit) from 0.8 to 400 pg/well and the sensitivity of the assay taken as the concentration of steroid that induced 90% of B/B0, was 1.5 pg. Inter-assay variations that gave approximately 50% displacement was 9.2% for 10 replicates and intra-assay co-efficient of variation was less than 10% over the central part of the standard curve between 3 and 200 pg/well. There was a strong positive correlation (r>0.999) between the amount of steroid added to plasma and the amount measured. Conclusion: Method described here was applied to measure progesterone in plasma and this methodology could be of great interest to researchers measuring steroid hormones.
Robabeh Taheripanah, Mohammad A Karimzadeh, Mohammad Ghafourzadeh,
Volume 2, Issue 1 (7-2004)
Abstract

Background: The retrieval of good quality oocytes that is accomplished with selection of the best induction ovulation protocol on the basis of patients condition, age and cause of infertility, is one of the most important aspects of ART cycles. The objective was to evaluate the efficacy of low dose, long acting GnRH-a (Decapeptyle) for pituitary desensitization and outcome of ART compared to long protocol of short acting GnRH-a (Busereline). Materials and Methods: In this randomized clinical trial that was performed at Yazd IVF Center, 60 patients with 61 cycles of ART were included. Patients with endometriosis or age > 40 were excluded in this study. Using COH-ET, patients were randomly divided into two groups. In group one, 30 patients received a single half dose of Decapeptyle (1.87mg) in mid-luteal phase. In the other group, 31 patients received Buserelin daily (0.5mg), starting from previous mid-luteal phase. This was reduced to 0.25mg from gonadotropin administration day and was continued until the day of hCG injection. In these groups, the number of oocytes, the fertilization, cleavage, pregnancy and cancellation rates were compared. Results: In two groups, there was no case of cancellation due to premature LH surge. In group I, the mean number of gonadotropins was 27.5+4.2 ampoules while in the second group, it was 28.4±2.8 ampoules (P>0.05). 312 oocytes from group I and 294 oocytes from group II were retrieved. Oocyte quality in group II was better than group I (84.3% vs 77.2%, P<0.05). In long-acting GnRH-a group fertilization rate was 81.9% versus 71.1%in group II (P<0.01). However, embryo development in Group I (85.6% vs 94.1%, P<0.05) was lower than group II. Although, pregnancy rate was 20% in Group I which was higher than group II (12.6%) but, there was no significant difference in cancellation, pregnancy rate and gonadotropins dose in two groups. Conclusion: The low dose long acting GnRH-a is a useful method for pituitary suppression. Low dose GnRH-a combined with gonadotropins permitted the retrieval of good quality oocytes and had no effect on oocytes. The fertilization and pregnancy rates with this method are acceptable and its cost and tolerance is valuable for patients.
Semra Kahraman, Nacati Findikli,
Volume 2, Issue 1 (7-2004)
Abstract

Since its first clinical application in early 90s, preimplantation genetic diagnosis (PGD) has became a powerful diagnostic procedure in clinical practice for avoiding the birth of an affected child as well as increasing the assisted reproductive technologies (ART) outcome . The technique involves the screening of preimplantation embryos for chromosomal abnormalities in certain indications such as advanced maternal age, repeated abortions and translocations, or for single gene defects, the majority of which are cystic fibrosis and thalassaemias. In this context, it becomes an alternative option for traditional prenatal diagnosis. So far, more than 1000 unaffected babies have been born after PGD, indicating that the procedure is safe and effective in prevention of genetic defects as well as increasing the ART outcome. Besides its diagnostic value and expanding indications such as cancer predisposition, dynamic mutations and late onset disorders, a new feature, namely preimplantation human leuckocyte antigen (HLA) typing also demonstrates its novel therapeutic role in contemporary medicine. This article summarizes the recent status of PGD and discusses the current limitations and future perspectives associated with PGD techniques . Key Words:   PGD, ART,FISH
Afsaneh Khademi, Leili Safdarian, Ashraf Alleyassin, Marzieh Agha-Hosseini, Ehsan Akbari Hamed, Hojatollah Saeidi Saeidabadi, Omid Pooyan,
Volume 2, Issue 2 (7-2004)
Abstract

Background: The etiologic cause in near one third of male factor infertility is unknown. The percentage of men with idiopathic infertility who have been successfully treated by the empirical therapeutic modalities is not high. Objective: The aim of this study was to assay the effect of L-carnitine on sperm parameters in patients who needs intracytoplasmic sperm injection (ICSI) as a method for infertility treatment. Materials and Methods: The study population consisted of 65 men (mean age± SD: 34.4 ± 6.07) presenting with primary infertility due to idiopathic oligoasthenoteratozoospermia. L-carnitine was prescribed 1gram orally every 8 hours for 3 months. Before and after the ending of the L-carnitine treatment, semen analysis was performed. Results: The proportion of patients who had motile and grade C sperms rose significantly after treatment. Percentile of abnormal shaped sperms decreased significantly after treatment. In approximately 22%, complete asthenozoospermia changed to relative asthenozoospermia. Conclusion: Appearing motile sperms will potentially improve the technique of ICSI. The magnitude of the elevation in normal morphology is not clinically obvious, but it seems that it can be important in obtaining normal-shaped sperms for intracytoplasmic injection. Designing a study on selected patients with complete asthenozoospermia who have not other abnormalities in semen parameters can reveal the real effect of carnitine therapy in this category. Article
Razieh Dehghani Firouzabady, Irandokht Mehri Mahani, Mehdi Dehghani Firouzabady,
Volume 2, Issue 2 (7-2004)
Abstract

Background: Embryo transfer has received little clinical attention and has been the most inefficient step in in-vitro fertilization (IVF). Recent reports have suggested that an awareness of the position and length of the uterus during embryo transfer might be helpful in improving pregnancy rate. Objectives: The main objective of the present study was to determine the relation between the length and position of the uterus during embryo transfer and pregnancy rate. Materials and Methods: Patients were randomly allocated to two groups. In case group A (n=40) length of uterus was measured at the day of oocytes collection and the position of uterus was determined. In the control group, Group B, (n=40) the length and position of uterus were not investigated. The embryo transfer catheter was advanced to 5 mm from uterine fondues based on the previously determined cavity length in group A. The embryo transfer procedures ( IVF/ICSI) at 48 hours after oocytes collection was done. The outcome of the treatment cycle in two groups was investigated. Data analysis was performed by using chi-square, fisher-exact and ANOVA tests. The statistical significant was defined (P?0.05). Results: There were no significant differences in the mean age (28.5+4.4, 27.8+6.2), and duration of infertility (7+3.4, 8.7+5.4). The pregnancy rate was not significantly different with respect to position and length of uterus. The pregnancy rate in case groups was 25% and in control group was 22.5%, the difference was not significant (P= 0.792). In both groups, there were ectopic peregnancy and in fact he incidence of ectopic pregnancy, per reported clinical pregnancy, was highest in group A (14.9%) in comparison with group B (1.8%). Conclusion: The pregnancy rate was not significantly different in the two groups. Misdirecting the embryo transfer can not be avoided by an accurate knowledge of the position or length of uterine at the time of oocytes retrieval. Further studies are required to evaluate the role of length and position of uterus related to the pregnancy rate. Article
Mohammad Ghafourzadeh, Mojgan Karimi, Mohammad Ali Karimazadeh, Mahshid Bokai,
Volume 2, Issue 2 (7-2004)
Abstract

Background: Infertility affects about 10-15% of reproductive-age couples. About half the causes of infertility are female related and approximately 40% of the cases are caused by anovulation, mostly in PCO women. Objective: This study was conducted to determine and compare the effects of two drug treatment regimens: higher dose of clomiphene and a combination of lower dose of clomiphene and tamoxifen in treating infertile women with PCO. Materials and Methods: The study was a randomized clinical trial conducted on 100 infertile patients who referred to Yazd-Iran Infertility Clinic between the years 2001-2003. The patients were selected who had received at least 3 periods of clomiphene, but no pregnancy had occurred. They were randomly divided into two groups. In the first group, clomiphene was increased to 100 mg and the second group 20 mg of tamoxifen was added to 50 mg of clomiphene from day 5-9 of menstruation cycle. Infertility duration, duration of medicine used, PCT score, endometrial thickness, ovulation, and pregnancy rate were studied in both groups. Results: Ovulation rate in clomiphene group was 54.9%; Tamoxifen + clomiphene group was 73.5% without significant differences in both groups. (PV = 0.053). Positive pregnancy rate in clomiphene group was 39.2%; clomiphene + tamoxifen group was 61.2% (P value < 0.05), which could be concluded that pregnancy rate was higher in clomiphene/tamoxifen group than in the clomiphene group. The presence of a dominant follicle in the two treatment groups in women between 18-24 was not significant, but in women between 25-39 years was significant (PV= 0.049) (Table III). Conclusion: The recommendation is to add Tamoxifen to Clomiphene in 35-39 women with 20? BMI ?26.99 before the use of gonadotropins treatment in PCOS with or without IUI, because these options have higher risk of multiple pregnancy and ovarian hyperstimulation syndrome. Article
Robab Davar, Abbas Aflatoonian,
Volume 2, Issue 2 (7-2004)
Abstract

Background: In patients with anovulatory infertility the first choice of treatment for ovulation induction is an antiestrogen, most commonly clomiphene citrate (CC). However, 20-25% of the women are resistant to CC and do not ovulate perhaps due to antiestrogenic mechanism of the CC action, which involves long-lasting estrogen receptor (ER) depletion. Objective: The objective of the study was to mimic the action of CC without depletion of ERs by the administration of an aromatase inhibitor letrozole in a selected group of Poly Cystic Ovary (PCO) patients who demonstrated failure to ovulate after treatment with CC. Materials and Methods: 20 patients with anovulation due to polycystic ovary syndrome (PCOS), who had previously inadequately responded to CC were selected for study. The aromatase inhibitor letrozole was administered orally in a dose of 2.5 mg on days 3-7 of the menstrual cycle. Then, occurrence of ovulation, endometrial thickness, and pregnancy rates were determined. Result(s): Only one patient had one dominant follicle (1.8 cm diameter) on day 14 of the cycle (estradiol = 200 pg/ml). IUI was done; however, no pregnancy took place. In the remaining cases, several sonographies were done between days 9 to 15 of the cycle; however, all cycles were cancelled due to absence of a dominant follicle (>1.4 cm). Conclusion(s): Our study did not confirm the favorable effect of letrozole for induction of ovulation in patients with clomiphene resistant PCO. Article

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