General Gynecology and Pelvic Floor
Mahnaz Ashrafi; Behnood Farazmand; Souzan Soufizadeh Balaneji; Maryam Dadkhah
Articles in Press, Accepted Manuscript, Available Online from 01 October 2023
Abstract
Background: Polycystic ovarian syndrome (PCOS), the most common cause of infertility, is widely treated with clomiphene citrate and human gonadotropins. Letrozole, an aromatase inhibitor, can also induce ovulation in patients resistant to clomiphene. However, there has been no comprehensive study comparing ...
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Background: Polycystic ovarian syndrome (PCOS), the most common cause of infertility, is widely treated with clomiphene citrate and human gonadotropins. Letrozole, an aromatase inhibitor, can also induce ovulation in patients resistant to clomiphene. However, there has been no comprehensive study comparing ovulation induction with clomiphene and letrozole versus clomiphene and human gonadotropin. This study aimed to compare an aromatase inhibitor with human gonadotropin for patients with clomiphene-resistant polycystic ovary syndrome. Methods: This randomized clinical trial was conducted on PCOS women resistant to clomiphene at Akbarabadi hospital, Tehran, Iran. Patients were randomly divided into two groups. The first group received letrozole and clomiphene citrate and the second received clomiphene citrate and human gonadotropin.Results: Total number of 120 patients enrolled in our study. No significant difference was seen between the two groups in terms of demographic and basic clinical characteristics (P>0.05). We also found no significant difference between the two groups in terms of hirsutism, galactorrhea, pregnancy rate, human chorionic gonadotropin (HCG) intake, primary and secondary infertility, and number of follicles (P>0.05). Conclusion: The combination of letrozole and clomiphene citrate was as effective as human gonadotropin and clomiphene citrate and it could be a treatment option for patients with infertility due to PCOS.Keywords: Clomiphene, Human menopausal gonadotropin, Letrozole, Polycystic ovary syndrome, Ovulation
Obstetrics and Gynecology
Fariba Seyedoshohadaei; Masomeh Rezaie; Nasrin Sofizadeh; farnaz zandvakili; Khaled Rahmani; Hosna liravi
Articles in Press, Accepted Manuscript, Available Online from 29 November 2023
Abstract
Introduction: This study aims to determine the effectiveness of simultaneous use of aspirin with clomiphene citrate and letrozole on the success rate of ovulation induction in women with PCOS.
Materials and methods: This study was a double-blind randomized clinical trial. 120 patients with PCOS with ...
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Introduction: This study aims to determine the effectiveness of simultaneous use of aspirin with clomiphene citrate and letrozole on the success rate of ovulation induction in women with PCOS.
Materials and methods: This study was a double-blind randomized clinical trial. 120 patients with PCOS with complaints of infertility due to lack of ovulation were randomly divided into four groups using clomiphene citrate + placebo, letrozole + placebo, clomiphene citrate + Aspirin, and letrozole + aspirin divided by block randomizes. Follicometry was performed with the help of transvaginal ultrasound on the 14th day of the cycle. In the case of a positive pregnancy, the patients underwent transvaginal ultrasound in the 6th week of pregnancy to observe the gestational sac. Patients were followed up until the 12th week of pregnancy in terms of the abortion rate.
Results: This study showed that there was no significant difference in the number of follicles of 14 to 18 mm, follicles larger than 18 mm, and the thickness of the endometrium of the studied women in the four investigated groups (p>0.05). The pregnancy test results showed that the clomiphene citrate + aspirin group and the letrozole + aspirin group each had the highest pregnancy rate with 13 people (36.1%) having a positive test.
conclusion: Although the addition of aspirin to letrozole or clomiphene citrate does not affect the number of mature follicles and the thickness of the endometrium, it can increase the probability of pregnancy.
General Gynecology and Pelvic Floor
Hadeer Mahmoud Hazem; Baydaa Hussein abed awn
Articles in Press, Accepted Manuscript, Available Online from 22 January 2024
Abstract
Background & Objective: This study's main objective was to establish physical characteristics (pH and flow rate) and dental caries experience among women with PCOS and to perform an assessment of dental caries relationship to salivary antioxidant biomarker (total antioxidant capacity and uric acid).Materials ...
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Background & Objective: This study's main objective was to establish physical characteristics (pH and flow rate) and dental caries experience among women with PCOS and to perform an assessment of dental caries relationship to salivary antioxidant biomarker (total antioxidant capacity and uric acid).Materials and Methods: There was 80 women in the study (40 female with PCOS and 40 healthy female served as controls) with ages ranging from 25 to 30 years and with a range of body mass indices 18.5-24.9 (normal weight). Unstimulated saliva was obtained. Both salivary pH and flow rate were discovered immediately. After that, saliva was subjected to biochemical analysis to determine salivary TAC and UA levels using ELISA method. Dental caries diagnosis and registration were assessed using WHO in 2013.Results: In the PCOS group, the mean salivary flow rate and pH were lower than in the control group, with a statistically significant difference (P<0.05). The salivary (TAC) and (UA) mean values were higher in the PCOS group than in the healthy females, with a statistically significant difference (P<0.05). while dental caries fractions was positively not significant correlated with total antioxidant capacity and uric acid in the study group except (DMFT) was positively significant correlated with antioxidant Parameter (TAC) (P< 0.05 ) and (DS and DMFT) were positively significant with uric acid among women with PCOS (P< 0.05).Conclusions: Furthermore, Salivary TAC and UA were elevated in PCOS which can be used in the future as indicators for the PCOS diagnosis.
Obstetrics and Gynecology
Fatemeh Davari Tanha; Mojgan Asadi; Zahra Shahraki; Zeinab Assaf; Zahra Kaveh; Mahsa Ghajarzadeh
Volume 9, Issue 2 , March and April 2024, , Pages 161-166
Abstract
Background & Objective: Sexual activity is a major determinant of health-related quality of life. The aim of this study was to investigate sexual activity in women with polycystic ovary syndrome.
Materials & Methods: A case control survey was conducted at a tertiary care university hospital ...
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Background & Objective: Sexual activity is a major determinant of health-related quality of life. The aim of this study was to investigate sexual activity in women with polycystic ovary syndrome.
Materials & Methods: A case control survey was conducted at a tertiary care university hospital (Yas Hospital Complex.). A total of 193 women were enrolled in this study. The Female Sexual Function Index (FSFI) questionnaire was used to assess the sexual dysfunction. In this study, 100 cases with PCOS and 93 healthy controls were studied.
Results: The mean FSFI total score and all domains except orgasm were significantly lower in PCOS patients as compared to healthy controls. With an FSFI score of less than 26.55, sexual dysfunction was found in 62% of PCOS cases versus 18.2% of the control group. Multiple regression analysis showed that FSH and free testosterone were independent predictors of FSFI score. The result showed that more than sixty percent of PCOS women suffer from sexual dysfunction.
Conclusion: PCOS women need to be asked about and managed for sexual dysfunction more frequently than non-PCOS women.
Reproductive Medicine
Mahrokh Abouali Gale Dari; Mona Keivan; Farideh Moramezi; Najmieh Saadati; Roshan Nikbakht; Maryam Farzaneh
Volume 8, Issue 4 , July and August 2023, , Pages 308-314
Abstract
Polycystic ovary syndrome (PCOS) is a hormonal disorder and a common health problem that affects women at the early to late reproductive stage. Several genetic and environmental factors such as obesity, liver diseases, imbalance of androgens, and menstrual dysfunction have contributed to the progression ...
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Polycystic ovary syndrome (PCOS) is a hormonal disorder and a common health problem that affects women at the early to late reproductive stage. Several genetic and environmental factors such as obesity, liver diseases, imbalance of androgens, and menstrual dysfunction have contributed to the progression of PCOS. Research has shown a link between diabetes, hypertension, miscarriages, and cardiovascular disease with PCOS. Experimental discoveries have begun to evaluate the mechanisms involved in PCOS. Although various classical interventions are used in the treatment of PCOS, current medications are not able to control outcomes of PCOS and the management of this syndrome is still challenging. Accumulating evidence showed that dysregulation of long non-coding RNAs (lncRNAs) is essential to PCOS pathogenesis. LncRNAs are a class of transcripts that mediate the process of gene expressions at the level of transcription and post-transcription. It has been found that lncRNA metastasis‐associated lung adenocarcinoma transcript‐1 (MALAT1 or nuclear-enriched abundant transcript 2 (NEAT2)) presents a vital role in regulating PCOS. MALAT-1 as a competing endogenous RNA (ceRNA) can suppress microRNAs (miRNAs) and decrease granulosa cell proliferation, apoptosis, and pathogenesis. Abnormal expression of MALAT1 is one of the prognostic factors for cell autophagy, migration, and drug resistance. MALAT1 can be used as a potential biomarker for treatment of PCOS. However, the exact roles of MALAT1 in granulosa cells of women with PCOS remain largely unknown and further studies are required to confirm its action. In the present article, we summarize the functions of the lncRNA MALAT-1/miRNA axes in women with PCOS.
Obstetrics and Gynecology
Hadeel Ali Mahamda; Reem Ali Haddad; Ameen Abdulhasan Al Alwany; Noora M. Hameed; Thulfeqar Ahmed Hamza
Volume 8, Issue 4 , July and August 2023, , Pages 366-373
Abstract
Background & Objective: An essential issue in obstetrics is the prevalence of maternal and fetal complications in pregnant women with polycystic ovary syndrome (PCOS). The purpose of the present study was to investigate the prevalence of pregnancy complications among various phenotypes of pregnant ...
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Background & Objective: An essential issue in obstetrics is the prevalence of maternal and fetal complications in pregnant women with polycystic ovary syndrome (PCOS). The purpose of the present study was to investigate the prevalence of pregnancy complications among various phenotypes of pregnant women with PCOS.Materials & Methods: In the current study, the pregnancy period of 143 women with PCOS who were referred to the Babylon teaching hospital in Iraq in 2021 was analyzed based on their medical records. These women were separated into two groups based on their PCOS-related clinical symptoms. People in the first group possessed a severe phenotype, while those in the second group possessed a mild phenotype. SPSS version 23 was utilized for comparing maternal and fetal complications during pregnancy and for data analysis.Results: Regarding maternal and fetal complications, there was a significant difference between the two groups regarding low birth weight (LBW) (P<0.05). In this study, there was no statistically significant difference between PCOS phenotypes and the incidence of gestational diabetes, preterm birth, or spontaneous abortion (P>0.05). In conclusion, women with a more severe phenotype are more likely to give birth to babies with low birth weight (LBW) (approximately 1.9 times).Conclusion: In clinical considerations of pregnant women with PCOS, it appears necessary to consider the disease's phenotype as one of the factors influencing fetal outcomes.
Reproductive Medicine
Zahra Rezaei; Mehrnaz Valadan; Pooneh Shojaee Asl
Volume 5, Issue 3 , November 2020, , Pages 84-87
Abstract
Background & objective: Insulin resistance can be seen in most overweight women with polycystic ovary syndrome (PCOS). Insulin resistance seems to play a key role in the pathophysiology of PCOS and infertility. This study aimed to evaluate the effects of insulin resistance on pregnancy rate ...
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Background & objective: Insulin resistance can be seen in most overweight women with polycystic ovary syndrome (PCOS). Insulin resistance seems to play a key role in the pathophysiology of PCOS and infertility. This study aimed to evaluate the effects of insulin resistance on pregnancy rate and regulation of the menstrual cycle following laparoscopic ovarian electrocautery (LOE).Materials & Methods: This prospective cohort study was conducted on 54 infertile metformin- and clomiphene citrate-resistant women with PCOS at Yas Hospital in 2007. These patients initially took a glucose tolerance test and then classified into two groups (i.e., insulin-resistant and non-insulin-resistant) based on the obtained results. Both groups, then, underwent LOE. Patients were evaluated for pregnancy rate and regulation of the menstrual cycle up to six months.Results: Out of 54 patients, 37 patients (68.5%) were non-insulin-resistant, and 17 patients (31.5%) were insulin-resistant. In the insulin-resistant group, after six months, menstrual cycles were less regular than those of the non-insulin-resistant group (OR=0.2; 95%CI, 0.07-0.87). Fifteen (40.5%) women in the non-insulin-resistant group became pregnant; in contrast, three (17.6%) women in the insulin-resistant group became pregnant. In the logistic regression analysis, the results demonstrated that age, duration of infertility, body mass index (BMI), and insulin resistance had no significant effects on pregnancy rate.Conclusion: Insulin resistance can be an important marker of the poor outcomes of PCOS infertility treatment, and LOE significantly improves insulin resistance in women with PCOS.
Obstetrics and Gynecology
Zahra Rezaei; Mehrnaz Valadan; Elahe Zabihi Soltani
Volume 5, Issue 2 , October 2020, , Pages 44-48
Abstract
Background & Objective: Laparoscopic ovarian drilling (LOD) is a method for ovulation induction in polycystic ovary syndrome (PCOS) patients. The aim of this study was to evaluate the serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) before and after LOD in one or ...
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Background & Objective: Laparoscopic ovarian drilling (LOD) is a method for ovulation induction in polycystic ovary syndrome (PCOS) patients. The aim of this study was to evaluate the serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) before and after LOD in one or two ovaries in women with PCOS.Materials & Methods: This study was a prospective cohort study. The study population included infertile women with PCOS resistant to clomiphene referred to the Infertility Clinic of Yas Hospital. They were candidates for LOD in 2016–2017. The serum levels of AMH and FSH were measured before and after three months in two groups of unilateral and bilateral LOD. Data were analyzed using Stata software.Results: A total of 35 female patients were enrolled in the study, 18 (51.4%) in bilateral and 17 (46%) in unilateral LOD groups; the average age of patients was 27 ± 3.4 years old. AMH levels significantly (P < /em><0.001) decreased in both unilateral and bilateral groups after LOD. FSH levels significantly (P < /em><0.001) increased in both groups after LOD, but this increase was higher in the unilateral group than in the bilateral group, and this difference was statistically significant (P < /em><0.001).Conclusion: It seems women with clomiphene-resistant PCOS when underwent unilateral or bilateral ovarian drilling experienced a significant decrease in AMH and a significant increase in FSH, indicating a decrease in their ovarian reserve.
Mina Jafarabadi; Fatemeh Ramezanzadeh; Samarand Salimi; Tahereh Forooghifar
Volume 2, Issue 1 , March and April 2017
Abstract
Background: Both in-vitro maturation and in-vitro fertilization have been used successfully to treat females with polycystic ovarian syndrome, who plan to have child. This study compared outcome of these two approaches to fertilize females with polycystic ovary side effects.
Methods: This prospective ...
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Background: Both in-vitro maturation and in-vitro fertilization have been used successfully to treat females with polycystic ovarian syndrome, who plan to have child. This study compared outcome of these two approaches to fertilize females with polycystic ovary side effects.
Methods: This prospective study was conducted at Vali-Asr reproductive health research center and included all females with polycystic ovarian syndrome, who underwent in-vitro maturation or in-vitro fertilization from January 2005 to January 2008. Measurements included demographic data, total cost (including drug and laboratory procedures), outcome (chemical and clinical pregnancy), and systemic complication (ovarian hyper-stimulation syndrome), obtained from the patients’ clinical files. Patients were informed about the procedures, side effects and goals, and the signed consent form for surgical approaches and use of their data in medical research. Finally, these variables were compared between the two groups.
Results: The in-vitro maturation and in-vitro fertilization groups included 20 and 22 patients, respectively. The range of body mass index was between 17.4 and 28.3 kg/m2 and the mean age of the patients was 29.35 ± 4.94 and 28.95 ± 3.84 years, respectively (P > 0.05). The total cost was significantly lower in in-vitro maturation group compared to in-vitro fertilization (201.6 ± 60.1 USD versus 380.5 ± 143.8 USD, respectively, P < 0.001). Positive outcomes were achieved significantly more frequently with the in-vitro fertilization method (1 chemical and no clinical pregnancy in in-vitro maturation versus 7 and 6 in in-vitro fertilization group, respectively, P < 0.001). Although, the rate of ovarian hyper-stimulation syndrome was higher in in-vitro fertilization than in in-vitro maturation approach, yet, it was not statistically significant (P = 0.233).
Conclusions: Our findings showed the superiority of execution of the in-vitro fertilization approach compared with the in-vitro maturation method in infertile females with polycystic ovary syndrome, who planned to have a child. However, in-vitro maturation approach is cheaper than in-vitro fertilization and is also associated with lower risk of ovarian hyper-stimulation syndrome.
