Marzieh Mehrafza; Azadeh Raoufi; Tahereh Zare Yousefi; Elmira Hosseinzadeh; Sajedeh Samadnia; Amirhossein Tamimi; Ahmad Hosseini
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Background and Objective: Repeated implantation failure (RIF) is still remain an ongoing challenge. RIF may be contributed to the embryo or the endometrium, which any abnormalities of each two may result implantation failure. The aim of present study was to report the effect of endometrial injury (EI) ...
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Background and Objective: Repeated implantation failure (RIF) is still remain an ongoing challenge. RIF may be contributed to the embryo or the endometrium, which any abnormalities of each two may result implantation failure. The aim of present study was to report the effect of endometrial injury (EI) during frozen embryo transfer (FET) on pregnancy outcome in RIF patients.Material and methods: In this retrospective case series, since 2018 to 2020, 20 patients with a history of RIF who underwent EI during FET cycle were evaluated. Results: Chemical, clinical and ongoing pregnancy and live birth was achieved in 8 (40%), 7 (35%), 6 (30%) and 6 (30%) patients, respectively.Conclusion: The present study shows that using EI in FET cycle is a feasible, safe and efficient method in improving clinical outcomes. More researches are needed to find out the real effect of EI during FET in RIF patients.
marjaneh zarkesh; Mandana Mansour Ghanaei; Marjan Malekifard; MARYAM GHALANDARI
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Objectives: We aimed to compare the correlation between nucleated red blood cell (NRBC) and creatine kinase (CK) levels with hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborns.Materials and Methods: This case-control study included 30 asphyxiated (case) and 30 healthy neonates (control) ...
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Objectives: We aimed to compare the correlation between nucleated red blood cell (NRBC) and creatine kinase (CK) levels with hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborns.Materials and Methods: This case-control study included 30 asphyxiated (case) and 30 healthy neonates (control) born at Al-Zahra Hospital in Rasht, Iran. We collected the cord blood samples for CK level and NRBC at birth. The clinical stage of Sarnat indicated the severity of HIE. Data were analyzed in the two groups using IBM SPSS Statistics for Windows, version 22. Results: The case group had a higher NRBC count (P=0.001). The CK level was significantly different between the two groups and was higher in the case group than in the control group (P= 0.002). Results demonstrated a significant association between NRBC count and the occurrence of HIE in neonates with asphyxia (P = 0.021). Besides, a positive correlation was found between HIE and CK levels in the case group (r = 0.7, P=0.001).Conclusion: According to our results, NRBC count and umbilical cord CK level measurement are valuable predictors of asphyxia and HIE in neonates. In addition, measuring these parameters may help clinicians for faster diagnosis and better management.
Reproductive Medicine
Autaf Talal Shaker; Saife D. Al-Ahmer; Farah Thamer Samawi
Articles in Press, Accepted Manuscript, Available Online from 01 January 2024
Abstract
The viruses considered one of the most factors that cause infertile because it represented sexual transmission disease. Objective. The purpose of this study was to study the correlations between viruses (HSV) viral load and semen parameters in groups of fertile and infertile Iraqi men. Methods. This ...
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The viruses considered one of the most factors that cause infertile because it represented sexual transmission disease. Objective. The purpose of this study was to study the correlations between viruses (HSV) viral load and semen parameters in groups of fertile and infertile Iraqi men. Methods. This study comprised fifty infertile males and fifty fertile healthy males. Seminal fluid analysis was conducted on all participants to detect the presence of HSV using the HSV1,2 quantification kit. Results: There was a high significant correlation between sperm concentration and percentage of rapid linear progression motility (r= 0.478**) of infertile men. A strong meaningful connection was seen between the percentage of sperm concentration and both the percentage of sluggish linear or nonlinear motility (r = 0.681**) and the percentage of non-progressive motility (r = 0.604**). There was a strong negative connection (r = -0.725**) between the concentration of sperm and the number of immotile spermatozoa. On the others hand, There was a high significant correlation between rapid linear progression and slow linear or nonlinear(r =0 .413**) non-progressive motility (r = 0.704**) respectively, and high negative significant between rapid linear progression and immotile spermatozoa. The correlation between slow linear or nonlinear and non-progressive motility was highly significant (r= 0.555**) and negative significant between slow linear or nonlinear and immotile spermatozoa. Finally, A strong negative correlation (-0.813**) was observed between non-progressive motility and immotile spermatozoa. Conclusions :The study found that HSV infection had effect on semen parameters and will cause male infertility.
Obstetrics and Gynecology
Khadijeh Elmizadeh; Marziyeh khezri; Hamideh Pakniat; vahideh pandamuz; nezal Azh; Simindokht Molaverdikhani
Articles in Press, Accepted Manuscript, Available Online from 02 October 2023
Abstract
Background: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage.
Methods: In this ...
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Background: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage.
Methods: In this single-blinded randomized clinical trial, a sample of 300 women with a singleton pregnancy, at 37 to 40 weeks gestation, who were scheduled for cesarean section was divided into two groups of 150 participants. In the intervention group after placental delivery, the uterus was covered with cold saline-soaked surgical sponges at 0-4°C at the time of hysterotomy repair, and the control group received standard cesarean section. The volume of blood loss, the hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocic therapy, and the incidence of adverse effects were recorded.
Results: The bleeding volume and hemoglobin concentration reduction were significantly lower in the intervention group than in the control group (260.86± 150.25 Vs 214.35± 83.51, P<0.0001 and 1.24±0.75 Vs 1.54±0.92, P = 0.007 respectively). There were no statistically significant differences between the two groups in the frequency of need for additional uterotonic drugs. (18% vs. 21.33%, P = 0.475.)
Conclusion: The use of uterine cooling during cesarean section reduced the volume of blood loss and the rate of decline in hemoglobin concentration.
Akhmetzhanova Dinara Oralgazyevna; Entsar Hachim Muhammad; Mohammed Ali; Ahmed Jalil Kadhim; Ayad Abas Hasan; Fathi Jihad Hammady; Noora M. Hameed; Hayfaa Attia Thijail
Articles in Press, Accepted Manuscript, Available Online from 08 February 2023
Abstract
Background & Objective: Episiotomy complications include infection, pain, hematoma, and third- and fourth-degree tears, and all primiparous women must undergo this procedure routinely. The current study aimed to compare the length of perineal tears in women referred to the Basra maternity hospital ...
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Background & Objective: Episiotomy complications include infection, pain, hematoma, and third- and fourth-degree tears, and all primiparous women must undergo this procedure routinely. The current study aimed to compare the length of perineal tears in women referred to the Basra maternity hospital in 2020 for their first births with and without episiotomy. Materials & Methods: The current clinical trial study involved 212 full-term, singleton, primiparous women with cephalic fetuses weighing between 2500 and 3000 grams. Randomly and evenly, the samples were divided into two test and control groups. In the test group, delivery occurred without an episiotomy, whereas in the control group, an episiotomy was performed. The length of the posterior perineal tear, the presence of an anterior perineal tear, and the necessity for repair were subsequently compared. Results: The results revealed that 45.3% of women in the test group gave birth without perineal tears, while the remainder experienced posterior perineal tears (P<0.001). The mean length of posterior perineal tears in this group was 3.64±1.15 cm, compared to 7.12±1.67 cm in the control group (P<0.001). The mean length of a second-degree tear behind the perineum in the test group was 5.32±1.17 cm, compared to 6.13±1.62 cm in the control group (P>0.05). Conclusion: Delivery without episiotomy decreased the incidence of posterior perineal tears; however, delivery without episiotomy should not be performed on all primiparous women.
Maternal Fetal Medicine
tayebeh sedighi
Articles in Press, Accepted Manuscript, Available Online from 27 May 2023
Abstract
Introduction: Elevated blood flow resistance in the uterine artery is related to the development of pre-eclampsia and fetal growth restriction, which can be evaluated with uterine artery Doppler ultrasound (UtA). However, there is a lack of studies regarding its reproducibility. Therefore, we aimed to ...
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Introduction: Elevated blood flow resistance in the uterine artery is related to the development of pre-eclampsia and fetal growth restriction, which can be evaluated with uterine artery Doppler ultrasound (UtA). However, there is a lack of studies regarding its reproducibility. Therefore, we aimed to compare the reproducibility of UtA using transvaginal (TV) and transabdominal (TA) methods in both the first and second trimesters.Materials and Method: This prospective, cross-sectional study was performed in the Prenatal Clinic at Yas Hospital, Tehran University of Medical Sciences. Inclusion criteria were gestational age between 11 to 13 weeks and 18 to 22 weeks based on crown-rump length. Both TV and TA techniques were performed by an experienced specialist in maternal and fetal medicine. Intra- and inter-observer variability of the UtA pulsatility index (UtA-PI) was evaluated using intra-class correlation coefficients.Results: This study included 400 pregnant women in the first and second trimesters of pregnancy. There was no significant difference in the mean UtA-PI measured by the operators. Intra-observer and inter-observer reproducibility of TV and TA in both the first and second trimesters, based on ICC and CCC, was moderate and poor, respectively. Intra-observer ICC ranged from 0.97 to 0.85, while the inter-observer ICC ranged from 0.93 to 0.84.Conclusion: Our results showed that intra-observer and inter-observer reproducibility of TV and TA was excellent, whereas the intra-observer and inter-observer reproducibility of TV was better. Measured UtA-PI was not influenced by the operator.
Obstetrics and Gynecology
Hoora Amoozegar; Nayereh Rahmati; Zahra Naseri; samira Shah-Hamzehi; mostafa vahedian; enayatollah Noori; alireza moradi
Articles in Press, Accepted Manuscript, Available Online from 15 July 2023
Abstract
Background: To evaluate the risk of uterine rupture during pregnancy, researchers use two-dimensional (2D) transvaginal ultrasound to assess lower uterine segment (LUS) thickness in the third trimester of pregnancy. This study aimed to compare the thickness of the LUS provided in a 2D transvaginal ultrasound ...
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Background: To evaluate the risk of uterine rupture during pregnancy, researchers use two-dimensional (2D) transvaginal ultrasound to assess lower uterine segment (LUS) thickness in the third trimester of pregnancy. This study aimed to compare the thickness of the LUS provided in a 2D transvaginal ultrasound with the findings during a cesarean section (C/S) of pregnant women with a history of previous C/S.
Materials and Method: This cross-sectional study was performed on 40 pregnant women referred to Izadi Obstetrics and Gynecology Hospital in Qom. All the women underwent transvaginal ultrasound followed by C/S within a maximum of one week later. Also, an expert gynecologist classified LUS thickness into four grades in the operation room.
Results: The mean age of women was 31.58 ± 4.56 years, and the mean thickness of the LUS was 2.17 ± 0.51 cm. Moreover, 57.5% of the women have grade I of LUS based on intraoperative findings. Results indicated that the mean thickness of the LUS measured by ultrasound significantly differed between the three grades detected by the gynecologist (P=0.04). However, there were no significant differences between maternal age, gestational age, parity, and time of last C/S among women with different LUS grades (P˃0.05). Transvaginal ultrasound could be helpful in evaluating the risk of scar dehiscence and uterine rupture among women with LUS grades I and II with a history of previous C/S.
Obstetrics and Gynecology
Mahsa Akbari Oryani; Mohaddeseh Shahraki; Marjaneh Farazestanian
Articles in Press, Accepted Manuscript, Available Online from 23 July 2023
Abstract
Disorders of sex development (DSD) result from intrauterine defects in sex discrimination. The clinical phenotype differs based on the disease type. Cases with ambiguous external genitalia are diagnosed at birth. However, diagnosis of cases with normal-appearing external genitalia may be delayed until ...
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Disorders of sex development (DSD) result from intrauterine defects in sex discrimination. The clinical phenotype differs based on the disease type. Cases with ambiguous external genitalia are diagnosed at birth. However, diagnosis of cases with normal-appearing external genitalia may be delayed until puberty. Here, we report a patient with a pelvic mass and a small uterus that was diagnosed by abdominal ultrasound, in addition to the history of primary amenorrhea and physical examination suggested Swyer syndrome, confirmed by genetic karyotyping. Pathological examination of the surgically removed mass revealed dysgerminoma. Until the age of 19, the patient did not have any idea about 46, XY karyotype, and assumed to be a female. The development of dysgerminoma (as a result of the simultaneous presence of gonadal dysgenesis and Y-chromosome) was another challenge that the patient had to deal with. The diagnosis of this patient at an earlier age could have prevented the development of gonadoblastoma, by removal of the streak gonads. By the presentation of this case, we intend to increase the physician’s awareness about DSDs; earlier diagnosis may help the patient deal with her disease better and reduce the risk of further complications.
Obstetrics and Gynecology
fatemeh davari tanha; Mojgan Asadi; Faeze Mirbagheri; Elham Feizabad; Zahra kaveh; Kazem Mousavizadeh
Articles in Press, Accepted Manuscript, Available Online from 01 August 2023
Abstract
Background and Objective: Endometriosis is a chronic gynecological condition that affects approximately 10% of women of reproductive age. Chronic pelvic pain is a common symptom of endometriosis and can have a significant impact on a woman's quality of life, including sexual satisfaction. Botulinum toxin ...
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Background and Objective: Endometriosis is a chronic gynecological condition that affects approximately 10% of women of reproductive age. Chronic pelvic pain is a common symptom of endometriosis and can have a significant impact on a woman's quality of life, including sexual satisfaction. Botulinum toxin injection has been used as a treatment for chronic pelvic pain in endometriosis, but its effect on sexual satisfaction is not well understood.Methods: A randomized controlled trial was conducted to evaluate the effect of botulinum toxin injection on chronic pelvic pain and sexual satisfaction in women with endometriosis. The study included 32 women with endometriosis who were randomly assigned to receive either botulinum toxin injection or placebo. The primary outcome measure was change in chronic pelvic pain assessed using the visual analog scale (VAS) at one month after treatment. Secondary outcome measures included changes in sexual satisfaction assessed using the Female Sexual Function Index (FSFI) at one month after treatment.Results: The results showed that botulinum toxin injection significantly reduced chronic pelvic pain compared to placebo at one month after treatment (p<0.001). There was also a significant improvement in sexual satisfaction in the botulinum toxin group compared to placebo at one month after treatment (p=0.001). Conclusion: Botulinum toxin injection may be an effective treatment option for women with endometriosis, chronic pelvic pain and sexual dysfunction.This research was also registered with the code IRCT20091012002576N20 in the Clinical Trial Registration Center of Iran. Date of registration performed between July2021and July 2022
Gynecology Oncology
Zahra Shiravani; Fatemehsadat Najib; Mahvash Alirahimi; Elham Askary; Tahereh Poordast; Nader Tanideh; Shohreh Roozmeh; Golsa Shekarkhar; Sana Atbaei; danilo porro; Soudabeh Sabetian; Claudia Cava
Articles in Press, Accepted Manuscript, Available Online from 03 September 2023
Abstract
The endometriosis treatment was critical issue due to complications associated with current drug delivery system. Present investigation compared the curative effect of Vitamin D3 (VTD3) and Omega–3 (OG3) with Diphereline during the treatment of endometriosis. Endometriosis was induced in different ...
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The endometriosis treatment was critical issue due to complications associated with current drug delivery system. Present investigation compared the curative effect of Vitamin D3 (VTD3) and Omega–3 (OG3) with Diphereline during the treatment of endometriosis. Endometriosis was induced in different groups containing 60 adult female rats. The rat model is categorized into 6 groups untreated and treated (Olive Oil (solvent), VTD3 (42 mcg/kg/day), OG3 (450 mg/kg/day), VTD3+OG3, Diphereline (3 mg/kg/day)). The suspension containing combination of Diphereline and supplements was injected and treated for 4 weeks to analyses the effect of supplements. The interleukin -6 (IL-6) and Tumor necrosis factor – alpha (TNFα) inflammatory responses were measured from the serum samples while endometrial implants was dissected and histopathological investigation was done. At the end of four weeks pathologic score was decreases significantly with simultaneous measurement of inflammation score of endometriotic lesion, size of implant area, IL-6, TNFα response and compared with untreated female rat. No significant different was observed in groups undergoing treatment of VTD3, OG3 and Diphereline. The combined effect of VTD3+OG3 has similar responses with Diphereline treated endometrial implants. In conclusion, treatment of VTD3 deficiency and making a change in dietary habits of high-risk population for endometriosis from adolescence may also play a preventative role in adulthood.
Pathology
Nasrin Ziamajidi; Nazi Moini; Hiva Danesh; Roghayeh Abbasalipourkabir; Nahid Radnia; Zeinab Barartabar
Articles in Press, Accepted Manuscript, Available Online from 05 September 2023
Abstract
Background & Objective: Breast cancer has the highest incidence of all cancers and the incidence of this disease is increasing rapidly in many countries around the world, including Iran. In this study, some epidemiological and pathological factors have been investigated in breast cancer patients.Methods: ...
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Background & Objective: Breast cancer has the highest incidence of all cancers and the incidence of this disease is increasing rapidly in many countries around the world, including Iran. In this study, some epidemiological and pathological factors have been investigated in breast cancer patients.Methods: This is a cross-sectional study which contains 476 patients with a confirmed diagnosis of breast cancer, was conducted in Tehran, Dr. Moini Breast Clinic from 2019 to 2021. Results: The mean age of patients was 50.2±11.40 years, of which 80.9% patients over 40 years. Ductal carcinoma was the most common in terms of histology (81.7%) and most patients are in grade 2 (63.6%). According to hormonal receptors, 73.8% of women had estrogen receptor positive and 68.9% of women had progesterone receptor positive and 18.9% of patients were triple negative. There is a significant relationship between grade and lymph node involvement (P-value=0.00) and also a significant relationship between metastasis with grade (P-value = 0.00 (and metastasis with lymph node involvement (P-value = 0.00) was seen.Conclusion The results of this study show that breast cancer has a high prevalence in Iranian women in Tehran, mainly seen in the 4th and 5th decades of breast cancer. HER-2 (epidermal growth factor 2 receptor overexpression) and triple negatives were the least subgroups. Considering that diagnosis happens late and about 63.6% of patients are in grade 2, it is necessary to implement programs in the field of screening and prevention in the female population of this province.
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
Reproductive Medicine
Kong Chi Pham; Viet Quoc Dao; Le Thi Phuong Nguyen; Vinh Dinh Tran
Articles in Press, Accepted Manuscript, Available Online from 07 October 2023
Abstract
Objective: To determine the causes of infertility of couples examined at Da Nang Hospital for Women and Children. Methods: A cross-sectional descriptive study included 512 reproductive-age couples diagnosed with infertility and treated at Da Nang Hospital for Women and Children from August 2018 to August ...
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Objective: To determine the causes of infertility of couples examined at Da Nang Hospital for Women and Children. Methods: A cross-sectional descriptive study included 512 reproductive-age couples diagnosed with infertility and treated at Da Nang Hospital for Women and Children from August 2018 to August 2020. Results: The mean age of the men and women was 31.0 ± 4.4 years and 33.5±5.0 years, respectively. Primary infertility accounted for 70.9%, whereas secondary infertility was only 29.1%. The mean time of infertility was 3.0±2.5 years. Male factor infertility accounted for the highest rate (39.6%), followed by female infertility (30.5%). Infertility due to both male and female factors was18.0%. Among the causes of male infertility, abnormal semen analysis accounted for the highest rate (57.6%), followed by varicocele (19.3%). Among the abnormalities of semen parameters, oligo-astheno-teratozoospermia (OAT) represented the highest rate (37.5%). There were 46 cases of azoospermia, accounting for 9.0%. Endometriosis accounted for the highest rate (17.6%) among causes of female factor infertility, followed by PCOS (15.6%). There were 51 cases of diminished ovarian reserve, accounting for 9.9%. Conclusion: Male factor infertility accounted for the highest rate in this study. Among the causes of male infertility, abnormal semen analysis had the highest rate. Endometriosis and PCOS were common causes of female infertility.
Reproductive Medicine
Abdelrehman Saber; Mohammed Ahmed Faris; Sayed Bakry
Articles in Press, Accepted Manuscript, Available Online from 13 November 2023
Abstract
Background: Intracytoplasmic sperm injection (ICSI), a technique that involves an injection of a spermatozoon into the oocyte cytoplasm, has allowed the achievement of fertilization for a wide range of couples suffering from infertility.
Objective: The study assesses the influence of modified ICSI followed ...
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Background: Intracytoplasmic sperm injection (ICSI), a technique that involves an injection of a spermatozoon into the oocyte cytoplasm, has allowed the achievement of fertilization for a wide range of couples suffering from infertility.
Objective: The study assesses the influence of modified ICSI followed by chemically induced activation by calcimycin and Ionomycin in couples with a history of total fertilization failure (TFF).
Methods: A prospective analysis study was conducted with sibling oocytes to compare the application of calcimycin and Ionomycin after the M-ICSI technique. The study was conducted in a private IVF centre in Cairo, Egypt. A case with a TFF history assessed their fertilization rates, cleavage, and good-quality embryos on day three.
Results: 21 cycles comprised 134 oocytes treated with calcimycin and 125 oocytes treated with Ionomycin. Calcimycin-treated oocytes showed a fertilization rate of 39.5 %, a degeneration rate of 3.7 %, an arrest rate of 3.6 %, a cleavage rate of 45.5 %, and a good quality embryo rate of 37.1 %. On the other hand, ionomycin-treated oocytes showed a fertilization rate of 68.0 %, a degeneration rate of 6.0 %, an arrest rate of 3.7 %, a cleavage rate of 74.3 %, and a good quality embryo rate of 31.5 %. Ionomycin-treated oocytes had a significantly higher t-value of fertilization and cleavage rates than calcimycin-treated (p-value < 0.05).
Conclusion: M-ICSI followed by Ionomycin or ready-to-use calcimycin may treat TFF patients. Calcium increase could be achieved directly by mechanical activation and last longer by assisted oocyte activation (AOA) treatment.
General Gynecology and Pelvic Floor
Rihab Majeed Shareef; Najah Shaker Yassen; Sallama Hamid Alkhudair
Articles in Press, Accepted Manuscript, Available Online from 13 November 2023
Abstract
Background: Melatonin play a role in pubertal development and reproductive function through the Hypothalamus-hypophysis-gonadal axis. In addition, melatonin production decreases with age, so that indolamine could be an anti-ageing agent. To assess Intra follicular melatonin level's role in ovarian ...
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Background: Melatonin play a role in pubertal development and reproductive function through the Hypothalamus-hypophysis-gonadal axis. In addition, melatonin production decreases with age, so that indolamine could be an anti-ageing agent. To assess Intra follicular melatonin level's role in ovarian reserve and the IVF cycle outcomes.
Patients and method: A prospective cross-sectional study was conducted from April 2022 to April 2023. Patients on a mini-long agonist, short agonist, and antagonist protocols were enrolled in the current study. Using ultrasound, the follicle development was observed from the stimulation day until the hCG day (done every 2 or 3 days).
Results: Melatonin were positively correlated with oocyte retrieved (r=0.705, P<0.001), number of fertilized oocyte (r=0.68, P<0.001), number of zygotes cleaved (r=0.660, P<0.001), high quality embryos (r=0.591, P<0.001), embryos for transplantation (r=0.604, P<0.001), percent of high quality embryos (r=0.58, P<0.001), and with percent of blastocyst rate.
Conclusion: Melatonin mean levels in follicular fluid were significantly decreased in poor response than in standard and high response. The follicular fluid melatonin levels were associated with each oocyte quantity and quality and can expect ICSI consequences and act as highly important biochemical indicators of ovarian reserve.
Gynecology Oncology
Ahmad Shuib Yahaya; Mohd Norazam Mohd Abas; Jamil Omar
Articles in Press, Accepted Manuscript, Available Online from 18 November 2023
Abstract
Objective:
This study aims to analyze the survival outcomes and prognostic factors of patients with uterine sarcoma in the Department of Gynae-Oncology, between June 2015 and December 2022.
Methods:
The study population consists of patients with histopathologically confirmed uterine sarcoma. Oncological ...
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Objective:
This study aims to analyze the survival outcomes and prognostic factors of patients with uterine sarcoma in the Department of Gynae-Oncology, between June 2015 and December 2022.
Methods:
The study population consists of patients with histopathologically confirmed uterine sarcoma. Oncological data collected includes stage, pathological report and type of surgery, adjuvant therapy, recurrence, and mortality. Kaplan-Meier analysis used to estimate survival.
Results:
We identified 58 eligible uterine sarcoma patients: 13 leiomyosarcoma (22.4%), 9 endometrial stromal sarcoma (15.5%), 32 carcinosarcoma (55.2%), 2 adenosarcoma (3.4%) and another 2 were undifferentiated sarcoma (3.4%). Mean age was 56.1 (SD=12.03) and 56% patients were postmenopausal. Majority of patients presented in stage III and IV (53.4%) and only 22 patients (37.9%) in stage I. Adjuvant radiotherapy was given to 21 patients (36.2%); 8 patients (13.8%) received chemotherapy and 9 patients (15.5%) received both radiotherapy and chemotherapy. Median follow up period was 13.5 months (range: 73 months) and total of 35 patients (60.3%) had recurrence with median time to recurrence of 6.0 months (range: 35). Death occurred in 21 patients (36.2%) with median time to death 5.0 months (range: 36 months). Progression free survival (PFS) among all patients was 26.64 (range: 4.32) months with significant correlation with stage of disease. Overall survival (OS) in patients received surgery only, radiotherapy and combine radiotherapy and chemotherapy were 23.3, 54.8 and 62.4 months respectively (p value 0.03).
Conclusion:
Uterine sarcoma is a relatively rare tumor type with worse survival. Multimodality adjuvant treatments showed to improve prognosis in those patients.
Reproductive Medicine
shayamaa Abd Hasan; Basma Salman Abdul Hammed; Qasim Mohammed Banjah
Articles in Press, Accepted Manuscript, Available Online from 19 November 2023
Abstract
Primary infertility affects a significant proportion of couples and is often attributed to female factors. Obesity, which is associated with increased levels of the hormone leptin, is a known risk factor for female infertility. This cross-sectional study aimed to investigate the association between BMI ...
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Primary infertility affects a significant proportion of couples and is often attributed to female factors. Obesity, which is associated with increased levels of the hormone leptin, is a known risk factor for female infertility. This cross-sectional study aimed to investigate the association between BMI and leptin levels in primary infertile females at Al-Nuaman Hospital and Al-Salama private hospital from September 2022 to March 2023. A total of 100 females were enrolled, and their BMI and serum leptin levels were measured. The participants were divided into four groups: Group 1 (normal weight, fertile), Group 2 (overweight infertile), Group 3 (obese infertile), and Group 4 (severely obese infertile) women, each consisting of 25 participants, categorized based on their BMI: normal BMI (18.5–24.9 kg/m²), overweight BMI (25–29.9 kg/m²), obesity BMI (≥30 kg/m²), and severely obese BMI (35-40 kg/m²). The mean leptin levels were compared between the four groups using ANOVA, and the association between BMI and leptin levels was assessed using Pearson's correlation coefficient. The study revealed a highly significant correlation between primary infertility and the parameters (BMI and leptin) (P < 0.001) and showed a positive correlation between leptin and BMI. It was shown that primary infertile females with a high BMI have elevated serum leptin levels. This underscores the importance of weight management in addressing primary female infertility.
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.
Anesthesia
Olumide Mathew Adebisi; Adebayo Augustine Adeniyi; Olabisi Timothy Adeyemo; Olayinka Tesleem Orewole; Olumide Emmanuel Adewara; Babatunde Sunday Awoyinka; Idowu Oluwaseyi Adebara; Adewumi Bakare; Oluwasesan Bamidele Afolabi; Adeola Emmanuel Adekanye
Articles in Press, Accepted Manuscript, Available Online from 01 December 2023
Abstract
Background and Objective: The commonly used analgesia for post caesarean pain include combination regimens containing acetaminophen, non-steroidal anti-inflammatory agents (NSAIDs) and opioids. The objective of this study is inter alia to determine the effects of dexamethasone as adjuvant to commonly ...
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Background and Objective: The commonly used analgesia for post caesarean pain include combination regimens containing acetaminophen, non-steroidal anti-inflammatory agents (NSAIDs) and opioids. The objective of this study is inter alia to determine the effects of dexamethasone as adjuvant to commonly used NSAIDs for post-caesarean pain management.
Materials and methods: One hundred and eighty-eight participants slated for caesarean delivery under spinal anaesthesia were randomized into two groups of 94 participants each. One group received 2ml intravenous 8mg dexamethasone while the second group received 2ml of intravenous sterile water as placebo . Both groups received similar doses of intramuscular acetaminophen and diclofenac. Intramuscular pentazocine at a dose of 0.5mg/kg body weight was used as rescue analgesia. Primary outcome was the mean summed pain intensity difference (MDPID) in the two groups while the secondary outcomes include the needs and frequency of rescue analgesia, and the levels of maternal satisfaction. P-value set as ≤0.05.
Results: The mean summed pain intensity difference (MSPID) at 24hours post-caesarean was higher in the dexamethasone group, (29.27±18.10 versus 24.24±13.14, p=0.036). The percentage of the participants that required rescue analgesia in the dexamethasone group was less (60.6% versus 76.1%, p=0.024). The Overall levels of maternal satisfaction were comparable in both groups.
Conclusion: Intraoperative dexamethasone given intravenously as adjuvant to intramuscular diclofenac and acetaminophen minimizes opioid administration within the first 24hours after caesarean section.
Maternal Fetal Medicine
Mahboobeh Shirazi; Fatemeh Rahimi Sharbaf; Fatemeh Golshahi; Behrokh Sahebdel; Elham Feizabad; Leila Asadi; Afsaneh Alimadad-Tafreshi; Arash Jafariyeh; Akram Valizadeh; tayebeh sedighi; Fatemeh Takaloo; Aazam Taghavi-Zahedkalaei
Articles in Press, Accepted Manuscript, Available Online from 09 December 2023
Abstract
Background & Objective: Clinical use of uterine artery (UtA) Doppler ultrasound imaging requires reference values but despite the common use of UtA Doppler examination during pregnancy, to the best of our knowledge, there is no such range for Iranian pregnant women. Hence, this study aimed to investigate ...
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Background & Objective: Clinical use of uterine artery (UtA) Doppler ultrasound imaging requires reference values but despite the common use of UtA Doppler examination during pregnancy, to the best of our knowledge, there is no such range for Iranian pregnant women. Hence, this study aimed to investigate uterine artery Doppler indices in Iranian normal pregnancies and compare these with the other country values.Materials & Methods: This observational longitudinal study was conducted on 486 low-risk pregnant women. The amount of plausibility index (PI) and resistance index (RI) as well as the presence of diastolic notch were assessed in weeks 11 to 14, 17 to 24, and 27 to 32 through Doppler ultrasound. Results: The bilateral notch for the gestational age of 11 to 14 weeks was detected at about 6%, for the gestational age of 17 to 24 weeks it was about 4.2% and for the gestational age of 27 to 32 weeks it was about 3.6%. Reference intervals for mean uterine artery PI according to gestational ages, show a significant (p<0.001) difference between different percentages. Also, there is a significant relation between the mean uterine arteries PI/RI and the presence or absence of pregnancy complications (IUGR, premature birth, IUFD) among the participants. Conclusion: The results of this research showed that there is a significant relation between PI and pregnancy complications, while this was not detected in RI and diastolic notch. These results are relatively consistent with the findings of researchers in other countries.
Obstetrics and Gynecology
Seyed Mojtaba Alavi; Mohammad Hosein Arjmandnia; meysam feizollahjani; enayatollah Noori; Maryam Yousefi
Articles in Press, Accepted Manuscript, Available Online from 12 December 2023
Abstract
Background: Placenta Accreta Spectrum is a condition in pregnant women where trophoblastic tissue attaches abnormally to the uterus myometrium, causing maternal deaths. Major risk factors include placenta previa and cesarean deliveries, which have been increasing without medical indication. This study ...
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Background: Placenta Accreta Spectrum is a condition in pregnant women where trophoblastic tissue attaches abnormally to the uterus myometrium, causing maternal deaths. Major risk factors include placenta previa and cesarean deliveries, which have been increasing without medical indication. This study aims to explore the risk factors of PAS, clinical outcomes, and strategies to minimize maternal morbidity and mortality.
Materials and Methods: A total of 142 women who had undergone at least one cesarean delivery in the past were included in our evaluation. Among them, 85 women had placenta accreta spectrum (PAS) in their current pregnancy (group 1) while the remaining 57 did not have PAS (group 2). We gathered information about their demographics and previous gynecological history, including placenta previa.
Results: The risk of placenta accreta spectrum (PAS) is significantly higher in cases where there has been a previous cesarean delivery or placenta previa (p-value<0.05). There were no significant differences between past elective or emergent CD (p-value>0.05). PAS was associated with more emergent cesarean deliveries (p-value<0.001) and hysterectomies (p-value<0.001). 97% of patients with history of placenta previa developed PAS (p-value<0.001). Most of the patients who underwent hysterectomy had PAS and placenta previa (p-value<0.001). There was no significant correlation found between previous hysteroscopies and curettages and a higher risk of PAS. (p-value>0.05)
Conclusion: Women with previous cesarean delivery are significantly at risk of placenta accreta in their future pregnancies. Pregnant women should avoid insisting on elective cesarean delivery without medical indication. Planned cesarean delivery could reduce the maternal complications
Obstetrics and Gynecology
Tiarma Uli Pardede; Heronimus Hansen Kaware; Leni Suhartini
Articles in Press, Accepted Manuscript, Available Online from 13 December 2023
Abstract
Background and Objective: Degenerated Uterine Leiomyomas (ULs) is one of the most common complications of UL in pregnancy and may cause severe maternal symptoms. In this study we present the rare case of UL permagna with cystic degeneration managed with Caesarean Section (CS) and Myomectomy with uterus ...
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Background and Objective: Degenerated Uterine Leiomyomas (ULs) is one of the most common complications of UL in pregnancy and may cause severe maternal symptoms. In this study we present the rare case of UL permagna with cystic degeneration managed with Caesarean Section (CS) and Myomectomy with uterus preservation.
Methods: A 37-year-old primigravid woman was referred to the clinic with the chief complaint of huge abdominal mass that coincides with the pregnancy. Physical examination showed that the abdomen was overdistended and upon palpation a mass at processus xiphoideus height was felt. Ultrasound examination showed that the foetus had IUGR (Estimated Fetal Weight below the 10th precentile of the fetal growth curve with oligohidramnion) and also a cystic mass with a clear border. The patient was diagnosed with cystic degeneration of UL premagna and IUGR. The first-line management given was CS and myomectomy as an effort to maintain the uterus because this is a case of pregnancy with 15 years primary infertility.
Result: The overall outcome was satisfactory. The neonate came out alive, Ballard score equivalent to 32 weeks, and weighing around 1480g. The degenerated UL was successfully extracted. The patient was discharged 4 days post-operatively. The baby was treated in the NICU for prematurity and went home after the baby's weight reached 1800 grams.
Conclusion : Degenerated UL permagna in pregnancy is a very rare and serious condition. It needs to be studied further as there are no global consensus on how to manage the case.
Obstetrics and Gynecology
Aida Mohamadi; Mahsa Ghajarzadeh; Fatemeh Davari Tanha; Amirreza Azimi
Articles in Press, Accepted Manuscript, Available Online from 21 December 2023
Abstract
Background: Women with multiple sclerosis (MS) suffer from a wide range of complications. The goal of this study was to compare sexual dysfunction (SD), depression, and sexual quality of life in women with MS with these problems in women without MS.
Methods: Fifty-four women with MS and 108 women without ...
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Background: Women with multiple sclerosis (MS) suffer from a wide range of complications. The goal of this study was to compare sexual dysfunction (SD), depression, and sexual quality of life in women with MS with these problems in women without MS.
Methods: Fifty-four women with MS and 108 women without MS were enrolled. All participants were asked to fill valid and reliable versions of BDI (Beck Depression Inventory), FSFI (Female Sexual Function Index), and SQOL (sexual quality of life) questionnaires.
Results: Mean scores for BDI, SQOL, and orgasm and satisfaction domains of FSFI were significantly different between case and control groups. Sexual quality of life (SQOL) had a significant positive correlation with FSFI (r=0.568, p<0.001) and a significant negative correlation with BDI scores (r=-0.528, p<0.001). A significant negative correlation was also found between FSFI and BDI scores (r=-0.325, p<0.001). According to the total FSFI cut-off point, 53.7% of cases and 44.4% of controls had SD (p=0.168).
Considering SQOL as a dependent variable and age, education level, marriage duration, husband’s age, and BDI and FSFI scores as independent variables, linear regression analysis showed that education level, BDI score, and FSFI score were independent predictors of SQOL in all participants, while among MS patients, only BDI and FSFI were significant predictors of SQOL.
Conclusion: Sexual quality of life and sexual function should be considered in women with MS, and depression should be assessed and treated as a possible risk factor.
Obstetrics and Gynecology
shereef elshwaikh; Ahmed Ossman; muhammad el-masry; ahmed swelam; yasmin elmasry
Articles in Press, Accepted Manuscript, Available Online from 24 December 2023
Abstract
Aim: To evaluate changes in serum AMH levels, fertility and metabolic conditions in reproductive-age severely obese women, after bariatric surgery.
Design: prospective cohort study.
Methods: This study had been conducted on marked obese women who were referred to BS in Tanta university hospital. the ...
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Aim: To evaluate changes in serum AMH levels, fertility and metabolic conditions in reproductive-age severely obese women, after bariatric surgery.
Design: prospective cohort study.
Methods: This study had been conducted on marked obese women who were referred to BS in Tanta university hospital. the AMH and other hormones (FSH- LH- free Testosterone- SHBG- fasting Insulin) levels had been measured as part of their evaluation will be reviewed before and after (6) months the surgery. The involved women were in reproductive age between 18 and 40 years old. With BMI > 36 kg/m2 and < 42 kg/m2.
Results: From 64 female who had been enrolled, 50 patients only completed the 6 months follow up , and it was found there was a significant difference as regard the weight and the BMI , fasting insulin level and regular menstrual pattern after 6 month follow but other fertility factors including were improved but had no significant difference .
Also 20 cases (40%) had a spontaneous ovulation after 6 moth follow up after BS , and by comparing them to those who had no spontaneous ovulation ,there was a significant effect on weight reduction on occurrence of spontaneous ovulation , BMI parameter, and the level of change of BMI, regular menstrual cycle, while the other fertility related parameters although improved but failed to show any significant relationship .
Conclusion: BS and reduction of the weight had a positive effect on the reproductive performance of obese female.
Maternal Fetal Medicine
Shalan HB Al-Mayoofee; Nabiha Missaoui; Sihem Hmissa; Ali Esmail Al-Snafi
Articles in Press, Accepted Manuscript, Available Online from 08 January 2024
Abstract
Background & Objective: Polycystic ovary syndrome (PCOS) is a common disease in women of childbearing age. The inflammation has participated in the metabolic disorders and irregular menstruation associated with this disease. This study was carried out to correlate between the disturbance of pro-inflammatory ...
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Background & Objective: Polycystic ovary syndrome (PCOS) is a common disease in women of childbearing age. The inflammation has participated in the metabolic disorders and irregular menstruation associated with this disease. This study was carried out to correlate between the disturbance of pro-inflammatory markers resistin, adiponectin and metabolic parameters in women with PCOS.Materials & Methods: Fasting blood samples were collected from 100 PCO married infertile women (23.30±4.659 years) attending Bint AL-Hoda and Al-Shatra hospitals in Thi- Qar province - Iraq, in addition to 50 healthy age matched (23.84±4.804 years) control, through the period from June 2022 to December 2022.Results: The BMI of PCO patients (27.22±7.20) was significantly (<0.001) more that BMI of the healthy control (22.84±4.63). PCO patients showed significantly elevation of serum levels of resistin (470.00±114.00 vs 350.00±90.60 ng/l, P<0.01 (and significant decline of adiponectin (5.13±1.22 vs 11.00±1.40 mg/l, P<0.001) in comparison with healthy control. PCO patients also showed significant elevation of the serum glucose (P<0.01), total cholesterol (P<0.05), triglycerides (P<0.001) and LDL (P<0.001). However, serum HDL level was insignificant declined and VLDL was insignificantly elevated in PCO group compared with healthy control group.Conclusion: Adiponectin and resistin represented part of the pathophysiology of PCO, and may serve as beneficial indicator in the diagnosis and treatment.
