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Ensieh Shahrokh Tehrani Nejad1, Tayebeh Naderi, Shohreh Irani, Elham Azimi Nekoo,
Volume 5, Issue 4 (7-2007)

Background: Mullerian disorders are present in 5-25% of infertile women. Myoma, polyp and endometrial adhesions are among other involved factors in infertility.
Objective: The aim of this study was to determine the frequency distribution of pregnancy occurrence in infertile women after the diagnostic-surgical hysteroscopy on selected infertile cases including those with abnormal uterine.
Materials and Methods: One hundred and fifteen women with at least 12 months infertility who had abnormal uterine cavity and patients who had at least 4 unsuccessful ART cycles with no confirmed diagnosis of uterine cavity problem, underwent diagnostic hysteroscopy and if required hysteroscopic surgery. Follow up sonography and HSG performed 2-3 months later and all subjects were followed for pregnancy occurrence for 12 months.
Results: Mean age of subjects was 32.65 ± 6.2 years and mean of infertility duration was 8.33 ± 5.25 years. Based on the sonography and HSG performed prior to the hysteroscopy, respectively 69.6% and 41.8% of the subjects had abnormality. In 65.2% of the cases, hysteroscopy showed septum, myoma, endometrial adhesion and irregularity and all of them underwent hysteroscopic operation. Among the operated cases, in 27 cases pregnancy occurred during the first 6 postoperative months and in 2 cases during the second 6 postoperative months of whom one case was EP. Conclusion: There was no significant difference in the rate of pregnancy occurrence between those who had abnormal hysteroscopy and those who were normal (p= 0.63). This can show the variation of infertility causes and the fact that infertility is not just due to uterine problems. Therefore, the repetition of therapeutic measures and longer follow up of infertile cases are necessary.
Mohammadreza Ghadir, Abolfazl Iranikhah, Mahboubeh Jandaghi, Farahnaz Joukar, Massih Sedigh-Rahimabadi, Fariborz Mansour-Ghanaei,
Volume 9, Issue 2 (7-2011)

Background: Celiac sprue (gluten sensitive enteropathy) is an autoimmune disease which is hereditary and its pathology mainly bases on immunologic intolerance to gluten. It has a vast variety of signs and symptoms and its clinical features range from a silent disease to a typical gastrointestinal disorder. In this study we reviewed and summarized some other related issues about this disease and its relation with infertility.
Case: The case is a 26 years old lady who had referred to a gynecologist because of infertility for 2 years and later it revealed that she has celiac sprue. Conclusion: Screening for its silent or subtle types especially among suspicious cases such as unexplained infertility seems to be a cost effective action. Meanwhile, in time administration of a gluten-free diet can lead to an almost complete cure.
Seyed Alireza Sobhani, Zahra Etaati, Sepideh MIrani, Paknoosh Saberi, Mahnaz Shiroodi , Hojjat Salmasian, Nadereh Naderi,
Volume 9, Issue 3 (7-2011)

Iron deficiency anemia (IDA) is a common problem in many developing countries. It is still considered the most common nutrition deficiency worldwide. Apart from its direct hematologic importance, IDA affects cellular and humoral immunity and predisposes the host to infections (1).
Pregnant women are highly prone to IDA. Controversial results are reported in studies targeting this group of patients. Tang et al showed a direct association between hemoglobin concentration and the count of CD4+ T-cell lymphocytes, serum levels of IL-2 and IgG, and an inverse association with susceptibility to infection (2). Ironically, Leush et al reported an increase in IgM and IgG in the second and third trimesters of pregnancy in women with IDA (3).
With regard to controversial results and the scarcity of studies focusing on pregnant women, we aimed to enlighten the relation between iron status and some immunological factors include some component of complement system, IgA, IgM, IgG subclasses of immunoglobulins and pro-inflammatory cytokines during the third trimester of pregnancy.
In a descriptive-analytic study participants  were recruited using convenient sampling from  the   women   in  the  third  trimester  of  pregnancy referred to the labor room of gynecology and obstetrics ward of Dr. Shariati Hospital of Bandar Abbas, Iran. Patients with signs and symptoms of thalassemia, infectious diseases or autoimmune diseases were excluded.
IDA were defined with two criteria, hemoglobin concentration of less than 10 mg/dL (its normal range during the third trimesters of pregnancy is 11-14mg/dL) (4) and ferritin less than 40 ng/dL. Patients were categorized into two groups: those with iron deficiency anemia (IDA) and those without this condition (no IDA).
Red cell indices including hemoglobin (Hb) levels, hematocrit (HCT), mean corpuscular volume (MCV), red blood cell distribution width (RDW), and mean corpuscular hemoglobin (MCH), serum iron (SI) and total iron binding capacity (TIBC), concentration of ferritin, C3 and C4 complements and IgA, IgM and IgG subclasses of immunoglobulins were determined. Data was analyzed using SPSS version 11.5 using Student t-test, Pearson’s correlation test and Kolmogorov-Smirnov’s test of normal distribution.
Ninety-two patients were studied. They were aged between 15 and 42 years (mean=25.69±6.2). According to our definition of IDA in pregnancy, 21 patients (22.8%) had IDA.
Our analysis of differences between the two groups in regard to immunologic markers showed that C4 levels are lower in the IDA group (p=0.009) and the levels of C3, IgM, IgG, IgA, IL-1, IL-6 and TNF-α were not statistically different in the two groups .
We noticed that higher levels of serum iron are correlated with higher levels of C3, C4 and IgG1. Due to important properties of IgG1 like complement fixation and opsonic activity, this subclass is dominant antibody to pneumococcal capsular polysaccharides and its deficiency is associated with current infections (5). Taken together noticing key roles of C3, C4 in complement-mediated bacteriolysis, opsonization, facilitated ingestion immune adherence (6) and association of C3, C4 with Iron serum levels found in this study we suggest that decreased level of Iron increases susceptibility of pregnant women to infections like chronic bacterial respiratory infections and recurrent genital herpes (5). Analyzing immunologic parameters differences between the two groups of IDA and no IDA we found that C4 levels are lower in the IDA group but not the levels of C3, IgM, IgG, IgA, IL-1, IL-6 and TNF-α .Our findings about IgM, IgG, IgA are in contradiction to scanty studies in this field. Tang et al (2) about significantly lower level of IgG, CD3+ and CD4+ cells, the ratio of CD4+/CD8+cells, serum IL-2 in second trimester of IDA pregnant woman and Leush et al (3) study showed increase of IgM and IgG in second and third trimesters of IDA groups.
Our findings about non-significant difference in C3 and significant difference in C4 levels in IDA and no IDA groups is  in agreement with Galan et al report about significantly positive correlation of C4 IgA, IgM and Serum ferritin (7). Despite of mounting evidence that TNF, IL-1, and IL-6 cytokines affect hemopoiesis and iron metabolism there was no significant association between IL-1, IL-6 and TNF-α and serum Iron, ferritin, TIBC in our study and inflammatory cytokines were statistically indifferent in the two IDA and no IDA groups. To our knowledge, there are no reports on inflammatory cytokine levels and Iron parameters in pregnant women, but a limited number of reports exploring this field in children and adults.
Bergman et al  which analyzed the in vitro production of IL-1beta, IL-2, IL-6, IL-10, and TNF-α by peripheral blood mononuclear cells from 20 patients with IDA report that  the secretion of the cytokines other than IL-2 did not differ from that of controls (8). In another study there was no difference in serum levels of IL-6 in iron deficiency anemia before and after iron supplementation in children with IDA but in the iron-deficiency group the production of IL-2 was found to be significantly lower than that in controls and became normal after iron supplementation (9). Safuanova et al work about adequate therapy by iron-containing drugs in IDA patients  resulted  in decreased concentrations of IL-1, IL-6, TNF-alpha and INF-gamma and recovering the functional status of the immune system (10). It is possible that discrepancy seen between our results and mentioned reports in non-pregnant patients is a reflection of dramatic change of immune function in pregnancy.
Analyze of the results of our study and similar researches leads us to the conclusion that  unlike extensive immunological changes have been observed in children, IDA has little effect on humoral immunity system of pregnant women, but decrease in  serum iron could predispose them to pyogenic infection  and may predict  increased susceptibility IDA pregnant women to infections.
Shohreh Irani, Firoozeh Ahmadi, Maryam Javam, Ahmad Vosoughtaghi Dizaj, Fatemeh Niknejad,
Volume 13, Issue 9 (10-2015)

Background: Several studies have assessed the correlation of fetal choroid plexus cyst (CPC) and the risk of congenital anomalies, but few ones have discussed isolated CPC (with no other abnormal sonographic finding).
Objective: The aim of this study was to determine the outcome of isolated fetal choroid plexus cyst and to specify its clinical significance.
Materials and Methods: This cross sectional study was carried out at Royan Institute in Tehran, Iran, between April 2009 and December 2012. All prenatal sonographies in this period of time were assessed using a computerized database and fetuses who had isolated CPC were recruited in the study. Sonography reports, mother serum screening test results, fetal echocardiography and amniocentesis were evaluated until birth. A follow-up phone call was made to all individuals to learn about the neonatal outcomes.
Results: Overall, 6240 prenatal sonographies were performed in this setting during this period. Isolated CPC was detected in 64 fetuses. The results of double test (N=30), triple test (N=5) and fetal echocardiography (N =24) were normal. Quadruple test result showed 3 abnormal out of 29 cases that all had normal karyotypes. Four samples were dropped out due to premature rupture of membranes (N=3) and intrauterine fetal death (N=1). It was found that the outcomes of all remaining fetuses (N=60) were normal and no anomaly ones were seen until birth.
Conclusion: Isolated CPC is a benign regressive condition with no clinical significance.
Mehran Dorostghoal, Hamid-O-Allah Ghaffari, Nahid Shahbazian, Maryam MIrani,
Volume 15, Issue 1 (1-2017)

Background: Endometrial receptivity plays a key role in the establishment of successful implantation and its impairment may contribute to subfertility and limit the assisted reproduction techniques (ART) success.
Objective: The aim of present study was to investigate endometrial receptivity in terms of β3 integrin, calcitonin and plexin-B1 expression in women with unexplained infertility.
Materials and Methods: We evaluated expression of β3 integrin, calcitonin and plexin-B1 through mRNA level measurement with real-time RT-PCR, in the endometrium of 16 infertile patients with unexplained infertility and 10 fertile women. Endometrial biopsies were collected during a single menstrual cycle on postovulatory day LH+7 in each subject.
Results: Significant differences regarding β3 integrin and calcitonin expression levels found between patients with unexplained infertility and the fertile women. Endometrial plexin-B1 expression levels showed no significant difference between fertile and infertile women. There were significant correlations between expression of β3 integrin with calcitonin and plexin-B1 in fertile and infertile women.
Conclusion: Reduced in endometrial expression of β3 integrin and calcitonin alone or together may contribute to unexplained infertility and these genes could account as the potential molecular markers of infertility
Masoud Mirzaei, Nasim NamIranian, Razieh Dehghani Firouzabadi, Somaye Gholami,
Volume 16, Issue 11 (November 2018)

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.

Jam Ashkezari, Nasim NamIranian, Somaye Gholami, Maryam Elahi, Masoud Rahmanian,
Volume 17, Issue 2 (February 2019 2019)

Anti-Müllerian hormone (AMH) is made by the granulosa cells of preantral and small antral follicles which blocks the transition from the primordial to the primary follicular stage. Metformin may be associated with a decrease in AMH serum level and antral follicles in women who suffer from polycystic ovary syndrome (PCOs)
It was reported that metformin in women with polycystic ovary syndrome (PCOs) is associated with a decrease in both AMH serum level and antral follicles.
The objective of the current letter was the evaluation of the effects of metformin on hormonal profile of women with PCOs. In this prospective, randomized, doubleblind controlled clinical trial, 42 women (aged 17–45 yr) with PCOs who were randomly allocated to receive 500 mg Metformin orally three times a day or placebo for three months were included. Fasting plasma glucose, follicular stimulating hormone, luteinizing hormone (LH), prolactin (PRL), testosterone and AMH levels were measured at baseline and at the end of the period. In this study, independent and paired t-test were used for quantitative comparison and chi-square analysis for qualitative variables. Logistic regression analysis was done to identify independent risk factors, and Pvalue of lower than 0.05 were considered significant. All of the statistical analyses were done by SPSS software, version 20.0. We didn’t find any significant change after the study between treatment and control groups in hormonal profiles especially AMH. However, in subgroup analysis, we revealed that AMH and LH levels decreased significantly in normal weight patients (p= 0.024, 0.048, respectively) and prolactin levels in subgroup of overweight patients (p= 0.001). Moreover, patients in metformin group at the end of study had more regular menses, more weight loss, and lower hair loss (p= .001, 0.04, 0.014, respectively). Women with PCOs have elevated levels of LH that is secondary to increased sensitivity of pituitary to GnRH. Increased levels
of LH lead to hyperandrogenism. Metformin can improve this condition. In this study, we observed that LH was decreased significantly in the metformin group of PCOs patients (p= 0.05). It is in agreement with some of the previous studies, however, De Leo and et al. reported a non-significant decrease in LH levels after treatment with metformin (1). Pieces of evidence showed that AMH levels in PCOs patients are 2 to 3 times higher than age-matched normal women (2), and this condition is a marker for PCOs and can be a surrogate test of hyperandrogenism (3). Metformin in our study improved the irregularity in the menstrual cycle (p< 0.001), hair loss (p= 0.014), and prolactin secretion (p= 0.024), as well as LH secretion (p= 0.05); however, it didn’t show any significant decrease on AMH levels. Metformin can reduce ovarian volume in PCOs patients especially in hyperinsulinemic subgroups (4); however, we observed that in normal weight subgroup of patients, metformin decreased AMH significantly (p= 0.024), and in overweight or obese patients, prolactin decreased in response to metformin, significantly (p= 0.001). Moreover, metformin leads to improvement in follicular development with fewer percentage of preantral follicles and cysts and higher percentages of antral follicles (5). Considering these pieces of evidence, it seems that AMH after metformin treatment in PCOs patients was secret in comparable amounts of pretreatment; however, the source of secretion after starting metformin is different from pretreatment and switched from small follicles and cysts to more developed follicles and structures such as antral follicles and corpora lutea. Further investigations that can differentiate secreted AMH from a different source will shed more light on this field. The most important limitation of our study is the small sample size. GI side effects of metformin caused some patients in metformin group to refuse getting the treatment. Studies with more attendants can display the difference between different phenotypes of PCOs patients in response to metformin. In conclusion, this study showed that
metformin can cause favorable effects on the hormonal profile of PCOs patients, and although AMH levels were not decreased significantly, menstruation improved in the treated group.
The most important limitation of our study is the small sample size. GI side effects of metformin caused some patients in metformin group to refuse getting the treatment. Studies with more attendants can display the difference between different phenotypes of PCOs patients in response to metformin. In conclusion, this study showed that metformin can cause favorable effects on the hormonal profile of PCOs patients, and although AMH levels were not decreased significantly, menstruation improved in the treated group.
Morteza Motedayen, Mohammad Rafiei, Mostafa Rezaei TavIrani, Kourosh Sayehmiri, Majid Dousti,
Volume 17, Issue 7 (July 2019 2019)

Background: One of the causes of maternal and fetal mortality and morbidity is pregnancy-induced hypertension, the most common form of which is preeclampsia that causes many complications for mother and fetus.
Objective: The aim of this systematic review and meta-analysis was to determine the relationship between body mass index (BMI) and preeclampsia in Iran.
Materials and Methods: Using valid keywords in the SID database, PubMed, Scopus,data obtained from all the articles, which were reviewed in Iran between 2000 and 2016, were combined using the meta-analysis method (random-effects model) and
analyzed using STATA version 11.1.
Results: A total number of 5,946 samples were enrolled in 16 studies with the mean BMI values of 25.13, 27.42, and 26.33 kg /m2 in the healthy, mild, and severe preeclamptic groups, respectively.
Conclusion: The results of this study revealed that there is a significant relationship between BMI and the risk of preeclampsia, so it can be said that BMI may be one of the ways to diagnose preeclampsia.

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