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Showing 8 results for Salehpour

Saghar Salehpour, Maryam Tamimi, Nasrin Saharkhiz,
Volume 11, Issue 11 (12-2013)

Background: Luteal phase support is mandatory in ART (Assisted Reproductive Technologies) for optimizing outcome, so the luteal phase is supported with either progesterone, addition of estradiol to progesterone, hCG or gonadotropin releasing hormone (GnRH) agonists. Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment.
Objective: To compare oral dydrogestrone with vaginal progesterone for luteal-phase support in IVF.
Materials and Methods: We performed this prospective, randomized trial in a tertiary infertility care unit in Taleghani hospital, Tehran, Iran. 80 Women with a history of male factor infertility undergoing controlled ovarian stimulation for IVF treatment (fresh cycle) randomly were divided in two groups (group A or oral dydrogesterone group and group B or vaginal progesterone group). The inclusion criteria were the use of GnRH analogue down-regulation and less than 40 years old with regular menstrual cycles. All women were euthyroid and normoprolactinemic. Group A (n=40) received 10 mg dydrogesterone QID (40mg daily) and group B (n=40) received 400 mg suppository vaginal Progesterone (cyclogest) twice per day (800 mg daily).
Results: Clinical pregnancy rate in cyclogest group was higher than dydrogesterone group but the difference was not significant (p=0.52), furthermore the miscarriage rate in two group was the same .The difference between two groups regarding antral follicle, embryo number, luteal-phase duration, endometrial thickness ,oocyte number and metaphase-II was not significant (p>0.05).
Conclusion: The results showed that oral dydrogesterone is as effective as vaginal progesterone for luteal-phase support in women undergoing IVF.
Saghar Salehpour, Nasrin Saharkhiz, Aida Moeini, Anahita Enzevaei,
Volume 11, Issue 12 (1-2013)

One of the most common endocrine disorders in women of reproductive age is polycystic ovary syndrome (PCOS) which its prevalence is reported around 6.5-8% (1). Some clinical trials assessed association between PCOS and other autoimmune related endocrinopathies such as impaired glucose tolerance (IGT), type 2 diabetes mellitus and thyroid dysfunction with controversial results (2). Some investigators showed increase level of serum antiovarian antibodies in the half of affected women (3, 4). However, the exact mechanism of autoimmune processes in PCOS pathogenesis is remained to be fully elucidated. Autoimmune thyroid disorder including hashimoto’s thyroiditis also has been shown to have correlation with PCOS (5). According to Janssen’s et al study the prevalence of autoimmune thyroiditis (AIT) was three times higher in patients with PCOS compared with control group (6). The cause of this high incidence is open to speculation. Genetic defect was assumed to predispose persons to AIT as well as PCOS. Both disorders seem to have an oligo-genetic background (5, 7). To date, a common genetic background has not been found. Gleicher et al hypothesized that development of PCOS could be attributed to functional autoantibodies including thyroid autoantibodies [anti-thyroid peroxidase antibodies (anti-TPO), and thyroglobulin antibodies (TG-Ab)] (8). Ott et al reported a poor treatment response in infertile PCOS women with elevated anti-TPO levels (9). In a cross-sectional study at Infertility and Reproductive Health Center (IRHRC), we evaluated serum level of thyroid function tests (TFT) including autoantibodies and to assess their relation with other characteristic and hormonal parameters of PCOS. A total of seventy five women with average age of 26 years who fulfilled the 2003 Rotterdam Criteria underwent gynecologic evaluation and blood sampling between January 2009 and December 2011. The mean±SD of serum anti-TPO in Ott et al, Ganie et al, Kachuei et al, Janssen et al and our study were 52.2±98.5, 321.4±189.6, 216±428, 123±328, and 41.06±91.18 IU/ml respectively (5, 6, 9, 10). The wide range of reported values could be attributed to different type of laboratory assessment, value of cut point and heterogeneity of selected patients. About fifteen percent of our patients were anti-TPO positive; the reported range of positive anti-TPO percentage was 15 to 30 in different studies (5, 6, 9, 10 and present study). In fact, the observed ratio in our research is lower than Kachuei’s study which held in a same country (5). In that research, authors did not find difference in rate of positivity between PCOS and control group. Percentage of anti-TPO positivity in Ganie et al and Janssen et al in normal women were zero and eight percent respectively (6, 10). In our study, presence or absence of anti-TPO did not have a major influence on the characteristics and hormonal values of the PCOS patients; only hip circumference and estradiol level were significantly higher in anti-TPO positive cases. In another study this difference was observed for hypoechoic ultrasound pattern, patient’s age and LH to-FSH-ratio. Ott et al suggested that anti-TPO could be a good predictive marker for treatment response in infertile women with PCOS (9). They reported a higher anti-TPO level in patients who were resistant to clomiphene citrate treatment. TSH level in our PCOS patients was 3.16±3.55 mU/l; other investigators report its value between 2 and 3 mU/l. We did not find any difference in biochemical and hormonal serum values of patients between euthyroid and hypothyroid ones. TSH level in PCOS patients and control subjects did not differ significantly in Ganie et al, Kachuei et al researches which is in contrast to the results of Janssen and colleagues (5, 10). High prevalence of thyroid autoimmunity in PCOS women of reproductive age brings this question in our mind that is it necessary to screen these patients for hypothyroidism? Due to increased risk of morbidity in hypothyroid mother and her newborn, it seems logical to assess thyroid function test in suspicious patients. To have a proper answer for this question, however, several prospective researches should be conducted with more number of participants in a longer follow up period. Based on our data, it is more likely to see a disturbance in serum values of thyroid function test and autoantibodies in women with PCOS. We recommend evaluation of these parameters by longitudinal cohort studies with more number of cases and a longer follow up period.
Anahita Enzevaei, Saghar Salehpour, Maryam Tohidi, Nasrin Saharkhiz,
Volume 12, Issue 7 (8-2014)

Background: Polycystic ovary syndrome (PCOS) is the most common hyperandrogenic disorder among women and is often defined as hyperandrogenic syndrome. These patients are at risk for oligo/amenorrhea, chronic anovulation, infertility, obesity, spontaneous abortion, insulin resistance, hyperinsulinemia and metabolic syndrome. Thyroid disorders especially hypothyroidism is more common in these people. In PCOS patients, subclinical hypothyroidism may aggravate insulin resistance.
Objective: The goal was to find any relationship between subclinical hypothyroidism and insulin resistance in PCOS patients.
Materials and Methods: In this prospective cross sectional study we included all PCOS patients coming to infertility clinic of Taleghani Hospital in 2010-2012 who had the criteria of Rotterdam for PCOS. Then the clinical examination was done for them and height, weight, body mass index and lab data were measured including thyroid hormone and biochemical profile. The data were analyzed by SPSS software version 20.
Results: Among 75 PCOS patients, 19 (25.5%) had subclinical hypothyroidism and 56 patients (74.4%) were euthyroid. The prevalence of insulin resistance was 22.7% and 77.3% of patients had no insulin resistance were normal.
Conclusion: We could find no relationship between insulin resistance and subclinical hypothyroidism in PCOS patients.
Nasrin Saharkhiz, Azadeh Akbari Sene, Saghar Salehpour, Maryam Tamimi, Masoumeh Vasheghani Farahani, Kourosh Sheibani,
Volume 12, Issue 10 (11-2014)

Background: The beneficial role of cabergoline as a prophylactic agent to prevent ovarian hyper stimulation syndrome (OHSS) among high-risk patients has been demonstrated in previous studies. But data for its role as a treatment for established severe OHSS is still limited. We represent the treatment results of high dose oral cabergoline in management of six patients after the syndrome is established.
Case: High-dose oral cabergoline (1 mg daily for eight days) was prescribed as an adjuvant to symptomatic treatment for six hospitalized patients with established severe OHSS following infertility treatment cycles. In two cases OHSS resolved rapidly despite the occurrence of ongoing pregnancy.
Conclusion: Considering the treatment outcomes of our patients, high dose cabergoline did not eliminate the need for traditional treatments, but it was a relatively effective and safe therapy in management of established severe OHSS, and prevented the increase in its severity following the occurrence of pregnancy.
Nasrin Saharkhiz, Saghar Salehpour, Mahboobeh Tavasoli, Ali Aghighi,
Volume 13, Issue 2 (2-2015)

Background: Premature luteinization during in vitro fertilization was commonly happened before the introduction of GnRh analogues. High level of unwanted progesterone is associated with adverse pregnancy outcome and is thought to be induced by inappropriate LH elevation.
Objective: To evaluate the progesterone level on the day of Human Chorionic Gonadotropin (HCG) triggering in GnRh agonist and antagonist protocols, and its correlation with clinical pregnancy rate and miscarriage rate.
Materials and Methods: One hundred and seven women underwent intracytoplasmic sperm injection with long agonist protocol (n=46) or antagonist protocol (n=61). Blood sample was obtained from each patient for progesterone level measurement in HCG administration day, then patients were divided into two groups according to their serum progesterone levels on the HCG triggering day: progesterone level <1.2 ng/ml, and progesterone level ≥1.2 ng/ml. Clinical pregnancy and miscarriage rates were evaluated as main outcomes and biochemical pregnancy rate and implantation rate were considered as secondary outcomes.
Results: The increased prevalence rate of premature progesterone (progesterone level ≥1.2 ng/ml) in total patients was 13.1% (14/107) and in long agonist protocol group and antagonist protocol group was 15.2% (7/46) and 11.5% (7/61) respectively. Premature progesterone rise had no significant correlation with clinical pregnancy rate in total patients (p=0.174), agonist protocol (p=0.545), and antagonist protocol (p=0.129). Also premature progesterone rise had no significant association with miscarriage rate in total patients (p=0.077), agonist protocol group (p=0.383) and antagonist protocol group (p=0.087).
Conclusion: A significant rise in progesterone levels at the time of HCG triggering doesn’t lead to decrease in pregnancy rate and implantation rate and increase in miscarriage rate.
Saghar Salehpour, Marzieh Zamaniyan, Nasrin Saharkhiz, Shahrzad Zadeh Modares, Sedighe Hosieni, Samira Seif, Narges Malih, Parinaz Rezapoor, Mohammad-Reza Sohrabi,
Volume 14, Issue 9 (9-2016)

Background: Recurrent implantation failure is one of the most issues in IVF cycles.Some researchers found that beneficial effects of endometrial Scratching in womenwith recurrent implantation failure, while some authors demonstrated contrary results
Objective: The present study aimed to investigate the effect of intrauterine. Salineinfusion as a form of endometrial injury, during fresh in vitro fertilization-embryotransfer cycle, among patients with recurrent implantation failure.
Materials and Methods: In this clinical trial study 63 women undergoing assistedreproductive technology were divided into two groups either local endometrialinjury by intrauterine saline infusion during day 3-5 of the ongoing controlledovarian stimulation cycle, or IVF protocol performed without any other interventionin Taleghani Hospital, Tehran, Iran. The main outcome measure was clinicalpregnancy rates.
Results: Patients who received intra uterine saline infusion (n=20), had significantlylower clinical pregnancy numbers (1 vs. 9, p<0.05) and implantation rates (4.7% vs.41.6%, p<0.05), compared to controls (n=39). However, there was no significantdifference in miscarriage rates (9.4% vs. 8.7%, p>0.05) and multiple pregnancynumbers (1 vs. 3, p>0.05) between groups.
Conclusion: When intrauterine saline infusion as a form of endometrial injury isperformed during the ongoing IVF cycles it has negative effect on reproductiveoutcomes among patients with recurrent implantation failure.
Leila Nazari, Saghar Salehpour, Sedighe Hoseini, Shahrzad Zadehmodarres,
Volume 14, Issue 10 (10-2016)

Background: Repeated implantation failure (RIF) is a major challenge in reproductive medicine and despite several methods that have been described for management, there is little consensus on the most effective one.
Objective: This study was conducted to evaluate the effectiveness of platelet-rich plasma in improvement of pregnancy rate in RIF patients.
Materials and Methods: Twenty women with a history of RIF who were candidates for frozen-thawed embryo transfer were recruited in this study. Intrauterine infusion of 0.5 ml of platelet-rich plasma that contained platelet 4-5 times more than peripheral blood sample was performed 48 hrs before blastocyst transfer.
Results: Eighteen participants were pregnant with one early miscarriage and one molar pregnancy. Sixteen clinical pregnancies were recorded and their pregnancies are ongoing.
Conclusion: According to this study, it seems that platelet-rich plasma is effective in improvement of pregnancy outcome in RIF patients
Leila Nazari, Saghar Salehpour, Sedighe Hoseini, Shahrzad Zadehmodarres, Eznoallah Azargashb,
Volume 17, Issue 6 (June 2019 2019)

Background: Adequate endometrial growth is principal for implantation and pregnancy. Thin endometrium is associated with lower pregnancy rate in assisted reproductive technology. Some frozen-thawed embryo transfer cycles are cancelled due to inadequate endometrial growth.
Objective: To assess the effectiveness of autologous platelet-rich plasma (PRP) intrauterine infusion for the treatment of thin endometrium.
Materials and Methods: A total of 72 patients who had a history of cancelled frozenthawed embryo transfer cycle due to the thin endometrium (< 7mm) were assessed for the eligibility to enter the study between 2016 and 2017. Twelve patients were excluded for different reasons, and 60 included patients were randomly assigned to PRP or sham-catheter groups in a double-blind manner. Hormone replacement therapy was administered for endometrial preparation in all participants. PRP intrauterine infusion or shamcatheter was performed on day 11-12 due to the thin endometrium and it was repeated after 48 hr if necessary.
Results: Endometrial thickness increased at 48 hr after the first intervention in both groups. All participants needed second intervention due to an inadequate endometrial expansion. After second intervention, endometrial thickness was 7.21 ± 0.18 and 5.76± 0.97 mm in the PRP group and sham catheter group, respectively. There was a significant difference between the two groups. (p < 0.001). Embryo transfer was done for all patients in PRP group and just in six cases in the sham-catheter group. Chemical pregnancy was reported in twelve cases in the PRP group and two cases in the shamcatheter group.
Conclusion: According to this trial, PRP was effective in endometrial expansion in patients with refractory thin endometrium.

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